This blog has been inspired by Dr Jeremy Shuman's (PsyD) presentation,
'Neurodiversity-Affirming OCD Care' (August 2023), available here.
All images created by Canva. Alt text, close-up of frozen stream
Exploring similarities and differences between Autistic and OCD monotropic flow states.
Can attention tunnels freeze, and thoughts get stuck?
Autism research is shifting; many people are moving away from the medical deficit model and seeing the value and potential of working towards a more neurodiversity-affirming approach to education and care. This article will explore the following:
1. Differences and similarities between autism and OCD and how they can co-occur. 2. How montropism could help develop a deeper understanding of autistic and OCD experiences.
3. Monotropic flow states and Autistic Burnout The concept of monotropism was explored in the research of Murray, Lesser and Lawson, (2005). Monotropism can be seen to be at the core of the autistic experience. Understanding monotropism may help provide more meaningful neurodiversity-affirming care and significantly help autistic people experiencing OCD. A deeper understanding of autism, OCD and monotropism can support a more positive understanding of people’s identity and neurodivergence. This will support better mental health outcomes for autistic people experiencing OCD. Autism and OCD
Research from 2015 showed that 17% of Autistic people also have OCD and further research from 2020 shows that between 17% and 37% of autistic young people also have OCD. This likely only reflects the tip of the iceberg, and there is a desperate need for a deeper understanding of autism and supporting OCD through a non-pathologising lens to support people. Dr Shuman suggests that neurodiversity-affirming care celebrates individual differences, is free from coercion and can be liberatory. There are many similarities between autism and OCD; some of my thoughts are highlighted below (see infographic). Some autistic trauma responses could be mistaken for OCD or may even lead to OCD for some people. For example, if you are anxious, you are more likely to be in a state of fight, flight, freeze and get stuck in loops of obsessive thoughts. Obsessive thoughts create a deep, painful urge to carry out compulsions to try and alleviate those thoughts and to feel 'better briefly'; this can look like and be mistaken for autistic ‘restricted and repetitive actions’. I believe a crucial difference between OCD and what are sometimes referred to as ‘autistic restricted and repetitive actions’ lies in the thought that autistic special interests are a mainly positive experience, and autistic routines are usually helpful to a person’s life and ability to function. In contrast, OCD obsessive thoughts are unwanted; compulsions are not helpful and can seriously interfere with and have a detrimental impact on mental health and a person’s quality of life. If you are autistic, research has shown you are more likely to be monotropic. 'Development and Validation of a Novel Self-Report Measure of Monotropism in Autistic and Non-Autistic People: The Monotropism Questionnaire' by Garau et al. was published as a pre-print in June 2023. This research showed that ADHD and autism were significantly associated with higher mean monotropism scores. As far as I am aware, there hasn’t yet been a monotropism research project specifically looking at the intersection of monotropism, OCD and autism, I would imagine this would be an exciting area to explore. It is the interplay between the loops of OCD thought processes and the autistic experience of being monotropic that fascinates me, and I feel it would be of value to explore further. Autistic special interests and routines + monotropism = positive mental health comes
OCD thoughts and rituals + monotropism = adverse mental health outcomes
The value of research led by those with lived experience is reflected in the recent Monotropism Questionnaire (MQ) preprint and subsequent self scoring questionnaire, which went viral across social media (July /August 2023) with millions of views. OCD research feels far behind autism neurodiversity-affirming research, supportive care, and practice. There seems to be much more stigma around OCD and significantly less OCD support groups and even less specifically autistic OCD focused research and support.
Monotropism and OCD
Many autistic people identify with monotropism, a good article explaining this is available here by Fergus Murray, (2018). Monotropic people focus more energy (attention/resources) on a smaller number of things at any one time. This has been likened to having tunnels of attention where monotropic people become so highly engaged in their specific interest that they may not notice what is happening outside of that space but equally could be hyper-vigilant within that attention tunnel, and consequently less aware of what is happening outside of that channel. This contrasts with polytropic people, who can divide their attention and energy resources across a wider number of channels of interest/tasks/ sensory stimuli at any time.
Eight factors came out of the data analysis of the Monotropism Questionnaire (2023)These elements are thought to be key to monotropic thought patterns. I have highlighted in the table below how these eight factors may also fit into the experiences of autistic people and how they may present for some people who experience OCD.
Attention and Energy Resources
In the context of OCD, a monotropic person's thoughts and sensory experiences may be felt more intensely, creating more difficulty in other areas of life. Executive functioning tasks, communication, sensory and emotional regulation may all be more difficult to manage as there is less capacity outside the monotropic channel.
This may result in thoughts getting ‘stuck’ in a monotropic channel and looping without moving forwards, without flowing. McDonnell and Milton ‘Going with the flow: reconsidering ‘repetitive behaviour’ through the concept of ‘flow states’. (2014) describe this as ‘clumping’ and is ‘Where the flow of attention resource is halted due to sticking together, and they can form blockages to prevent attention resource bringing certain information into person’s awareness.’ This was also explained in Woods (2019) ‘An Updated Interest Based Account (Monotropism theory) & a Demand Avoidance Phenomenon discussion.’ presentation available here.
If thoughts are stuck, or frozen, it is likely to impact the sensory system too and could lead to autistic inertia. This is when autistic people feel stuck/frozen and unable to start or end tasks or thought processes. If you also experience OCD, you may not only be feeling stuck in your monotropic channel but also stuck in endless loops of obsessive-compulsive thoughts within that frozen channel.
