Autism and complex trauma (C-PTSD): an unbreakable connection

When we talk about autism and complex trauma (C-PTSD), we open the door to an exceptionally complex and sensitive topic. Both of these dimensions can significantly shape a person’s experiences and daily life, and their overlap often brings profound challenges, as well as opportunities for understanding, support, and personal growth.

Autistic individuals often encounter heightened sensory experiences, different patterns of social interaction, and specificities in information processing. However, in a world designed according to neurotypical standards, they frequently face misunderstanding, exclusion, and the dismissal of their unique needs.

Research shows that autistic individuals are more likely to experience traumatic life events, particularly exposure to interpersonal trauma due to a lack of social support, which increases the risk of PTSD (Brewin et al., 2000).

Given that the prevalence of complex trauma (C-PTSD) alongside autism is between 32-60%, and that as many as 70% of autistic adults experience some form of sexual abuse, there is a high likelihood that an autism diagnosis may be overlooked in the background.

You may have experienced a psychologist or psychiatrist refusing to delve deeper into a suspected autism diagnosis, attributing all symptoms solely to “trauma.”

Autism, as a form of neurodivergence, offers a unique perspective on the world. These everyday experiences can become chronically stressful and lay the groundwork for what we call complex trauma.

What is complex trauma (C-PTSD)?

Post-traumatic stress disorder (PTSD) is a mental health condition that can occur after experiencing a traumatic life event. PTSD symptoms include re-experiencing the traumatic event, avoiding triggers associated with the event, negative changes in mood and thinking, and heightened sensitivity and reactivity (DSM-5, APA, 2013).

Complex trauma arises when an individual faces repeated, prolonged, and often interpersonal stressors without adequate support. These can include situations such as neglect, abuse, or systemic dismissal of desires, needs, and feelings.

For autistic individuals, trauma often stems from everyday situations such as forced adaptation to neurotypical norms (masking), failure to recognize and respect sensory sensitivities, exclusion or bullying, and a lack of interest and support for their specific needs and interests.

The combination of these experiences can create deep wounds that shape a diminished sense of self-worth and a distrust of others.

How does complex trauma affect autistic individuals?

An autistic child or adolescent tends to experience the world as threatening due to difficulties in social communication and a different sensory system.

Early life stressors, particularly childhood abuse, are associated with significant changes in the brain in adulthood, especially in the hippocampus, corpus callosum, insula, dorsolateral prefrontal cortex (PFC), orbitofrontal cortex, anterior cingulate gyrus, and caudate nucleus (Teicher et al., 2016).

For autistic individuals, the consequences of complex trauma can be further intensified due to their specific processing of emotions and information.

Due to heightened emotional sensitivity, traumatic events can be deeply engraved in memory, leading to the re-experiencing of those events.

Autistic individuals often have a different way of expressing emotions, including alexithymia, which can make the process of seeking support more difficult.

Traumatic experiences can further worsen sensory sensitivity, creating a state of constant arousal and tension.

The difference between autistic traits and autistic trauma

To better understand the difference between autism and trauma, I will show you the distinction between inherent autistic traits and trauma in autism.

Autistic traits (inherent characteristics of autistic individuals):

  • Hypersensitivity
  • Stimming (self-regulatory movements)
  • Meltdown, shutdown
  • Avoidance and unusualness in maintaining eye contact
  • Avoidance of sensory-overloading stimuli
  • Need for support in daily functioning (other people, technology, or animals)
  • A strong need for autonomy; avoidance of following commands
  • Bottom-up processing / sensory-verbal processing
  • Atypical expressions of emotions
  • Behavior varies depending on experienced levels of stress or safety
  • Neurodevelopmental difficulties and/or learning difficulties
  • Difficulties with transitions/activity changes
  • Limited and/or specific interests
  • Monotropic attention

Autistic trauma (reactions to trauma in autistic individuals)

  • Hypersensitivity (above an individual’s baseline level)
  • Inability to regulate body movements (dyspraxia)
  • Shame spirals, shutdown
  • Forced, inauthentic eye contact
  • Subjecting oneself to sensory-unfavorable experiences
  • Unmet needs, conditioned independence with extreme energy depletion (leading to burnout)
  • Hypersensitivity, dissociation, disconnection between mind and body
  • Suppressed emotions
  • Masking (subconsciously hiding autistic behaviors)
  • Hidden disorders, autoimmune conditions
  • Worsening of anxiety or depression

Factors that trigger trauma in the autistic population

Autistic individuals may experience certain situations as traumatic due to heightened sensory sensitivity, differences in communication and social interactions, as well as distress caused by changes in routine and the inability to engage in usual self-soothing stimming behaviors.

Tomu dodatno doprinose neurološki i genetski čimbenici u podlozi, kao i tendencija fokusiranja na detalje situacije, pojačano ruminiranje tj.nemogućnost prestanka razmišljanja o negativnim osjećajima i mislima, nefleksibilno razmišljanje i izbjegavanje te teškoće u samoregulaciji emocija (Kerns et al 2015; Hoover 2015; Haruvi-Lamdan et al 2018).

Trauma triggers include abandonment/loss of a loved one (family member, pet, friend), sensory experiences (e.g., fire alarms), transitions and changes (e.g., transitioning from university to work or to a new job, changes in routine with the seasons, unpredictability in daily life), social difficulties and confusion (trouble interpreting social cues, misunderstandings, and conflicts), and associated mental health challenges (e.g., depression or autistic burnout).

