There’s a new study in Journal of Autism and Developmental Disorders of anxiety in autistic adults that indicates anxiety diagnoses in 20.1% of us as compared to just 8.7% of neurotypicals. The authors suggest possible explanations for this discrepancy drawn from both the social and medical models of disability.
Higher rates of anxiety disorders in people with ASD may occur for a number of reasons (Kerns and Kendall 2012). For example, people with ASD may be more likely to experience peer rejection and prevention or punishment of their desired behaviours (for example restricted, repetitive interests). Additionally, social difficulties such as repeated experiences of misinterpreting social situations or communication leading to misunderstandings may produce anxiety, particularly in social situations. In typically developing adolescents and those with ASD, social difficulties have been associated with increased anxiety (Bellini 2006) and in particular an individual’s perception of their social skills difficulties is predictive of social anxiety (Bellini 2004). The impact of social stressors may be increased by a biological vulnerability to anxiety. For example, limbic system dysfunction and behavioural inhibition are associated with both ASD and anxiety disorders. Lower arousal thresholds in the amygdala associated with behavioural inhibition may in turn result in people with ASD avoiding and being conditioned by negative experiences (Bellini 2006). Sensory over-responsivity has also been suggested as a possible cause of anxiety disorder in ASD (Mazurek et al. 2013), causing problematic fears to develop as a result of increased sensitivity to certain stimuli. In OCD, whilst obsessional thoughts are common in the general population, it has been suggested that the cognitive deficits associated with ASD may influence the manner in which these thoughts are appraised, resulting in more anxiety and the development of OCD (Russell et al. 2005).
(My own co-morbid diagnoses were social anxiety and obsessive-compulsive disorder. Should I ever find my way back to a mental health practitioner covered by insurance, I fully expect there’s at least one more co-morbid diagnosis lurking in there, somewhere.)
This argument that that both external conformity pressures and internal neurological pressures likely play roles in autistic anxiety squares with my own experience, and, I think, likely that of many other adult autistics.
Conformity pressures can be confronted fairly directly through our own individual and collective self-advocacy.
What potentially stymies addressing the neurological pressures, however, as the study’s authors point out, is the relative lack of clear and certain knowledge of how both psychotherapeutic and pharmacological methods devised for neurotypical brains impact autistics.
For all those reasons and more, this study definitely will get linked on my How To Avoid Providing Mediocre Support reference site for my medical, mental health, and social services practitioners.