Autism and Trauma: How They Intersect and How to Manage Trauma-Related Stress

For many people, fully understanding an autism diagnosis means unpacking their relationship to trauma. This was true for me after I was diagnosed with both autism spectrum disorder (ASD) and complex post-traumatic stress disorder (CPTSD) in my late twenties. 

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Many autistic people experience trauma, which can affect them in distinct ways compared to neurotypical peers. For these individuals, digging into the relationship between autism and trauma can make a profound difference in regulating their nervous systems and improving their mental health. For me, my autism and CPTSD diagnoses have been equally revelatory and often intertwined. Exploring the relationship between the two has helped me better understand myself and tangibly improve my quality of life. 

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Read on to learn about the link between autism and trauma-related disorders, as well as how to cope.

Autistic people are more likely to experience trauma than their allistic (non-autistic) peers. Experiences that neurotypical people may not feel affected by—or might not even notice—can be incredibly taxing for an autistic person. Autistic individuals have less flexible nervous systems than those of allistic people, and sensory inputs like loud noises, bright lights and rapid movements can be incredibly distressing, leading to sensory overload. Additionally, autistic people often experience changes to routines or plans, especially when unannounced, as highly distressing. 

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People on the spectrum often endure a number of traumatic external stressors, including social trauma. We autistic individuals often have different communication styles from allistic people, who may misunderstand us, which leaves us feeling othered and unseen. At some point in their lives, many autistic people also experience bullying and face stigma. Autistic styles of thinking and working are also largely not accommodated, leaving many autistic people to struggle at work or school and worry that they’re seen as less valuable than their neurotypical peers.

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Medical trauma is also very common among autistic individuals. Doctor visits are only one example of an activity that may feel routine for neurotypical people, but can be very taxing or even traumatizing for autistic people. Additionally, the process of getting diagnosed with autism in and of itself can be traumatic if conducted from a non-affirming perspective. While early diagnosis can make a huge difference in connecting an autistic child to necessary support and accommodations, it can also lead to bullying and, in some cases, a diminishing of their agency.

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The hurdles of seeking diagnosis later in life can also be traumatic. Pursuing a diagnosis is an often arduous process, often involving extensive research and encounters with clinicians who may hold regressive, outdated beliefs about autism in adults. One small study from the UK found participants waited an average of 1.7 years after first contacting a healthcare provider to receive a diagnosis. Entering and navigating adulthood without a diagnosis is its own challenge, leaving many people with battered self-esteem as they hold themselves to neurotypical expectations, wondering why things that seem easy for others can feel so incredibly hard for them.

Trauma- and stressor-related disorders are a category of mental health conditions that can emerge after a person experiences trauma or significant stress. They include the following diagnoses:

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• Post-traumatic stress disorder
• Complex post-traumatic stress disorder
• Adjustment disorder
• Acute stress disorder
• Prolonged grief disorder

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In general, acute stress disorder and adjustment disorder are associated with a shorter duration of symptoms. PTSD, CPTSD and prolonged grief disorder can be chronic conditions, although with treatment, individuals with these diagnoses can improve and heal. 

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Not everyone who experiences trauma will develop a mental health condition. However, because autistic people are more likely to experience trauma, they are more likely to develop a trauma- or stressor-related mental health disorder than their allistic peers.

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What is PTSD?

PTSD is a mental illness that can emerge after a person experiences an acute traumatic event like an accident, violent incident or death of a loved one. Symptoms of PTSD fall into a few categories such as:

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• Intrusions: Unwanted and uncontrollable thoughts of or flashbacks to the trauma, as well as physiological stress responses to re-experiencing the trauma or encountering reminders of it
• Avoidance: Avoiding any potential reminders of the traumatic event, including memories, people or places.
• Changes to mood and cognition: Low mood, losing interest in activities previously enjoyed and changes to executive function, like poorer memory and difficulty focusing.
• Reactivity: Becoming irritable or having a shorter fuse. Startling easily, becoming very watchful or paranoid about danger, or having difficulty falling or staying asleep.

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Some individuals with PTSD may also experience dissociative symptoms. At times, they may feel like they are not in their own body (known as depersonalization) or as if they are not living in the real world (derealization).

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Because PTSD is associated with acute trauma, it can show up in people of all ages after they have experienced a traumatic event. The lifetime prevalence of PTSD in U.S. adults is around 6%.

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What is complex PTSD?

Complex PTSD is a newer diagnosis that is gaining increasing recognition, although it isn’t included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). As of 2018, however, it is recognized in the World Health Organization’s International Classification of Diseases (ICD-11).

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CPTSD presents in individuals who have histories of chronic trauma, which is not only ongoing but often tied to a context the person cannot escape. Some examples include childhood neglect, neglectful or abusive relationships with partners or friends and even bullying. It is commonly associated with childhood trauma, but can come on after chronic trauma exposure at any point during a person’s life.

