The OCD Whisperer Podcast with Kristina Orlova

Episode 174: STOP Treating Autism like OCD — The "Golden Rule" of Differential Diagnosis with Dr. Jeremy Schuman

Release Date: March 6, 2026

Episode Overview

In this episode, host Kristina Orlova is joined by psychologist Dr. Jeremy Schuman to demystify the often-confusing overlap between Autism Spectrum Disorder (ASD) and Obsessive Compulsive Disorder (OCD). With warmth and clarity, Dr. Schuman breaks down the "golden rule" of differential diagnosis, highlighting why it's so crucial to stop treating autism like OCD. The conversation covers the internal and external experiences of autistic individuals, how their repetitive behaviors differ fundamentally from OCD compulsions, the impact of diagnostic confusion, and how families and clinicians can approach neurodiversity with greater compassion and nuance.

Key Discussion Points & Insights

1. Understanding Autism: The Basics and Beyond

[02:58–05:44]

• Autism is not a monolith: Dr. Schuman emphasizes the wide spectrum and variance in autistic experiences, noting "it's not one singular thing... there’s a lot of different presentations that we’re all calling autism." (Dr. Schuman, 02:58)
• Defining traits:
  • Autism is a neurodevelopmental condition from birth, identified by observable behaviors in two main domains:
    • Social differences ("social deficits" in the DSM)
    • Restricted and repetitive behaviors, such as sensory reactivity (can be seeking or avoiding), preference for sameness, and self-stimulating actions.
• The Neurodiversity movement: Challenges traditional DSM definitions, focusing on the lived experience and internal logic behind behaviors rather than just outward complaints, and noting most definitions reflect research with white, school-aged boys.

2. Recognizing Early Signs — What to Notice Before Diagnosis

[05:44–07:14]

• School settings: Early signs often look like:
  • Difficulties with social engagement (either seeming uninterested or receiving negative feedback for their methods of interaction)
  • Self-stimulatory behaviors (e.g., hand-flapping, rocking)
  • Sensory seeking or avoiding (preferences for certain textures, smells, or sensations)
  • "Monotropism": intense tunnel vision on favorite interests

3. The Heart of Differential Diagnosis: Autism vs. OCD Behaviors

[07:14–11:59]

• Key distinction—Function of Behavior:
  • Autistic repetitive behaviors are generally self-soothing or regulating and not driven by fear of outcomes.
    • Quote: "There's no feared outcome that I'm trying to prevent... I do this motion because it feels good" (Dr. Schuman, 07:44)
  • OCD compulsions are attempts to neutralize anxiety or avert imagined catastrophes.
    • Quote: "I locked this door. I gotta lock it again until it feels right. That's very different..." (Dr. Schuman, 07:56)
• Surface similarities: Untrained observers may confuse the two due to repetition, but the function and internal experience are distinct.

4. How to Distinguish: The Golden Rule in Action

[09:58–11:59]

• Ask, "What does this behavior achieve?"
  • If it's about comfort or positive regulation, it may be autism.
  • If it's about averting a feared event ("something bad will happen"), it's probably OCD.
• In OCD, compulsive behaviors reinforce the problem (cycle gets stronger), in autism, denial of regulating activities leads to dysregulation.
• Nuance required: Autistic clients may be defensive about their traits, OCD clients might lack insight about their compulsions.

5. Cognitive and Therapeutic Nuances

[11:59–17:14]

• Assessment and conceptualization come before therapy: avoid jumping straight to exposures.
• Listen for:
  • OCD: Neutralizing unwanted thoughts, fear of catastrophic outcome, intolerance of doubt
  • Autism: Sensory issues, overfocused attention on interests, eventually draining but not driven by fear of catastrophe.
• Anecdote: Dr. Schuman describes a client ruminating over a personal mistake, misdiagnosed as OCD, but really demonstrating singular autistic focus with no sense of "neutralization" (15:30–17:14).

6. Clinical and Family Approaches: Supporting Loved Ones

[17:14–24:01]

• Therapeutic strategies: Mindfulness, metacognitive techniques (like non-engagement), psychoeducation about how the autistic brain works; focus on flexibility and self-compassion.
• For families:
  • Begin with compassionate education ("What is Autism?" by Donna Henderson recommended at 20:12).
  • Don’t assume "I’ve been there too"—the frequency and intensity of these experiences can be worlds apart (compelling car analogy at 21:00–23:34).
    • Quote: "We are not talking about the same problem here." (Dr. Schuman, 22:39)
  • Seek a balance of accommodation—don't demand loved ones erase their traits.

7. Is OCD Neurodivergent?

[24:01–26:45]

• Short answer: Yes, OCD fits the neurodivergent model—heritable, brain-based, chronic, involves minority stress.
• Nuance: Neurodivergence doesn't mean traits can't cause distress or shouldn't be addressed.
  • Quote: "People who recover from OCD deserve compassion for the amount of weight they’re carrying every day in their managing of it...I just don’t see them as being that different." (Dr. Schuman, 26:20)
• There's no single authority defining neurodiversity.

8. Golden Rule for Practitioners: Collaboration and Context Matter

[26:52–29:18]

• Beware of polarization: Some in the autism community see CBT/exposure as harmful; danger comes from contextless application, not the method itself.
• Advantage lies in behavioral and psychoeducational tools when adapted with collaboration and understanding.
  • Quote: "It’d be a shame to keep the whole autism community away from those tools just because they can be used in ways that are harmful. The same way that a knife can be a scalpel...or...a very dangerous weapon." (Dr. Schuman, 28:28)

Notable Quotes & Memorable Moments

• "The commonality is that it’s a neurodevelopmental condition. It’s something you’re born with...we really define it based off these observable behaviors…"
  — Dr. Jeremy Schuman, [03:24]

• "To an untrained eye, we might say, ‘I don’t understand why the person is doing that.’ This all looks the same, and it can be confusing."
  — Dr. Jeremy Schuman, [08:16]

• "We are not talking about the same problem here."
  — Dr. Jeremy Schuman (car analogy about family understanding), [22:39]

• "I think by those definitions, I would call it [OCD] neurodivergence...people who recover from OCD deserve compassion for the amount of weight they’re carrying every day..."
  — Dr. Jeremy Schuman, [24:32–26:20]

Important Timestamps

• 02:58 – The diverse and evolving definition of autism
• 05:44 – What autism looks like before a diagnosis
• 07:44 – Distinguishing between autistic repetitive behaviors and OCD compulsions
• 12:56 – How assessment and approach should change for autistic vs. OCD clients
• 15:30 – Real-life example of diagnostic confusion
• 20:12 – Book recommendation for families ("What is Autism?" by Donna Henderson)
• 21:00–23:34 – The car breakdown analogy for family compassion
• 24:01 – Is OCD neurodivergent?
• 26:52 – Why some see CBT/exposure as harmful for autistic people, and the importance of nuance

Final Thoughts

Dr. Schuman emphasizes the necessity of asking what a behavior does, not just how it looks, when discerning between autism and OCD—and urges clinicians and families to approach with curiosity, compassion, and an individualized lens. Effective treatment and support stem from truly understanding the person, not just the diagnosis.

Contact/Resources:

• To connect with Dr. Schuman: Email jeremy@mindfulstl.com or search for his YouTube channel.
• Special Interest Group (OCD & Autism): Monthly meetings, details via listserv.

Episode takeaway:
Don’t confuse surface behaviors for shared motives—seek to understand the function and experience underneath, and use that knowledge for more compassionate, effective support.