The link between autism & PTSD

“It seemed we were ignoring a huge part of the picture.”

The more the researchers look, the more we see that many autistics have post-traumatic stress disorder (PTSD). In fact, in my own work as a therapist and as an advocate of the autism community, I have met only one person with autism who does not have PTSD.

Sadly, autism does increase the risk of trauma.

The fact that we are bullied, teased, ostracized, and misunderstood more than neurotypicals, and that we are more sensitive to these events, is what explains the high prevalence of PTSD in autistic people.

Causes

The reasons we develop PTSD are different than in neurotypicals.

Research from 2017 indicates that among autistic students, social incidents such as ostracization are much stronger predictors of PTSD than violent ones, such as war, terror, or abuse. In neurotypicals, the opposite tends to be the norm.^[1]PTSD and autism—are they related, and how?

Abuse, sexual assault, violence, natural disasters and wartime combat are all common causes of PTSD in the general population. Among autistic people, though, less extreme experiences—fire alarms, paperwork, the loss of a family pet, even a stranger’s offhand comment—can also be destabilizing. They can also be traumatized by others’ behavior toward them.^[2]PTSD and Autism Spectrum Disorder: Co-morbidity, Gaps in Research and Potential Shared Mechanisms

One woman that was interviewed by researchers got PTSD from having to fill out paperwork yearly for housing assistance.

Vulnerability

Having autism predisposes us to a potential lifetime of harm.

Before Gabriel could even talk, his father’s girlfriend at the time told him his mother had abandoned him. At age 3, he was sexually abused by a cousin. He was mercilessly bullied once he started school, showed signs of depression by age 7, and by 11 began telling his mother he did not want to live.

About three years ago, while at summer camp, he almost drowned. Shortly after that, he experienced life-threatening heatstroke when he went to get his Legos from the car trunk and accidentally locked himself in.

Six months ago, just after his grandmother died, he attempted suicide.^[3]At the intersection of autism and trauma | Spectrum

Prevalence

In 2013 researchers published a study stating that PTSD was not more common in autistics (with both groups at 3%).^[4]The Phenomenology and Clinical Correlates of Suicidal Thoughts and Behaviors in Youth with Autism Spectrum Disorders However, it just looks different in us, and the DSM does not account for ostracization as a cause, so many of us are overlooked and remain undiagnosed.

PTSD simply looks different in people with autism than it does in the general population.

“It seems possible to me that it’s not that PTSD is less common but potentially that we’re not measuring it well, or that the way traumatic stress expresses itself in people on the spectrum is different,” Kerns says.

“It seemed we were ignoring a huge part of the picture.”

As such, the prevalence of PTSD among autistic people is likely significantly higher than the 3% prevalence rate we see in the general population.

Update: According to research from 2020, 40% of autistics had PTSD symptoms during the last month, and over 60% experienced PTSD at some point in their lives.^[5]Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM ‐5 and Non‐DSM ‐5 Traumatic Life Events (Rumball, Happé, & Grey, 2020)

Overlap

Researchers are finding a significant overlap between autism and PTSD; people who have more autistic traits have more signs of PTSD, such as depression and avoidance.

In addition, researchers found some surprising trends. While PTSD is more common in neurotypical females, it is autistic males that are more likely to get PTSD!

I would think that the reason for this is two-fold:

• First, male autistics are not forced to socialize the ways female autistics are. As a result, female autistics are better at masking, and less vulnerable to being ostracized.
• Second, females are still hugely under-diagnosed, causing a potential for skewed data.

Characteristics

Another discovery was that the type of PTSD we are likely to get is characterized by hyperarousal:

More easily startled, more likely to have insomnia, predisposed to anger and anxiety, or have greater difficulty concentrating than is seen in other forms of PTSD.

It is a tragedy of this world that these beautiful people, who share ethics, honesty, deep empathy for those they care about, and are autodidacts who contribute significantly to society, are at an increased risk of harm.

Read about why the autistic brain
is vulnerable to PTSD here:

The autistic brain & PTSD