Navigating Autism and Anxiety: Understanding the Unique Challenges Faced by Autistic Adults

It’s normal to feel anxious sometimes—but what if anxiety gets in the way of your day-to-day life? For nearly half of autistic people, severe anxiety disorders are a reality. Anxiety disorders come with psychological and physical symptoms that can be distressing and even make it difficult to function every day. For an autistic person, they can make common stressors like sensory and social stress even harder to manage. Understanding the relationship between autism and anxiety can help an autistic adult better understand themself and get support that makes a difference.

Autism spectrum disorder (ASD) and anxiety commonly co-occur. Anxiety is one of the most common diagnoses among autistic individuals, with 40 to 50% of autistic individuals experiencing an anxiety disorder at some point in their lives. Social anxiety disorder is particularly common, occurring in as many as 50% of autistic people. They’re also more likely to confront chronic stress due to:

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• Stigma
• Social trauma
• Sensory overload
• Feeling misunderstood
• Distress at sudden changes to routines
• Unmet support needs

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Anxiety disorders can present ongoing strain to a person's nervous system and lower their distress threshold. For an autistic person, this may look like:

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• Increased sensory sensitivity
• Increased difficulty in communication and self-expression
• Increased distress with changes to routines or set plans
• Overthinking and getting stuck in thought loops (perseveration)
• Intense need to seek social reassurance
• Increased meltdowns
• Increased need for stimming and self-soothing

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In sum, anxiety disorders can make common challenges for autistic individuals, like sensory overload, coping with sudden change, or communicating their emotions, even more difficult. The cumulative effect of chronic anxiety and these heightened stressors can contribute to autistic burnout as well.

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Anxiety disorders are highly treatable, and a variety of approaches can help autistic individuals manage and reduce anxiety. These include clinical interventions, such as therapy and medication, and self-care skills like mindfulness.

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Psychotherapy

Psychotherapy, sometimes called “talk therapy,” is the most common intervention for anxiety disorders. Clinical approaches like cognitive behavioral therapy (CBT) can improve outcomes for autistic individuals with anxiety disorders. CBT works by helping people identify unhelpful patterns of thinking and behavior, such as believing something bad is bound to happen or that something is intrinsically wrong with them. CBT helps people replace these beliefs with more supportive alternatives—in these examples, perhaps, “Bad things don’t always happen, and I have the tools to manage when they do,” or, “Stigma and misunderstanding are other people’s problems—there’s nothing wrong with me.”

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Dialectical behavior therapy (DBT) is another type of psychotherapy commonly used to treat anxiety disorders. DBT works similarly to CBT, but its key difference is that DBT also focuses on emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness.  A therapist can help you decide the best treatment approach for you, whether that’s CBT, DBT, or another modality.

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Medication

While not everyone needs or wants to take medication to manage their anxiety, the right prescription can make a huge difference for some autistic people. Antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat anxiety in both autistic and allistic individuals. They are taken daily and build up in a person’s system over time, taking at least a few weeks to notice significant change.

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Psychiatrists may also prescribe medications to take as needed to help with acute anxiety symptoms or panic attacks. Two common types of anxiety medications are:

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• Benzodiazepines: These sedative medications quickly reduce mental and physical symptoms of anxiety. However, they can become habit-forming, and for this reason, they are not a long-term solution to anxiety. Benzodiazepines are often prescribed only for short periods when a person is anticipating or experiencing significant distress, while also taking an SSRI or SNRI.
• Beta blockers: These are medications that alter the effects of adrenaline in the body and de-escalate physical anxiety symptoms like rapid heart rate, shaking and sweating. They are often used to help manage stressful events like job interviews or other overstimulating environments.

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Each individual may respond differently to medications. A psychiatrist can discuss your medical history with you and collaborate on the right plan if you are considering medication. They can also help you explore other options if a medication isn’t working well for you.

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Mindfulness

Mindfulness approaches like meditation, mindful breathing techniques and body scanning can effectively reduce anxiety and stress, especially when practiced regularly. Mindfulness can be a great help, although some autistic people find typical mindfulness practices like meditation difficult or even stressful. For these individuals, less structured approaches may be more effective. AuDHD psychologist Dr. Elliot Gavin Keenan recommends a few neurodivergent-friendly mindfulness practices:

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• Mindfully drinking a hot beverage: Tune in and notice each sip’s smell, flavor and temperature. Notice how your lips, mouth and throat feel while you drink, and how the mug feels in your hand
• Stimming mindfully: Pay attention to how stims feel in your body, and what effect they have on your mood, focus and physical tension in your body.
• Listening to music mindfully: Choose a song you’d like to listen to, whether it’s new or one you love, and listen to it a few times, dialing in on different individual instruments, lyrics or vocals each time. Follow this up by listening to the song one last time and trying to take it in as a whole.

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These approaches can reduce anxiety by grounding you in your senses, making it easier over time to connect with the sensations you experience in your body.

