Autistic Anxiety—what psychologists have been missing
Autism causes anxiety, and it's absolutely crucial that we talk about this because...
1. Trained mental health practitioners are mistaking autistic anxiety for many other types of anxiety and missing / misunderstanding the actual root cause of the anxiety
2. Autistic people are receiving autism diagnoses but are being sent away with no meaningful explanation regarding what that means for them
(This is where mention of autistic anxiety would be life changing for many newly diagnosed autistic people)
3. Autistic anxiety is being treated incorrectly (I'll explain this more shortly) causing many autistic people to experience continued mental and physical health decline...
When if they were getting the correct supports and accommodations, they could experience meaningful, even life changing improvements to their mental and physical health
I could go on, but for the purposes of this post, I'll move on to my next point, which is…
Missing / misunderstanding the root cause of autistic anxiety often results in several extremely detrimental things including...
- Incorrect supports, like focusing on talk therapy when accommodations are what's needed...
- Psychiatric treatment that attempts to address the anxiety chemically, but doesn't actually improve or reduce the anxiety because the root issue isn't chemical…
- Autistic people fending for themselves because they're not getting the support they need from others, causing them to resort to harmful coping responses (like drugs, alcohol, gambling, etc)
Or worse… feeling such extreme hopelessness and despair that they just want to escape life, which contributes to higher rates of suicidal ideation, attempted suicide, and suicide
Now that I've explained why this matters so much and what's at stake…
I'm going to explain what autistic anxiety actually is and how we know it exists.
I'll start with how we know it exists.
A study published in 2022 (I'll share a link to it below) identified a type of anxiety that it specified is “unique to autism” and “would not be captured by traditional assessments.”
The study referred to it as “autism distinct anxiety,” (and “distinct anxiety” for short) because of its distinct features related to autism.
And the way it identified this type of anxiety was by identifying physiological differences between brains with distinct anxiety and brains with other types of anxiety, or no anxiety at all.
Ok, but what exactly is distinct anxiety?
Here's how the study described distinct anxiety (broken up a bit to make it easier to read)…
“Autism-distinct anxieties (henceforth referred to as distinct anxiety) include fears related to social confusion (as opposed to fear of negative evaluation, which is required for a DSM diagnosis of social phobia)...
Uncommon phobias (e.g., specific sounds, facial features)...
Excessive worry related to losing access to materials related to circumscribed interests...
And fears of change.”
The study differentiated distinct anxiety from clinical anxiety (conditions outlined in the DSM) by referring to clinical anxiety as “DSM anxiety.”
For those curious, the clinical anxiety examples it included were generalized anxiety disorder, separation anxiety, specific phobia, and social phobia.
Ok, so we know distinct anxiety exists…
We know it's different from all other anxiety disorders…
And we have a usable definition of what it is…
But we don't know WHY it exists. At least, not yet.
And this is where I believe I can offer some clarity...
For context, I'm autistic and have formal degrees in philosophy and psychology…
I call myself an “autistic philosopher of human difference” because I believe this does a good job of communicating how my perspective has been shaped and the central thesis of the work I do as an autistic advocate…
And for the purposes of this conversation, what I'm about to propose is a synthesis of my domains of formal knowledge, over 20 years of applied expertise, and 42 years of lived experience as an autistic person…
It is my belief that autistic (distinct) anxiety is caused by unmet autistic needs.
And that those unmet needs show up whenever there is a mismatch between our autistic brain and the environment it is in.
For example…
Autistic brains process sensory information differently than nonautistic brains.
We are therefore often more sensitive to sensory inputs… and require different environmental supports than nonautistic people.
But because most environments are set up to support nonautistic brains… there is often a mismatch that causes us to have a need gap.
That need gap… when left unfilled… causes us to be dysregulated.
Dysregulation… when left unaddressed… causes more extreme dysregulation…
AKA distress.
And THIS is where anxiety shows up.
It shows up at some point between when the need gap shows up and when we experience distress. (I believe the exact moment it shows up depends on the individual, but that's a topic for another post)
And it shows up AGAIN when our nervous systems predict a repeat of the same experience in the future.
That's where anticipatory anxiety comes in.
Ok... I think that's where I will end this post because I recognize that what I just shared might already be too much to process.
But I'm happy to do a follow up post if there's interest.
I've talked at length about this before and have provided numerous examples of how distinct anxiety can look.
I'd be happy to do another post on that… or answer other questions that come up in comments.
And for those interested, I just launched my learning library, which has all my long form content (like this) organized by topic.
I'll share a link to it in the comments. If you're looking for my earlier content on this topic, you can find it in the Deep-Dive section of my Article Library, in the Autistic (Distinct) Anxiety catalog.
(So... Learning Library → Article Library → Deep-Dive → Autistic (Distinct) Anxiety)
I hope you found this post helpful. And if you do dig deeper…
Happy learning 😊 🙏🏻
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P.s. An important note that I didn't want to put in the post itself because it would have interrupted the progression of ideas...
Autism and "DSM anxiety" are extremely common comorbidities.
This means that autistic people have a notably high rate of co-occurring clinical anxiety.
(According to current research, anxiety disorders are one of the highest co-morbidities with autism. But this can partially be due to what I'm calling attention to in this post, which is that autistic anxiety is frequently mistaken for other types of anxiety... so, it's complicated.)
That said, this means that autistic people receiving treatment for other anxiety disorders may not actually be getting *incorrect* treatment. But rather *incomplete* treatment.