Do Autistic People Develop PTSD More Often? Why?

Autism is, at its heart, a different kind of brain wiring — there for life. Not only do autistic people experience and process the world and everything in it in unique ways, whether we're talking about sensory stimuli or social interaction, the part of the world that's made up by neurotypical people also process and experience them differently. 

Many autistic people immediately stand out, causing neurotypicals to immediately mark them as "odd", often frightening them off. Social isolation is incredibly common among autistic people, research shows, and folks on the spectrum are both less likely to be well-liked and more likely to fall victim to bullying and ridicule, often from childhood all the way into adulthood. They might not have that robust, supportive, social network that helps form a buffer to better cope with all the bad stuff in life. Even if they do, they may have achieved it through "masking", an exhausting process of trying to act as neurotypical as possible. As a result, people can feel as though it's not them their social support network really values, but their mask. 

And contrary to popular belief, you bet that that bothers many people on the spectrum, who research shows see themselves as alone, different, out of place, and even "alien" — a painful experience. 

So, with that as the backdrop, do autistic people develop PTSD more often than people who aren't autistic? 

Do autistic people have a higher risk of being exposed to trauma?

It seems so. 

Research shows that trauma is a pretty common part of life — around 68 percent of teens will have been exposed to a potentially traumatic event by the time they're 16. Only a modest one percent of them will go on to be diagnosed with post-traumatic stress disorder, but get this: the risk of developing PTSD rises with each exposure to trauma. A full 50 percent of young people who lived through more than one trauma were found to end up with PTSD. 

Research shows that autistic people:

• Have a higher risk of being bullied by their typically-developing peers. 
• Are more likely to be physically abused, including by caregivers. 
• Fall victim to sexual abuse more often. 

All these things could fall under "trauma", as defined by the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) — "exposure to actual or threatened death, serious injury, or sexual violence". Research also indicates, however, that autistic people may experience other things as traumatic, including "social insults and degradation, sensory overstimulation, abrupt changes in known routines". Not all these things would necessarily be considered traumatic under the DSM-5, but they can result in the same symptoms PTSD causes. For all intents and purposes, they can, then, lead to PTSD. 

Why might autistic people develop PTSD more often than neurotypicals?

Autistic people seem to develop PTSD more often that neurotypical folks, whether or not it's formally diagnosed, in part because they so often lack the social support buffer that helps protect against post-traumatic stress disorder after a traumatic experience. Their neurology may also make it harder for autistic people to "bounce back" from trauma, and make them more vulnerable to rumination and anxiety. 

Might the symptoms of PTSD be missed in autistic people?

Some autistic people are, research shows, reluctant to seek help when they're victimized or after they've experienced a trauma. Others are non-verbal or minimally-verbal, and less able to seek help. In children, caregivers may miss signs of abuse and mistake communication attemps for "challenging behavior". This may cause the trauma to go on for longer than it otherwise would have. Trouble with verbal communication can also, on the other hand, stand in the way of treatment for PTSD, since verbal processing plays an important role. 

Autistic people who also have alexithymia, a reduced ability to express emotions as well as recognize them in others and themselves which is pretty common on the spectrum, may also have a harder time recognizing the symptoms of PTSD in themselves. This may stand in the way of them seeking treatment. 

But watch it — autism and PTSD may even be confused in children!

One psychologist wrote of a case in which a boy with post-traumatic stress disorder from parental abuse was thought to be autistic — though he wasn't — because his PTSD caused him to avoid social interaction and engage in repetitive play. I personally know of a case where the opposite happened, and a psychologist suspected that a girl later diagnosed as autistic had been abused in some way and was showing signs of PTSD. 

The two may have some overlapping outward signs, like social withdrawal and social communication difficulties, a preference for routines that feel safer, angry outbursts (that may be autistic meltdowns or a symptom of PTSD), and repetitive play (often an inherent preference among autistic children, but potentially a way to process trauma among those with PTSD). 

A child can, of course, both be autistic and have PTSD — but differentiating between the two is essential.