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Addressing chronic stressors

By definition, anxiety disorders don’t respond proportionately to environmental stressors. However, taking stock of what in your life is causing you stress and anxiety can be worthwhile. Can any of these things be eliminated or adapted to cause less stress?

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Both big and small changes can make a difference. If you’re in a job that causes chronic stress, taking steps toward a big change, such as switching jobs, may be helpful. It can also be valuable to address more minute sources of anxiety. For example, I identified that my cramped bedroom closet was causing me low-grade stress daily. Creating a new organization system that shifted some of my stuff to under-the-bed drawers and made things I need frequently easier to reach reduced a small amount of my daily “background” anxiety and gave me a little relief.

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Sometimes, the people in your life have the power to limit external stressors. Asking them to meet needs like clear and direct communication, advance notice about changes to plans and warnings when social plans will include new people can be helpful, too. Accommodations at work or in school are also an essential tool for many autistic individuals and can help reduce anxiety by addressing unmet support needs. 

Anxious feelings are a normal part of life—many of us feel worry or tension thinking about high-pressure events, difficult choices or stressful topics like finances and health. For some people, however, anxiety can be incredibly difficult to manage. It may feel disproportionate, popping up in the absence of significant stressors and feeling very intense, sometimes even leading to panic attacks.

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Anxiety disorders are relatively common mental health diagnoses. The American Psychiatric Association (APA) estimates that nearly 30% of U.S. adults will experience an anxiety disorder at some point in their lives. Often, the term “anxiety” is used as a shorthand for generalized anxiety disorder, a mental health condition where a person experiences intense anxiety that is not limited to a specific circumstance or trigger. However, multiple diagnoses fall under the umbrella of anxiety disorders, including:

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• Social anxiety disorder
• Panic disorder
• Specific phobia
• Selective mutism
• Agoraphobia
• Separation anxiety disorder
• Substance or medication-induced anxiety disorder

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Individuals with these diagnoses may experience intense fear or worry in different contexts or somewhat different ways, but these conditions share the core symptoms of anxiety disorders.

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Anxiety disorder symptoms

Anxiety disorders are associated with many symptoms that range from psychological to physical. While different anxiety disorders manifest in specific ways, they each share a main symptom: anxiety that is difficult to control, getting in the way of quality of life and functioning. 

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Some of the most common anxiety disorders include generalized anxiety disorder (GAD), social anxiety disorder and panic disorder. 

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Generalized anxiety disorder symptoms

• Worrying intensely about a wide variety of events
• Difficulty controlling worrying or focusing on other things
• Inability to relax
• Nausea and other gastrointestinal discomfort
• Muscle tension
• Trouble concentrating or making decisions 

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Social anxiety disorder symptoms

• Feeling fearful of social situations
• Inability to control worrying about previous social interactions or upcoming social events
• Fear of being judged or embarrassed in social settings 
• Physical symptoms like blushing, shaking or sweating
• Fear of people noticing you’re anxious in these scenarios
• Avoiding social engagements due to anxiety

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Panic disorder symptoms

• Recurring panic attacks that come out of nowhere
• Sudden feelings of extreme fear or impending doom, often accompanied by physical symptoms of anxiety, such as:

• Elevated heart rate
• Chest pain
• Trouble breathing 
• Sweating
• Shaking or trembling
• Chest pain
• Numbness or tingling

• Fear of dying or losing control 
• Extreme fear of having another panic attack

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While many people may feel some of these symptoms during a stressful event, individuals with anxiety disorders experience these symptoms more regularly, in a way that can make it difficult for them to go about their day-to-day lives.

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Causes

Several factors can contribute to the development of an anxiety disorder. Some people may be genetically predisposed to anxiety disorders, which researchers believe have heritabilities of 30-40%. Experiences a person may have during their life, like traumatic events or chronic stress, can also contribute to anxiety disorders. 

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Anxiety also commonly co-occurs with other mental health conditions like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and depression, all of which can make an individual more likely to experience anxiety symptoms.

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Age of onset

Anxiety disorders can emerge at any point during a person’s life, though on average, anxiety first appears during a person’s young adulthood. One meta-analysis estimates the average age of onset at around 21 years. Anyone can have anxiety, but it is less commonly reported by cisgender men compared to other genders. Cisgender men may still experience anxiety in the same way, but are less likely to reach out for help. 

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For some people, anxiety disorders can resolve fairly quickly with treatment and a reduction in external stressors. For others, anxiety disorders can endure for years or a lifetime. Numerous supports and treatments are available that can bring a person’s anxiety into remission or reduce the severity of symptoms and make chronic anxiety manageable.

Prosper Health’s therapists are specialized and highly experienced in supporting autistic adults with common challenges, including anxiety disorders. Your therapist can work with you to understand your unique needs and circumstances and make a plan to address them. Therapy with Prosper Health is covered by insurance and 100% remote, and clients report a material difference in their lives in as few as four sessions. 

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With Prosper’s support, relief from anxiety is possible. Fill out the form below or give us a call to start today.