Is it anxiety, autism, or both?

Autism and anxiety are different, but they can overlap. An autistic adult may experience anxiety linked to sensory overload, uncertainty, masking, or difficult social experiences. They may also have an anxiety disorder. Understanding both the anxiety and the person’s autistic needs helps identify the right support.

If you have spent years being told you are “just anxious,” you may still feel that something is missing. Why does an unclear plan take so much out of you? Why is a social event exhausting even when you enjoy the people? And why does reassurance sometimes help less than knowing exactly what to expect?

Those experiences deserve attention. They do not establish that you are autistic, but they are worth exploring alongside your developmental history and the wider pattern of your experiences.

How common is anxiety in autistic adults?

Anxiety disorders are common among autistic adults, although estimates vary substantially. A major systematic review and meta-analysis estimated that approximately 27% had a current anxiety disorder and 42% had experienced one during their lifetime. These figures describe anxiety disorders, rather than everyone who experiences anxiety.^[1]Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis (Hollocks et al., 2019)

For many autistic adults, the answer to “Is this autism or anxiety?” is both. But that does not tell us what is contributing to the anxiety, or what will help.

Why sensory experiences and uncertainty matter

A 2021 study by Normansell-Mossa and colleagues examined relationships between autistic traits, sensory sensitivity, intolerance of uncertainty, and anxiety. Intolerance of uncertainty describes difficulty coping with situations where the outcome is unclear.

The researchers analysed questionnaire data from 55 autistic and 199 non-autistic adults together. Their better-fitting statistical model linked higher autistic traits with greater sensory sensitivity and intolerance of uncertainty. Sensory sensitivity was also associated with intolerance of uncertainty, which was strongly associated with anxiety.

The findings are consistent with a possible pathway connecting sensory experiences, uncertainty, and anxiety. However, the study measured these factors at one point in time. It could not establish what caused what.^[2]Sensory sensitivity and intolerance of uncertainty influence anxiety in autistic adults (Normansell-Mossa et al., 2021)

A useful question is: What is uncertain here, and what might that uncertainty mean for this person? Not knowing how loud a venue will be, whether plans will change, or whether leaving is possible may matter when considering their anxiety.

How the social environment can contribute

Anxiety also needs to be understood in the context of how people are treated.

A 2023 review by Rivera and Bennetto examined how identity, stigma, and camouflaging may help explain autistic mental health. It highlights the importance of social experiences, including exclusion, negative stereotypes, and pressure to fit non-autistic expectations. These factors can place additional demands on autistic people.^[3]Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people (Rivera & Bennetto, 2023)

For someone who has repeatedly been misunderstood or rejected, anticipating another difficult interaction may be understandable. Support needs to consider those experiences, as well as the anxiety itself.

This does not mean that every autistic person’s anxiety has the same origin, or that changing the environment will resolve it entirely. It means that the environment belongs in the conversation.

What anxiety can feel like for autistic adults

A 2025 systematic review by Da Silva and colleagues brought together 11 qualitative studies containing autistic adults’ accounts of anxiety. Participants described varied physical, emotional, and cognitive experiences. Some found anxiety difficult to describe; others experienced intense or sudden distress.

The review highlighted several interconnected experiences:

• Effortful social interaction: interpreting other people while monitoring one’s own words and behaviour.
• Uncertainty: difficulty with unpredictable interactions, changes, or unclear expectations.
• Feeling different or excluded: experiences of being “the other” that could also make seeking support harder.
• Sensory experiences: sensations that could contribute to anxiety, express distress, or help soothe it.

The review also described cycles between anxiety and coping. A strategy may offer immediate relief while carrying longer-term costs. Its usefulness depends on the person and the situation. These accounts illustrate experiences; they do not establish how frequently each occurs across all autistic adults.^[4]A systematic review of autistic adults’ experiences of anxiety from a qualitative perspective (Da Silva et al., 2025)

What does research say about masking and anxiety?

