Mental health experiences of autistic people

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Common challenges associated with mental health issues 

Autistic people may face unique and complex mental health challenges influenced by a range of contributing factors. These can affect how an autistic person presents in front of diagnosis and treatment providers. As such they can influence diagnosis and in term, treatment.

These deserve important consideration. If you’re an autistic person reading this and recognize yourself in them, you’re not alone in your experience. Bring them up to your healthcare providers, find support and be kind to yourself. If you’re a caregiver, provider or educator, awareness of these challenges can help you better understand and communicate with autistic people. Be kind to them.

Autistic burnout  

Autistic burnout is the experience of physical, mental and emotional exhaustion associated with navigating a world that doesn’t support autistic individuals. Times of great change or transition can trigger burnout, as can unrealistic expectations from oneself or others. It is more than just fatigue. Case in point: While a nap may provide relief for autistic burnout, it is not a long-term solution.

Autistic burnout may be associated with prolonged masking, especially in autistic women (See Autistic masking, or camouflaging).  If one is experiencing autistic burnout, it is important to seek the help of a mental healthcare professional as ongoing burnout may lead to depression and/or suicidal ideation. Stress management, professional support and a self-care regime can all help with autistic burnout. 

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Autistic masking, or camouflaging  

Masking, also known as camouflaging, is the act of suppressing one’s autistic traits as an attempt to ‘fit in’. The effort to mask autistic traits and behaviors in social settings can be emotionally exhausting and may result in or exacerbate mental health challenges such as panic attacks and depression. 

Embracing one’s autism and giving oneself time to unmask, or present as their full self in social situations, be it work, school or get togethers, can lead to better self-acceptance, increase self-confidence, and reduce anxiety. Finding your community, whether it is based on an autism connection, a special interest, cultural, religion can greatly help too. Being authentically you leads to finding your place and/or people, or even one person, which is known to contribute to an increase in happiness, improved health and a better quality of life. 

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Emotional regulation 

Emotional regulation is the ability to recognize, manage, and respond to one’s emotions effectively. For many autistic people, emotional regulation can be challenging due to differences in sensory processing, communication, and social understanding. Constantly feeling frustrated is common. A lack of emotional regulation may lead to outbursts, increases in stress and anxiety, and eventually burnout (See Autistic burnout) or shutdown.

Mindfulness-based interventions, or relaxation techniques, like meditation and progressive muscle relaxation, help promote self-awareness, acceptance of emotions, and calm the body. The phrase “exercise is medicine” proves true, too. Whether it is going for a fifteen-minute walk, bouncing on a trampoline, dancing, or participating in a full-on contact sport, exercise can help with moods and emotional regulation. Working out frustration is literally possible.

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Bullying  

Evidence shows over 60% of children and young adults with autism experience bullying. Among them, high school students are most likely to be bullied. School-aged children on the autism spectrum who do not need special health care and those from disadvantaged neighborhoods were identified in the study as more likely to be bullied than other autistic children. 

However, bullying does not end at school. Autistic people of all ages can face bullying in the workplace, online, and in social situations. Bullying can look like verbal abuse, exclusion, or harassment, and can create feelings of anxiety, depression, and low self-esteem. Cyberbullying can actually be considered a crime. It is important to document the behavior and report it to online platforms. It may even need to be reported to the authorities. The local police would be a good place to start.

Bullying can take an emotional toll on anyone who experiences it but can be especially bad for autistic people. Some may not realize that they are being bullied or may be unable to communicate what is happening at school or in the community. 

The emotional impact of bullying can increase social isolation and can make one more vulnerable to emotional distress. Victims of bullying are at increased risk of developing mental health problems including depression and anxiety, as well as physical health issues such as headaches, stomachaches, and sleep problems. Some shut down. Others have outbursts of aggression without a clear trigger. Research has found that adolescents on the autism spectrum who were bulled were twice as likely as peers to develop suicidal tendencies.  

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the 988 Suicide & Crisis Lifeline network is available 24/7 across the United States. It is free and confidential.  

Call or text 988 on your phone.  

Línea de Prevención del Suicidio y Crisis: 1-888-628-9454. 

988 also has a few important resources for neurodivergent adults who are in crisis, have suicidal ideation, or are at risk of suicide:   

Prevention is key. The first step is to learn what bullying is and why it is not okay. It starts early. Teach your child or your student to know the difference between appropriate and inappropriate treatment from classmates. The basic rule: If the behavior hurts or harms your or your child, either emotionally or physically, it is bullying. 

Individual therapy with a licensed professional counselor or social worker, or group talk therapy, like found in support groups, can help someone recover from and manage the long-term effects of bullying. 

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Trauma 

Trauma is an emotional response to a terrible event like an accident, crime, natural disaster, physical or emotional abuse, neglect, experiencing or witnessing violence, death of a loved one, war, and more. Research shows autistic individuals may be at higher risk of adverse events and experiencing trauma. Specifically challenges in social interaction and understanding make them more vulnerable to bullying, abuse, and other forms of victimization, and repeatedly experiencing such events.

Whether caused by a single episode or an ongoing experience, trauma can lead to mental and physical stress. Most often trauma has been found to be associated with anxiety and depression in autistic people. But it can also lead to outbursts, trouble concentrating, disrupted sleep, eating problems including loss of appetite, and low self-esteem. For autistic people who are unable to communicate their trauma, often these symptoms are the first sign they have experienced a traumatic event.

People may be diagnosed with post-traumatic stress disorder (PTSD) if their symptoms last for an extended period after a traumatic event and begin to interfere with aspects of daily life, such as relationships or work. Studies suggest that autistic people have more re-experiencing symptoms of PTSD than the general population. 

Trauma-focused cognitive behavioral therapy (CBT) and other treatments tailored to an autistic person’s communication styles, sensory sensitivities, and other autistic traits, can be effective.  

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Sensory issues 

Sensory issues are part of the broader ‘restrictive and repetitive behavior’ features of an autism diagnosis (See Signs and symptoms of autism).  

These issues can manifest hypersensitivity (over-responsiveness) or hyposensitivity (under-responsiveness) to auditory, tactile and visual stimuli.  

For example, bright lights, fluorescent lights, loud noises, constant tapping or dripping sounds, overwhelming scents, unpleasant textures and tastes can become overwhelming. Sensory overload can result in sensory avoidance, like running away, covering ears or refusing certain clothes or foods. Some can even engage in sensory seeking behavior to get more input from the stimuli. For example, people with autism may stimulate their senses by making loud noises, touching people or objects, or rocking back and forth. Even the anticipation of overwhelming sensory input can result in anxiety and stress and can evolve into panic attacks or trauma.  

Sensory-friendly spaces that are quiet and low-lit, sensory tools like fidget spinners and weighted blankets, and taking sensory breaks are all low-cost effective strategies to help manage overload. In some cases occupational therapy (OT) can help people process sensory input. Cognitive behavioral therapy (CBT) can help manage anxiety related to sensory issues.  

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