Autistic Trauma:

Autism and Trauma

In the lead up to writing this post, I’ve been considering the relationship between trauma and Autism. I believe these things interact with each other on a number of different levels. It turns out people on the spectrum report PTSD symptoms more frequently than the general population (Rumball, 2022). And some evidence shows that people on the spectrum experience life stressors at a younger age (Attwood & Garnett, 2024) 

Statistics like these ones naturally make us question why. What is it about Autism that brings trauma? This seems to be for a number of reasons, including the types of trauma people on the spectrum are exposed to (ie. interpersonal or complex). But also the sensitivity people on the spectrum have for certain types of stressful experiences. According to my understanding of neuro-diversity neuro-diverse nervous-systems are hyper-sensitive (or less flexible as Neff at Neurodivergent insights calls it). Just like how autistics are more likely to experience inflammation or an immune response to small irritants or even as a response to stress. Trauma symptoms may set in in response to things that feel traumatic to the person, but are generally considered banal to the average neuro-typical (Cleary, West, Kornhaber, & Hungerford, 2023; Neff, Neurodivergent insights).

In their 2024 article Attwood & Garrett cite “a tendency to misinterpret benign social experiences as being threatening” in autistics. But I (perhaps with bias) would disagree with this phrasing. I believe it would be more accurate to say that social moments that are benign to neuro-typicals are threatening to neuro-diverse people (Neff at Neurodivergent insights seems to agree with me). A socially stressful moment might lead a neuro-diveregent to consider all the ways the present situation might lead to more hurtful moments in the future, it inspires us to draw conclusions about the people and places around us, and decide that those people and places feel unsafe. 

“The reality is that just a simple social interaction with a neurotypical can be traumatic when you’re on the autism spectrum. It can trigger feelings of not being good enough, stupid, or worthless. Over time, this trauma may cause you to feel hopeless, numb, and have negative thoughts about yourself, other people, and the world.” -Oswald, 2020 

Neuro-typicals have a tendency to focus on physical safety when talking about trauma. But in my experience neuro-diverse people tend to speak more about emotional safety. I would actually say that my emotional safety is much more important to me than my physical safety, because emotional hurts last longer and require more care. All this sort of implies that the autistic experience of trauma isn’t the same as the neuro-typical experience.
Autistic Types of Trauma

There are a lot of different types of trauma, and not all kinds get the same attention and care in our current healthcare system. The sort of trauma that is common for neuro-divergents may lead to additional barriers in health (physical and mental) and lifestyle (Attwood & Garnett, 2024). (For example, health trauma can make navigating the healthcare system near impossible, especially in the absence of accommodations or support). So, when exploring the ways autistic experiences of trauma differ, it’s important to keep in mind that, here too, being different can come with a lot of consequences.

“To be chronically misunderstood and misjudged is traumatic.” -Oswald, 2020.

People on the spectrum are more likely to be exposed to traumatic events, particularly interpersonal or social trauma. Some examples include:

• Bullying

• Physical and sexual abuse

• Feelings of abandonment 

• Intense sensory experiences (at the wrong time or with enough overwhelm)

• Transitions and change (people on the spectrum rarely like change, making times of transition particularly vulnerable)

• Social difficulties and confusion (not understanding the rules or scripts we use can create a pervasive sense of being lost or not belonging)

• Mental health difficulties (Autism increases a person's chances of developing other mental health disorders)

• Being told to stop, or withhold from, soothing behaviours by people that don’t understand them (repetitive tasks, stimming, etc,)

• Loss of work or schooling, or being kept from opportunities for advancement

(Attwood & Garnett, 2024; Buuren, Hoekert, & Sizoo, 2021; Neff, Neurodivergent insights; Oswald, 2020; Rumball, 2022). Neff at Neurodivergent insights also writes about how “sensitive sensory profiles … encode memory with more intensity”, and “the chronic stress and invalidation of navigating an allistic world”.

So, as you can see, people on the spectrum face a two-pronged risk to trauma: first because a broader variety of experiences are coded as traumatic, and because more traumatic experiences are likely to occur to Autistics (Neff, Neurodivergent insights). Masking may also be framed as a source of trauma and/or a response to social trauma (Oswald, 2020). According to Cleary, West, Kornhaber, & Hungerford, 2023, masking can lead to:

• A lack of self-acceptance

• Feelings of disassociation

• Burnout, emotional exhaustion and/or physical fatigue

• Low self-worth and/or internalized stigma (or self-stigma)

• Depression and/or anxiety, suicidality

• Social disconnectedness

• Feelings of inauthenticity

• Executive functioning issues

• Worries about betraying the autistic community

• A lower capacity for healthy boundaries. 

The Autistic Narrative

While there is less research on this facet of autism, I have noticed that many of my autistic friends and clients have experienced similar hurtful things. I believe certain categories of discrimination or ignorance can contribute to trauma experiences that are more or less common for people on the spectrum. I call this the Autistic Trauma Narrative. At different phases of life (school, work, friends, romantic relationships, sexual development, and even family dynamics) people on the spectrum become vulnerable to certain kinds of interpersonal or social traumas (ie. exclusion, criticism, feeling confused or like you don’t belong, have unique limits and boundaries, rejection, chronically feeling misunderstood). These experiences accumulate over time to develop into insecurities, core-beliefs, or self-image concerns that are also common for people on the spectrum. For example, regular social rejection, explicit or otherwise, can lead to long-lasting trauma symptoms and will also instill the belief that a person is never enough or rarely wanted. This belief will be compensated for with perfectionism, avoidance, or other strategies. When this core belief is activated it may throw the person into an unexpected panic or intense self-doubt that can be difficult to explain or tolerate. Many people on the spectrum are used to dealing with things alone, either because they don’t have supports available, or because they don’t feel understood or validated. This often reaffirms the trauma-based beliefs they may be struggling with.