Differences and overlaps between trauma and autism (Dr. Neff)

AutismTrauma
Main characteristicsCharacteristics in communication, difficulties in reading neurotypical cues and expectations, special interests, sensory sensitivity, need for routines and predictabilityIntrusive thoughts and flashbacks, nightmares, avoidance of triggers related to the traumatic experience
CognitiveNegative beliefs about oneself as a result of internalized ableism, tendency to ruminate, challenges with executive functionsNegative beliefs about oneself and the world, rumination, being stuck in recounting the traumatic experience, difficulties with executive functions
EmotionalDifficulties in regulating intense emotions, impulse controlEmotional overwhelm or numbness can be easily experienced
Sensory sensitivityDifferent levels of heightened and reduced sensory sensitivityThe entire nervous system is in a state of alert
AvoidanceSelf-soothing through stimming and routinesAvoidance of everything related to the trauma

Overlap between autism and trauma:

  • Increased risk of substance abuse
  • Self-harming behavior
  • Dissociation
  • Suicidality

Autistic individuals are 3-7 times more likely to die by suicide. Suicidality is also more common among those who have survived trauma. Therefore, trauma treatment for the autistic population must be approached responsibly and with a neurodivergent-affirmative approach.

Treatment of complex PTSD in autistic persons

The treatment of trauma includes psychotherapeutic support. Autistic individuals often require a greater number of treatments, longer or shorter session durations, and regular breaks. It is useful in therapeutic work to use projective and associative techniques related to a special interest to reduce anxiety and create a broader space for self-expression beyond just verbal and dialogic communication.

There is a myth that working on trauma will make a person “less autistic,” and some “experts” mistakenly attribute the characteristics of autism and ADHD to trauma symptoms. The treatment of complex trauma does not make an autistic person more neurotypical. On the contrary, working on trauma may, in the early stages of therapy, increase the atypical behavior of an autistic person as they reconnect with and rediscover their innate neurodivergence. It may appear as though the condition has “worsened” because an autistic person often requires more, not less, support following traumatic interventions.

The reason for this is that previous connections with others were often based on masking our needs, behavioral traits, and interests to avoid being rejected for who we truly are. Some autistic individuals may subconsciously sabotage the psychotherapy process. The defense mechanisms developed as a result of trauma protect us from experiencing intense and painful rejection again. Perfectionism, self-sufficiency, rigid boundaries, or even people-pleasing are ways we support ourselves to avoid relying on others—even on the psychotherapist—by trying to be the “good client.”

Unfortunately, the first experiences with psychologists, psychotherapists, and psychiatrists are often negative due to rejection and a lack of understanding of neurodivergent traits, which are closely tied to their later trauma experiences. Some autistic individuals found it difficult to understand or explain their feelings, making communication and discussions about their experiences more challenging. Others faced situations where their trauma was minimized or not taken seriously.

If trauma interventions are offered to autistic individuals within the framework of the medical/pathology/treatment model, autistic individuals may experience retraumatization, fragmentation, and worsening mental health issues.

At the moment when we remove the protection of our traumatic defenses, we must already have a well-established support system in place. Appropriate support for an autistic person requires an identity-affirming approach, as well as adjustments and support tailored to the needs of autistic individuals.

How to support yourself and an autistic person?

Before starting trauma-focused therapy, it is important to build a relationship of trust and safety, as well as a sense of predictability, routine, and security in one’s home and daily environment. This can be achieved by using a so-called safe object or a photograph that evokes calmness and safety, and by using it as a stimming object.

Support strategies that have proven to be useful include practices that cultivate awareness and presence in the current moment (such as walking in nature, yoga, mindfulness). Any type of physical activity is also grounding and calming for the nervous system (dance, pilates, strength training). Additionally, there have been great benefits from music, art, and wellness therapies (essential oils, painting, creative writing), as well as animal-assisted therapies. Another significant source of support can be the experience of volunteering, where helping and contributing to others helps to rebuild confidence and self-esteem.

Here are a few more key steps on the path to healing trauma as an autistic person:

1. Affirmation of your traumatic experience. We often learn to minimize our own pain in order to fit in with society. Empathetic acknowledgment of your reality is crucial for healing.

2. Adjustment of therapeutic support. Traditional therapeutic methods are often not designed for autistic individuals. Therefore, it is important to use approaches that respect our way of thinking and communicating (e.g., using visual aids and templates, structured sessions, sensory adjustments to the space, a more direct approach).

3. Support system without masking. Masking autism, although it can be a survival mechanism, often comes with a high emotional cost. Seek individuals and therapists who encourage releasing the need for masking in a safe environment. Building a support network is key to healing. This can include family, friends, therapists, or communities of neurodivergent individuals who offer understanding and solidarity.

4. Self-regulation and managing sensory stress. Tools for calming sensory overload, such as noise-canceling headphones, weighted blankets, or structured routine activities, can significantly reduce daily stress.

Conclusion

The overlap of autism and complex trauma can indeed bring numerous challenges, but it also offers an opportunity for a deeper understanding of the richness of human diversity. When we provide empathetic support, adjust therapeutic approaches, and create safe spaces where autistic individuals feel accepted and seen, we open the doors not only for healing but also for empowerment.

It is essential to remind ourselves that the needs and rights of autistic individuals are no less important than anyone else’s. Autism is not an obstacle – it is an authentic way of being that deserves understanding, respect, and support.

If you want psychotherapeutic support for working on trauma as a neurodivergent person through a neurodivergent-affirmative approach, learn more about me and my approach here.

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