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CPTSD shares the core symptoms of PTSD, as well as a few additional symptoms:

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• Emotional dysregulation: Instability of mood or intense moments of anger and irritability.
• Negative sense of self: Negative feelings and beliefs regarding oneself, often including shame and guilt.
• Interpersonal challenges: Difficulty maintaining meaningful interpersonal relationships or trusting others.

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Because CPTSD is a newer diagnosis, it’s less researched than PTSD. We don’t know for certain how common CPTSD actually is, but researchers estimate that it affects between 1 and 8% of the population.

If autistic individuals are more likely to experience trauma than allistic peers, then it follows that they are also more likely to develop PTSD or CPTSD. The data supports this—studies show up to to 45% of autistic adults may have PTSD, compared to only about 4% to 12% of allistic adults. Research on CPTSD in autistic people is still very limited and has yet to estimate its prevalence in autistic populations. Complex trauma histories are widespread among autistic individuals, and many people believe CPTSD is somewhat prevalent among autistics.

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Some qualities that are common among autistic people can look similar to PTSD and CPTSD symptoms, and autistic individuals with either of these diagnoses may experience an intensification of these traits. These qualities include:

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• Emotional dysregulation
• Reactivity to stimuli, including sensory inputs
• Irritability
• Low mood
• Negative self-concept
• Nervous system dysregulation
• Challenges with executive function (such as difficulty focusing or remembering things)
• Interpersonal differences (like trouble forming relationships or trusting others)

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The amplification of these traits can lead to chronic stress, dysregulation and anxiety for autistic individuals. This ongoing strain can contribute to autistic burnout, a state of severe fatigue and decreased functioning that autistic people sometimes enter due to chronic stressors. It can also increase the risk and frequency of meltdowns—the involuntary, intense outpouring of emotion that autistic individuals can experience when pushed past their emotional, mental and sensory limits.

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Building resilience is essential to healing from trauma. Autistic individuals who have experienced trauma show great strength and resiliency in their survival; building resilience is less about starting from nothing and more of a long-term project of expanding one’s strength. Cultivating resilience can help autistic individuals cope with past trauma, develop their sense of stability and self-efficacy and confront triggers and new challenges with more confidence.

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Psychotherapy can be an effective tool towards building resilience, serving as a kind of “home base” for the work. A therapist can help you develop coping skills and craft a plan to build resilience, as well as monitor your progress and adjust your plan when needed. Some other approaches to building resiliency include:

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• Build support networks: Build strong support networks with people who make you feel safe and seen. This can develop a deeper sense of stability, and can allow you to talk about your experiences with people you trust more easily.
• Establish routines: Explore day-to-day routines that feel good for you in order to create more predictability in your daily life.
• Practice being gentle with yourself: Show yourself compassion for any unhelpful coping strategies you may have learned through trauma as you work to unlearn them. Work towards recognizing the strengths that your neurodiversity presents.
• Tend to your needs: Take care of yourself as best you can—sleep enough, drink water and eat, but also tend to your sensory and emotional needs. Stim, use sensory tools, cry when you need to and dedicate time to your special interests.
• Challenge negative beliefs: Identify unhelpful beliefs you may have about yourself or your trauma, and work to replace them with more affirming or even just more neutral ones. Cognitive behavioral therapy (CBT) is discussed in the next section and can support this work.
• Explore new ways of processing trauma under the guidance of a therapist: Many different ways of processing trauma can help, like talking about it with safe people, journaling, making art, listening to music and even mindfulness practices like body scanning. Try a new approach, or a few, and see if they help you.

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Finding support in peers who share similar experiences can be helpful as well. Many people find peer support groups to be validating and a source of strength. While there may not be many groups specifically for autistic survivors of trauma, these individuals may find other support groups for trauma meaningful. However, they may also find them alienating, not finding others in the group who share significant parts of their lived experience with trauma. Online communities can help bridge this gap—many communities for autistic individuals or for survivors of trauma on platforms like Reddit and Facebook can make space for people with both identities to connect with each other about their experiences.

Several approaches, including therapy, medication and mindfulness, can help autistic adults manage and cope with traumatic experiences and trauma-related disorders.

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Psychotherapy

Psychotherapy, also called talk therapy, is the most recommended treatment for trauma- and stressor-related disorders. Cognitive behavioral therapy (CBT) is considered the gold standard for psychotherapy and is effective at treating conditions like PTSD and CPTSD. CBT works by helping a person identify patterns of thinking and beliefs that are harmful or unhelpful and replace them over time with more positive alternatives. For example, a person with a trauma history who believes they are always in danger or that they are unlovable can learn to identify these unhelpful thought patterns and challenge them.

