Understanding OCD and Repetitive Thinking in Neurodivergent People
28 July – written by Katrin Kemmerzehl – Blog
Have you ever found yourself replaying a conversation long after it ended? Wondering whether you said the wrong thing, forgot something important or made the right decision? Perhaps you’ve gone back to check that you locked the door, reread an email one more time before sending it or found yourself imagining different ways a situation could unfold.
Most of us have moments like these. They are part of being human.
We all spend our lives trying to make sense of ourselves, the people around us and the world we live in. We reflect on what has happened, wonder what might happen next and search for meaning when life feels uncertain.
We notice patterns, solve problems and try to learn from our experiences. Much of the time, these mental habits help us navigate everyday life (Kahneman, 2011).
For many neurodivergent people, this way of engaging with the world can feel especially rich or absorbing. Questions may linger for longer. Small details that others barely notice can feel significant. For some people, uncertainty can also feel more uncomfortable, making the wish to understand things fully all the more important.
Every neurodivergent person has their own way of experiencing the world. For many, uncertainty can feel a little harder to sit with, and questions may take longer to settle. Research reflects these experiences too (Wigham et al., 2015).
These qualities can be wonderful strengths. They can bring curiosity, creativity, empathy, persistence and a remarkable eye for detail. They are often part of what makes someone uniquely themselves.
Sometimes, though, our very human wish to feel safe or certain can become exhausting. Questions that once felt manageable become harder to put down. The search for reassurance no longer brings comfort for very long. Instead of helping us move forwards, our minds seem to circle back to the same place again and again.
When everyday uncertainty becomes overwhelming
None of us can be certain about everything. We can’t know exactly what other people are thinking. We can’t guarantee that we will never make a mistake or that nothing difficult will happen. Living with a little uncertainty is something we all do every day, often without even noticing.
For someone living with obsessive compulsive disorder (OCD), uncertainty can begin to feel much bigger than it does for other people. A passing doubt can refuse to pass. An unanswered question can feel impossible to leave alone. A fleeting thought can suddenly seem as though it must mean something important (Freeston et al., 1994).
Understandably, people often do whatever they can to settle that uncomfortable feeling. They might check something again, ask for reassurance, search online, mentally replay a conversation or try to convince themselves that everything is okay. For a little while, this can bring relief.
The difficulty is that the relief rarely lasts. Before long, another doubt appears, another question pops into mind or another “What if?” asks for attention. It can become a tiring cycle as we try to protect ourselves from uncertainty (NICE, 2022).
When your thoughts don’t define you
One of the most reassuring things to know is that OCD is rarely about the thoughts themselves. In fact, the thoughts are often the very opposite of who someone is. Kind people may be haunted by thoughts of causing harm. Loving parents may become frightened by unwanted images that go against everything they value. Honest people may find themselves questioning whether they have done something wrong when they haven’t (International OCD Foundation, 2023).
Research tells us that intrusive thoughts are something almost everyone experiences from time to time. What makes OCD so distressing is not having the thoughts, but feeling that they must be understood, solved or made completely safe (Salkovskis, 1985; Rachman, 1997).
If you recognise yourself in any of this, you are far from alone. OCD is a pattern that many people become caught in, often because they care deeply, want to do the right thing or long to feel certain in an uncertain world.
OCD can involve many different themes, such as relationships, morality, health, sexuality, religion, contamination, responsibility, or fear of causing harm, among others. Although the themes vary, the underlying pattern is often the same: an overwhelming need to find certainty (International OCD Foundation, 2023; NICE, 2022).
When is it OCD, and when is it neurodivergence?
This is a question many people ask, and the answer is not always straightforward. Some experiences can look similar on the surface but come from very different places.
For example, an autistic or AuDHD person may enjoy routines because they bring comfort, predictability or a sense of calm. Someone with OCD may also have routines, but they often feel driven to follow them in a very specific way because of a fear that something bad might happen if they don’t (National Autistic Society, 2024; NICE, 2022).
In a similar way, many neurodivergent people naturally enjoy exploring ideas in depth or understanding things thoroughly. Someone with OCD may also spend a great deal of time thinking, but the thoughts often feel unwanted and difficult to let go of.
Instead of bringing curiosity or enjoyment, they can leave the person feeling trapped in cycles of doubt, reassurance or endless “What if?” questions (Salkovskis, 1985).
People with ADHD and AuDHD often describe replaying conversations, jumping between ideas or finding it difficult to shift their attention away from something that feels unfinished.
With OCD, replaying a conversation is usually driven by the need to work out whether something went wrong, whether they upset someone or whether they can finally feel certain that everything is okay (Abramovitch et al., 2021).
Of course, life is rarely this clear-cut. Many neurodivergent people also experience OCD, and the two can overlap in ways that are not always easy to untangle.
Often, the more helpful questions are:
How does it feel?
Does it bring comfort, meaning or genuine interest?
Or does it leave you feeling anxious, stuck or as though you have no choice but to keep going?
There isn’t always a simple checklist that can answer these questions. Rather than trying to fit ourselves neatly into a category, understanding sometimes develops gradually as we become more curious and compassionate towards ourselves (Neff, 2003).
Taking the first steps
Living with OCD can be exhausting, but change is possible. While there is no quick fix, small steps can make a real difference over time.
Many people find it helpful to begin responding to their thoughts in slightly different ways. This might mean noticing a thought without immediately responding or trying to work it out, and trying to resist the urge to seek reassurance or check things repeatedly, allowing some uncertainty to be present, or bringing your attention back to the people, activities and values that matter most to you. Although this isn’t easy, even small changes can help everyday life feel a little lighter over time (International OCD Foundation, 2023).
If OCD is having a significant impact on your life, it’s worth knowing that support is available. Different types of therapy can help, depending on your individual needs. Some people benefit from specialist OCD treatment, while others find counselling a valuable source of support (NICE, 2022). Whatever approach you choose, you don’t have to face it alone.
How counselling can help
Counselling can offer a different way of meeting uncertainty. Together, we can begin to understand these patterns with curiosity, creating space for life to feel a little more manageable and enjoyable again.
Living with OCD can feel lonely, especially if you’ve spent a long time keeping your thoughts to yourself or wondering what they might say about you. Therapy offers a safe, compassionate space to explore these experiences without judgement. If you are autistic, have ADHD or are AuDHD, we can also explore how your neurodivergence and OCD may overlap, helping you better understand your unique experience.
If this article has resonated with you, you don’t have to make sense of it on your own. If you’re looking for a warm, neurodiversity-affirming space where you can explore your experiences at your own pace, I’d be happy to support you. Feel free to get in touch to arrange a free initial phone consultation.
References
- Abramovitch, A., Dar, R., Mittelman, A., & Schweiger, A. (2021). Don’t judge a book by its cover: ADHD-like symptoms in obsessive-compulsive disorder. Psychiatry Research, 302, 114025.
- Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791–802.
- International OCD Foundation. (2023). What are intrusive thoughts?
- Kahneman, D. (2011). Thinking, fast and slow. Penguin Books.
- National Autistic Society. (2024). Obsessive compulsive disorder (OCD) and autism.
- National Institute for Health and Care Excellence. (2022). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (Clinical Guideline CG31).
- Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101.
- Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793–802.
- Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583.
- Wigham, S., Rodgers, J., South, M., McConachie, H., & Freeston, M. H. (2015). The interplay between intolerance of uncertainty, anxiety, repetitive behaviours and restricted interests in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(4), 943–952.
Katrin Kemmerzehl
I am a qualified psychotherapeutic counsellor in Newcastle upon Tyne.
Please get in touch if you’re interested in arranging a consultation.