2025.02.22ブログ
強迫性障害、結構ASDのこだわりと同時に存在している、神奈川県厚木市の児童精神科医が解説
強迫性障害、結構ASDのこだわりと同時に存在している、神奈川県厚木市の児童精神科医が解説
こんにちは、神奈川県厚木市の児童精神科専門クリニック、きもとメンタルクリニックです。
今回は、強迫性障害、結構ASDのこだわりと同時に存在している、について解説します。
強迫、汚れが気になる、数が気になる、手順が気になる、鍵をかけたかが気になる、儀式的なことにこだわる、ものを置く場所が気になる、などなどなんでもいいのですが、強迫、つまりは自動思考、頭に自分の意志とは関係なく自動的に思い浮かんでくる、そして、それを打ちけすために脅迫行為をする。
そして、それに対し苦痛を感じている
これが強迫です。
しかそ自閉症スペクトラム障害（ASD)昔でいうところの、PDDNOSまでいれたら、日本はASDの頻度が高いと思います。
強迫でも、ASDのこだわりが混ざっていることは、かなり多い。
そうすると何が起きるかというと、ただでさえ内服が効きにくい強迫が、さらに効きにくいことになります。
やりたくてやっていることを、内服ごときでとめれるものではないからです。
そして周りがそれは悪いこと、良くないことだからやめなさいと、となると、本人の自己評価が下がってきて、病態水準がさがり、よりこだわり的な強迫がひどくなっていく、という悪循環に入っていくことがあります。
単純に症状のことで怒られすぎたり、生活につかれてきたりすると、うつっぽくなってきて、より強迫、こだわりが目立つようになることもあります。
ＡＳＤの方を見つけてあげることができれば、そっちのせいで日常生活でうまくいっていないことを発見してあげることができれば、ストレスが減って、全体として病態が改善し、結果として強迫もよくなるかもしれません。
とにかく内服は効きにくいですし、抗不安薬や、抗精神病薬なんか下手に使ったりすると、ボートしたり、思考力が落ちて、余計にストレスを感じて強迫の方が悪化するかもしれません。
薬がきかないなら、心理療法にもっていきたいところですが、あまりに調子悪いと心理療法をやることもしんどいこともあるかもしれません。
そういう時は、少し症状に戦う力をつけるためにも、ＴＭＳ治療とかを少しつかうのも手ではあると思います。
本質的な戦いをしていく前に、状態が少しでも上向いていた方がいいにこしたことがないので、当院ではＴＭＳを勧めることもあります。
典型的な強迫も、精神病圏への前駆症状のことがあるから注意が必要ですが、ＡＳＤが混在しているときも、内服が効かないから変に増やしてしまって悪循環パターンに陥りやすいので、これも注意が必要です。
治療が停滞している方は、このようなケースの可能性ありますので、当院へご相談ください。
Today, I will explain how Obsessive-Compulsive Disorder (OCD) frequently coexists with Autism Spectrum Disorder (ASD) traits and why this combination can make treatment more challenging.
1. The Nature of OCD
OCD involves intrusive, repetitive thoughts (obsessions) that lead to compulsive behaviors (rituals) aimed at reducing anxiety.
Common OCD symptoms include:
Fear of contamination (constantly washing hands)
Fixation on numbers or order (repeating actions until it feels "right")
Compulsion to check things (repeatedly ensuring doors are locked)
Ritualistic behaviors (having to follow a strict sequence of actions)
Intense concern over object placement (feeling distressed if things are misaligned)
The key feature of OCD is that the individual finds these thoughts and behaviors distressing and often wants to stop but cannot control them.
2. The Overlap Between OCD and ASD
ASD (Autism Spectrum Disorder) is relatively common in Japan, including cases that would have been classified as PDD-NOS in the past.
Individuals with ASD often exhibit strong fixations and repetitive behaviors, which can resemble OCD. However, there are important differences:
OCD behaviors are driven by anxiety, whereas ASD fixations are more about personal preference, comfort, or routine.
OCD sufferers find their compulsions distressing, whereas people with ASD often enjoy or feel comforted by their routines.
Since OCD and ASD frequently coexist, treatment becomes more complicated.
3. Why OCD with ASD Is More Difficult to Treat
OCD alone is already challenging to treat with medication, but when ASD traits are present, it becomes even more resistant to treatment.
💊 Medications Are Less Effective
SSRIs (Selective Serotonin Reuptake Inhibitors), commonly used for OCD, may have limited effect when ASD traits are involved.
Anti-anxiety or antipsychotic medications can sometimes worsen symptoms, leading to brain fog, reduced cognitive ability, or increased stress.
🔄 The Vicious Cycle of Stress and OCD Worsening
If people with ASD are repeatedly forced to stop their compulsions or criticized for their fixations, their self-esteem declines.
Stress accumulation worsens both obsessions and fixations, creating a downward spiral.
When daily stressors add up, they may become more depressed, which in turn exacerbates OCD symptoms.
4. A Different Treatment Approach for OCD with ASD Traits
✅ Identifying ASD Traits and Reducing Stress
If ASD traits are recognized, addressing stressors in daily life can significantly improve the overall condition.
When external stress is reduced, OCD symptoms may also decrease.
✅ Avoiding Medication Overuse
Since medications often have limited effects, increasing dosages unnecessarily can lead to cognitive dullness and worsened compulsions.
Instead of relying on medication alone, alternative non-drug interventions should be considered.
✅ Using TMS (Transcranial Magnetic Stimulation) as a Supportive Treatment
OCD symptoms can be extremely difficult to manage when the person is already feeling overwhelmed.
TMS (Transcranial Magnetic Stimulation) can help stabilize brain activity, improving cognitive flexibility and making it easier to cope with compulsions.
Once the patient feels slightly better, they can engage in behavioral therapy or psychological interventions more effectively.
5. Important Considerations in Treatment
🔍 Be Aware of Early Psychotic Symptoms
OCD symptoms can sometimes be early signs of psychotic disorders.
Atypical cases should be carefully evaluated to rule out other psychiatric conditions.
🚨 Avoid the Medication Trap
When medications don’t work, there is a tendency to keep increasing doses, which can worsen the condition instead of improving it.
Recognizing ASD traits early can prevent unnecessary medication escalation.
6. Summary
✔ OCD and ASD traits frequently coexist, making treatment more complex.
✔ Medications are often less effective, and increasing doses unnecessarily can be harmful.
✔ If ASD traits are present, reducing daily stress can significantly improve symptoms.
✔ TMS therapy can help stabilize brain activity, allowing patients to engage in behavioral therapy more effectively.
✔ A careful, personalized treatment approach is necessary to avoid worsening symptoms.
➡ If you or a loved one struggles with treatment-resistant OCD, there may be underlying ASD traits affecting recovery.
At our clinic, we offer TMS therapy and individualized treatment strategies to help patients break free from the cycle of compulsions and distress.
📩 If you are struggling with OCD and have not found success with medication, feel free to consult us at Wako Clinic Nagoya.
