OCD, rituals and PDA

OCD (Obsessive Compulsive Disorder) and PDA (Pathological Demand Avoidance) can sometimes look similar on the surface. Both may involve repetitive actions, strong feelings of anxiety, and behaviours that seem ritualistic. This can lead to confusion between the two, or critically, diagnostic overshadowing can occur. This is where one condition masks or hides the other, making it harder to identify both. For example, PDA-related behaviours can be mistaken for OCD, or OCD symptoms might be missed because they are wrongly attributed to autism or PDA. Understanding the differences is key to providing the right support.

OCD stands for Obsessive Compulsive Disorder. Breaking down the words helps us understand what this means:

• Obsessive – when a thought, image, or feeling becomes overwhelming and takes over someone’s mind.
• Compulsive – the action the person feels they must do to reduce the distress caused by the obsession.

This cycle of obsessive thoughts and compulsive actions can be intense and difficult to break. Even though people with OCD often know their thoughts don’t make sense, they feel very real and hard to ignore.

Obsessions in OCD are usually unwanted and distressing thoughts, images, or urges. They come into a person’s mind unexpectedly, causing anxiety or fear. The person might believe that just by thinking these things, they could make them happen. This creates a difficult cycle: “I thought about this, it happened, so I made it happen by thinking about it.”

Even though they know it’s irrational, OCD makes it feel like the thoughts are true.

What this can look like:
Someone might seem lost in thought, going over scenarios repeatedly. They might get upset if they can’t remember something exactly or if they believe they’ve done something wrong.

Compulsions are the actions people with OCD take to ease the anxiety caused by their obsessions. These can be physical (like tapping or washing hands) or mental (like counting or asking for reassurance). The compulsion provides temporary relief, but obsessive thoughts return, creating a cycle.

For PDAers who also experience OCD, talking about these patterns can help-but these conversations need to happen gently, at a pace that feels safe. Both PDA and OCD are anxiety-driven, so keeping things low-pressure is important.

OCD can look different for different people, depending on the types of thoughts they experience. Some common subtypes include:

• Checking – repeatedly checking things are safe, done properly, or in the right place.
• Contamination – fears about germs, dirt, or unsafe substances, leading to cleaning or hygiene rituals.
• Counting – needing to count things or do things a certain number of times.
• Harm – fears about causing harm to others or oneself.
• Hoarding – keeping things because throwing them away feels dangerous or wrong.
• Magical thinking – believing that certain thoughts or actions can influence unrelated events (e.g. thinking that saying something aloud will make it happen).
• Existential – obsessive worries about the meaning of life or one’s purpose, which become overwhelming and hard to move past.

An example of the OCD cycle

• Obsession: a person fears they might accidentally push someone into the road.
• Compulsion: they avoid walking near roads.
• Worst case: they brush past someone near a road and panic, fearing their obsession might come true.

Some PDAers might avoid roads too, but for very different reasons-such as sensory overload from traffic noise or the discomfort of unexpected touch. The outward behaviour might look the same, but the cause is different.

Understanding whether a behaviour comes from OCD or PDA helps to offer the right support.

A ritual is an action or set of actions (including words) that must be done exactly the same way each time. Rituals are common in OCD, where they help ease the anxiety caused by obsessions.

Autistic people, including PDAers, may also have rituals or repetitive actions-but these usually help regulate sensory input or emotions. For example, tapping or fidgeting can soothe sensory overload. The key difference is that OCD rituals are about preventing something bad from happening, whereas PDA or autistic rituals are about self-regulation.

The best way to understand whether a behaviour is a compulsion (OCD) or a regulatory action (PDA or autism) is to talk about it. But this should always happen in a way that feels safe, low-pressure, and respectful of the person’s pace.

Tips for opening conversations

• Using a low-arousal approach: sitting down, speaking softly, and letting the person know they can share in their own time.
• Being empathetic: explaining that you want to understand because you care, not because you want to change or control them.
• Avoiding big words or too many questions: keeping language simple.
• Planting seeds for later conversations: “I’ve noticed that when you do this, it’s always exactly the same. One day, if you ever feel like it, I’d love to understand more about that.”

This approach removes the pressure and keeps the door open for future discussions.

PDA and OCD can overlap in how they look, but understanding the differences can make a real difference in people are supported. OCD is driven by obsessive thoughts and the need to take action to prevent harm or reduce fear. PDAers may also use rituals or avoid situations, but often as a way to manage sensory overload or anxiety from demands.

Taking time to listen, understand, and reduce anxiety can help PDAers feel safe enough to share what’s going on.

Our trainers really know their stuff, almost all of them have both personal and professional experience of PDA. So if you are looking to learn more about PDA you are in the right place.