“The trauma originates from the ongoing invalidation, rejection, misunderstanding and prejudice we face” -EWOR, 2023

Discrimination in School and Work might include refusal to accommodate, lost opportunities, unhelpful criticism from authority figures, bullying, exclusion, physical or verbal violence, threatening behaviour, sexual assault, or just general stigmatization (Cleary, West, Kornhaber, & Hungerford, 2023). Stigma is something I talk about in session a lot with my neuro-divergent clients. Overt discriminatory behaviours can lead to internalized negative self-concepts, but are generally easier to argue against and then unlearn (everyone knows hitting people is wrong). But more subtle kinds of discrimination (using manipulation or implication) which make up stigmatized societal conceptualizations of neuro-diversity are internalized just as much, and much harder to identify or argue with. And therefore much harder to unlearn. 

Healthcare Systems can be more difficult to access for people on the spectrum (Cleary, West, Kornhaber, & Hungerford, 2023). I know in Ontario right now the burnout levels in health care professionals and the reduction of accessible and affordable healthcare has become a constant and inescapable barrier for my autistic clients. Sometimes people decide to give up on it entirely, even when they know they feel happier and healthier with medication or regular care. Other times people procrastinate appointments as long as they can reasonably get away with. The social difficulties autistics need to navigate are exacerbated by doctors or nurses that have a reduced capacity for empathy, focus too much on medication or pathologization, are misinformed about recent neuro-diversity research, or have a tendency to rush through an appointment. Health care trauma is only becoming more common in a system where most people already feel abandoned, criticized, ignored, deprioritized, or pressured to comply against their own instincts, wants or needs.

Treatment

Some evidence demonstrates that different brain types might exacerbate PTSD symptoms. The examples below were pulled from articles by Attwood & Garnett, (2024), Neff (Neurodivergent insights), Oswald (2020), Rumball (2022).

• Tendencies towards rumination

• Inflexible thinking, black and white thinking, or catastrophizing thinking (trauma recovery requires adapting new perspectives)

• Focusing on the details of an experience, rather then the big picture, might get in the way of healthy narrative integration 

• Difficulty communicating or describing experiences, or other language issues

• Issues emotionally regulating, hypervigilance

• Concentration issues

• Issues finding social supports, experiences of social betrayal or abandonment, misinterpreting social interactions

• Poor sleep

• Exacerbating mental health issues (like anxiety or sensory issues)

• Intensely coded sensory memories

• The stress of masking

• Failing to receive an Autism diagnosis or identification

• Compounding marginalized identities

• Confusion between meltdowns and trauma responses 

• Alexithymia (difficult identifying or describing emotions)

• Lagging information processing, or processing barriers (especially for emotional information)

“An accurate and timely diagnosis of autism is trauma prevention.” -Neff, Neurodivergent insights.

People on the spectrum may experience trauma differently. They may have a hard time separating the parts of their identity/experience which are explained by their neuro-diversity from that which is explained by their traumas. Some may develop an intense interest towards understanding their traumatic experiences (Rumball, 2022) (this is not necessarily a bad thing). Many have a hard time finding professional care that can adapt to the autistic experience of trauma and general autistic needs and limitations. Treating autistic trauma often requires creativity when forming interventions that suit client needs and strengths; these may feel counterproductive to more traditional approaches. Examples include:

• Leaning into client’s special interests

• Focusing on psychoeducation

• Creating a sensory safe environment

• Incorporating emotional//body sensory awareness

• Grounding techniques and movement

• Being conscious of the language used in session (perhaps actively challenging the language used outside of session as well - this is a strategy I use with many of my clients)

• Encouraging unmasking (to an extent that makes sense for the client) 

(Cleary, West, Kornhaber, & Hungerford, 2023; Neff, Neurodivergent insights; Rumball, 2022).

Sources

Attwood & Garnett, 2024. Autism and Trauma. Attwood & Garnett Events. https://www.attwoodandgarnettevents.com/blogs/news/autism-and-trauma

Buuren, Hoekert, Sizoo, 2021. Autism, Adverse Events, and Trauma. In: Autism Spectrum Disorders [Internet]. Chapter 3. https://www.ncbi.nlm.nih.gov/books/NBK573608/

Cleary, West, Kornhaber, & Hungerford, 2023. Autism, Discrimination and Masking: Disrupting a Recipe for Trauma. Taylor and Francis: Online. https://www.tandfonline.com/doi/full/10.1080/01612840.2023.2239916#abstract

EWOR, 2023. Unmasking Autistic Experiences: Understanding Masking, Fortressing, and the Longing for Authenticity. https://ausometraining.com/understanding-masking-as-trauma/

Neff. How are Autism and Trauma Related? Neurodivergent insights: https://neurodivergentinsights.com/autismandtrauma/

Oswald, 2020. Autism and Trauma: Masking. Open Doors Therapy: https://opendoorstherapy.com/autism-and-trauma-masking/

Rumball., Freya, 2022. Post-traumatic stress disorder in autistic people. National Autistic Society: https://www.autism.org.uk/advice-and-guidance/professional-practice/ptsd-autism