Autistic traits in obsessive compulsive disorder: A systematic review and meta-analysis

Abstract

Background: Several lines of evidence point to a strong association between OCD and autism-spectrum disorder and broader autism phenotype. However, the extent and nature of overlapping autistic traits has not been completely understood.

Method: A systematic review in Pubmed and Scopus databases was performed to compare autistic traits between OCD patients and healthy controls (December 1990 to March 2025). A random-effects meta-analyses were conducted.

Results: Current meta-analysis included 27 studies consisting of 1677 patients with OCD and 1239 healthy controls. Compared to healthy controls, total autistic traits (g = 1.27, CI = 1.02, 1.53), also ratings in social-communication domain (g = 0.98, CI = 0.66, 1.31), and restricted/repetitive behaviors (RRBs) domain (g = 1.65, CI = 1.27, 2.04) were increased in OCD patients. OCD symptoms were more strongly related to RRBs domain scores (r = 0.34, CI = 0.19, 0.48) than social-communication domain scores (r = 0.18, CI = 0.09, 0.27).

Conclusions: OCD is associated with significant increases in both RRBs and social-communication domains. A substantial subset of OCD emerges in youth who have autistic traits, particularly RRBs. In adults, elevated social-communication scores might, at least partly, reflect the effect of chronic OCD symptoms on social functioning rather than true increase in this domain.

Keywords: Autism; Autistic traits; Meta-analysis; Obsessive-compulsive disorder.