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Dialectical behavior therapy (DBT) is another therapeutic approach that can help individuals with trauma histories, and it’s particularly effective for addressing complex PTSD. DBT is a type of cognitive behavioral therapy that incorporates CBT’s key principles while also focusing on emotional regulation, mindfulness and distress tolerance skills. This therapy also emphasizes interpersonal effectiveness, helping individuals build relationships that meet their needs and support appropriate boundaries.

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Another therapeutic approach called eye movement desensitization and reprocessing (EMDR) therapy was specifically designed to treat PTSD. EMDR was first developed before complex PTSD had been proposed, but it can also be an effective treatment for CPTSD as well as PTSD. It uses eye movements and bilateral stimulation along with exposure in an effort to change how memories of a traumatic experience are stored in the brain. While there is research to support the effectiveness of EMDR, it is not clear from the data that EMDR provides any benefit beyond the element of exposure that is already a part of cognitive-behavioral therapy.

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Medication

Some individuals who experience anxiety or depressive symptoms due to their trauma histories may also benefit from medication that treats those specific symptoms. A psychiatrist can work with you to understand your mental health history, devise a treatment plan and monitor how your medications are working.

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Antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) can help reduce trauma-related symptoms of anxiety and depression. These medications are taken daily and slowly build up in a person’s system, often taking effect after four to six weeks.

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Anxiety medications can also help with acute symptoms of anxiety, including panic attacks. These include medications like benzodiazepines, which are taken during or right before triggering or very stressful events. Benzodiazepines are highly effective at treating anxiety but can become habit-forming when taken frequently, and are often prescribed in smaller amounts. Sometimes, clinicians prescribe other anti-anxiety medications, like beta blockers, which bring down the intensity of the physiological symptoms of anxiety.

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Mindfulness

Research shows that mindfulness can improve outcomes for people with trauma- and stressor-related disorders. Practices like meditation, mindful breathing and yoga can all help people with trauma histories regulate their nervous systems and manage symptoms associated with trauma more effectively.

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Some mindfulness approaches, like traditional guided meditations, can be difficult for autistic people, who may find it challenging or stressful. It’s important to be flexible and find approaches that work well for you. Mindfulness can be incorporated into many different activities and practices, even washing dishes, spending time with a pet or drinking a hot beverage.

Family and social dynamics are a critical part of recovering from trauma—they can offer tremendous support, or hold back a person’s healing. Many people with trauma experience issues with trust and feeling safe, and they may need to rework patterns of how they relate to others. Family and social support can provide a sense of stability, support and safety while a person does this work.

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For many people, their trauma originates within family systems. In these cases, it is up to each individual to decide what kind of relationship they may want with their family moving forward, and many factors can influence this decision. Sometimes, individuals are able to restore or transform how they relate with their family, and this work is a part of their healing. Others may not feel this is an option, or may believe the work of restoration is too uncertain or more than they can handle; these individuals can heal from their trauma in different ways. For any individuals with family-related trauma, social support is especially important to provide the sense of stability and support that they did not receive from their families.

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Family and social support systems can support autistic survivors of trauma in many ways, which will vary based on the individual and their unique circumstances and needs. Some general approaches that help include:

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• Understanding and respecting boundaries: Make an effort to understand the individual’s needs and boundaries, honor them and support the individual in upholding these boundaries themself.
• Learn about autism and trauma: Learning about the relationship between autism and trauma can give you insight into what the individual has gone through and can help you better support them.
• Listen and be affirming: Listen to understand, rather than assuming you know what the individual is experiencing. Affirm the validity of what they share, and let them know you appreciate their willingness to let you in.
• Check in: Autistic individuals who have experienced trauma may not always want to open up; other times, they may want to talk but may not want to or know how to start the conversation. Checking in periodically in a low-pressure way shows them you care and gives them the opportunity to talk if they want to.
• Be consistent: Stability and consistency go a long way towards building resilience and recovering from trauma. Continue to reach out to your loved one, even if they sometimes withdraw or want to be alone. Knowing you will continue to show up can make a huge difference.

Unpacking trauma is both taxing and extremely rewarding. Working with a therapist who makes you feel safe and seen is essential for healing. 

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Prosper Health’s neurodiversity-affirming therapists specialize in autism in adults. Plus, they’re highly experienced in treating challenges common among autistic adults, including trauma and trauma-related disorders. Sessions are 100% remote and covered by most insurance carriers.

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My Prosper Health therapist, who specializes in trauma, was the first therapist I’ve seen across ten years to diagnose me with CPTSD. Our work together has helped me meaningfully address my trauma history and develop new coping skills while processing a new autism diagnosis.

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If you’re ready to get started, click the link below and get connected to a Prosper Health clinician within days.