Camouflaging involves strategies used to conceal or compensate for autistic characteristics during social interaction. It can include closely monitoring behaviour or trying to fit in despite discomfort.

A study published in January 2026 examined camouflaging, anxiety, and suicidal ideation in 471 women, including 72 autistic women. Across the combined sample, higher camouflaging scores were associated with higher anxiety, and anxiety statistically accounted for part of the association between camouflaging and suicidal ideation.

This was an association, not proof that camouflaging caused anxiety or suicidal thoughts. The main mediation analysis was also not limited to autistic women.^[5]The association between autism, camouflaging and anxiety with suicidal ideation in women (Conde-Pumpido-Zubizarreta et al., 2026)

The findings reinforce the value of asking about the effort involved in social participation. Appearing comfortable does not necessarily tell us how someone feels.

Can autism be mistaken for anxiety?

Anxiety can overlap with how autistic differences appear from the outside. Avoiding a social situation, for example, does not tell us whether someone fears judgment, finds the sensory environment overwhelming, struggles with its communication demands, or experiences several of these together.

Assessment therefore needs to consider the person’s developmental history, longstanding characteristics, current difficulties, and possible co-occurring conditions. Whether someone benefits from clear instructions or predictable plans cannot, by itself, distinguish autism from anxiety.^[6]Autism spectrum disorder in adults: Diagnosis and management (NICE)

There is no need to decide that only one experience is real. An autistic person can have genuine sensory needs and an anxiety disorder at the same time.

What support and treatment can help?

Research specifically on anxiety treatment in autistic adults remains limited. A 2022 systematic review included 15 psychosocial treatment studies, one medication study, and one study combining both approaches. Cognitive behavioural therapy (CBT) was the most investigated treatment, but results across the literature were inconsistent. This uncertainty does not mean that treatment cannot help.^[7]Treatment of anxiety in autistic adults: A systematic review (Menezes et al., 2022)

NICE recommends addressing co-occurring mental health conditions while adapting care to autistic needs. Support may involve environmental changes, adapted psychological therapy, and medication when appropriate to the condition and individual.^[8]Autism spectrum disorder in adults: Diagnosis and management (NICE)

Questions worth bringing into that conversation include:

• What feels overwhelming or difficult to anticipate?
• Would clearer expectations or sensory adjustments help?
• What does the person want to be able to do?
• Which supports and treatment approaches fit their needs?

Can mindfulness help autistic adults with anxiety?

A 2025 trial involving 89 autistic adults evaluated a six-week programme using a customized version of the Healthy Minds Program app. Participants receiving the intervention reported greater reductions in anxiety and perceived stress than those waiting to receive it. Improvements were retained at six-week follow-up.

The programme included lessons of up to seven minutes and practices lasting 10 or 15 minutes. Participants could choose sitting or active practices and their narrator. They were instructed to complete an activity five days per week.

These are promising findings, with limits. Outcomes were self-reported, the comparison was a wait-list rather than another treatment, and the study did not establish superiority to CBT or exposure-based approaches. Some participants reported emotional discomfort.^[9]Smartphone mindfulness intervention reduces anxiety symptoms and perceived stress in autistic adults: A randomized controlled trial (Li et al., 2025)

Mindfulness is an option to consider, not an obligation or a guarantee of relief. An approach needs to work for the person using it.

Understanding both autism and anxiety

The question “Is this anxiety or autism?” can be the beginning of a useful conversation. Further questions matter too: What is contributing to the distress? What needs have been missed? What would make daily life more manageable?

Recognizing autistic needs and treating anxiety can be part of the same plan. The aim is to understand the person’s experience well enough to offer support that fits.

If you recognize longstanding patterns in your sensory experiences, communication, routines, or social effort, you may wish to explore whether autism is part of the picture.

At Embrace Autism, you can explore our free autism screening tools or learn about our adult autism screening and assessment options. Screening questionnaires can support reflection, but they cannot establish or rule out an autism diagnosis on their own.