As your monotropic channel freezes so will your flow state. It may feel as if your thoughts keep growing and expanding as they freeze, they become totally consuming, OCD fills and takes up available all resources/ energy and attention. If you are polytropic, it may be easier to engage in therapy such as Exposure Response Therapy as you have access to other channels of attention and there may be more resources available so you are more open to suggestions. It would be intersting for research to explore what support has the greatest outcomes for autistic monotropic people who are struggling with OCD.
People may find it hard to physically move or function outside of this loop, as there is no capacity left to move in the channel, it may feel like you are frozen in an OCD loop. A way of creating flow is to carry out the compulsion; this temporarily provides relief. The temporary relief carried out by the compulsion breaks the loop and allows it to become unstuck; feelings and thoughts may feel like they momentarily melt. Metaphorically, the monotropic current is then able to flow, until the cycle starts again.
Monotropic Flow States Engaging in your special interest can be a wonderful joyful experience and may feel like it is recharging your energy levels. If you are monotropic, switching / changing channels of attention to other tasks can be challenging; it can feel like trying to swim upstream and climb out of a deep riverbank, it uses up more energy. This means that on a day-to-day basis, life can be difficult as it takes more time and energy to pull yourself out of one channel of thought into another channel to refocus on what needs doing; it is exhausting, and it can lead to burnout. The difference between a happy monotropic flow state and the contrasting differences in OCD experiences has been highlighted by my recent social media projects available here, showing that some other people resonate with this thought:
Autistic Dream Realms Project (2023). (A collaborative community project with Katie Munday, Autistic and Living the Dream).
Alexythemia and Interoception If you are experiencing OCD, you are likely to be anxious and in a hyper-aroused sensory state. If you cannot interpret your internal body signals (interoception) and identify your feelings and emotions (alexythemia), it will likely cause more anxiety, confusion, and distress. Both alexythemia and interoception difficulties are common co-occurring difficulties within for many neurodivergent people and are worth considering. Autistic Burnout It is exhausting to live in a constant hyper-vigilant, survival state, spending a significant amount of time and energy engaged in obsessive thoughts and carrying out compulsions; it can cause considerable distress and seriously impact the quality of life. There is only so much anyone’s mind and body can take before they reach their capacity and enter burnout, leading to other mental health difficulties and potentially a crisis. If external demands outweigh a person’s internal capacity, it will lead to dysregulation and burnout (Raymaker, 2020). Raymaker describes Autistic Burnout as; “A state of pervasive exhaustion, loss of function, increase in Autistic traits, and withdrawal from life that results from continuously expending more resources than one has coping with activities and environments ill-suited to one’s abilities and needs.” In other words, Autistic Burnout results from being asked to continuously do more than one is capable of without sufficient means for recovery.” For an autistic person, as a way of trying to regain control, it is likely that they will need to spend more time stimming and engaged in their monotropic interests/experiences. They will have less energy available to mask/meet expectations of neuronormative communication and social demands. There may be a deep yearning to seek a monotropic flow state more often and for longer periods to try and regulate and recharge.
Seeking Monotropic Safety and Therapy
Being autistic can make finding support and advice for managing OCD particularly difficult. As described by Damian Milton (2012), the double empathy problem can add to misunderstandings and more difficult communication problems. Dr Shuman highlighted some of the primary therapy types available for supporting those with OCD: CBT, ERP IB-CBT, MBCT ACT Trauma-informed therapy. Whichever therapeutic approach and path you take, if you are struggling with OCD and are also autistic or caring for an autistic OCD person, then the double empathy problem needs to be considered in order to receive the best care.
Valuing autistic communication and understanding that ‘talking therapy’ may not be the best route for everyone, especially if a person is autistic, needs to be considered. This is important alongside having a deeper understanding of a neurodiversity affirming autistic identity so there are not additional layers of stress, shame, trauma, stigma and negativity added to an already complex situation.
A monotropic flow state is a natural state to seek for many autistic people; engaging with special interests can help autistic monotropic people feel rested recharged, and help to prevent or recover from burnout. Monotropic interests can feel safe as they are somewhat predictable, and lowering uncertainty can help lower anxiety and support well-being.
If a monotropic person experiencing OCD gets into a flow state with obsessive thoughts and compulsions, it will not feel like such a positive experience. It could seriously impact their mental health and quality of life. It can potentially limit life to such an extent that people are unable to engage in life outside of their OCD monotropic channel and become utterly disabled by it, their monotropic channel may become stuck/frozen and the only movement are the repetitive all consuming loops of OCD thought processing.
A Positive Future
We need to understand, value, and validate autistic identity to help develop a deeper understanding of OCD within the context of autism and monotropism. Providing neurodiversity affirming therapeutic support for autistic people struggling with OCD will help them to manage and enable them to live their best lives. Signposting & Further Information
OCD-UK | A national OCD charity run by and for people with lived experience of OCD (ocduk.org)
OCD Action (UK Charity)
Monotropism
Mental Health Crisis Support
Samaritans | Every life lost to suicide is a tragedy | Here to listen
Papyrus UK Suicide - Prevention | Prevention of Young Suicide (papyrus-uk.org)
*Disclaimer – I am not a medical professional or therapist; please seek professional advice if you have mental health concerns. This article was written to explore concepts and open discussions around autism, OCD and monotropism.*