Autism and Post-Traumatic Stress Disorder

Autism and post-traumatic stress disorder (PTSD) are often co-occurring — in other words, they're often seen together. In fact, many autistic people on their diagnosis journey often wonder if they're autistic or living with complex PTSD. For this reason, it's important to have a good understanding of PTSD symptoms and why being autistic might increase chances of developing PTSD. 

Topics discussed also include:

• The ways that PTSD can magnify autistic traits
• How PTSD differs from complex PTSD (C-PTSD)
• Attributes of autistic brains that set the stage for repeated PTSD

Theme music: "Everything Feels New" by Evgeny Bardyuzha.

All episodes written and produced by Kristen Hovet.

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Transcript

Today we're talking about autism and post traumatic stress disorder, often abbreviated to PTSD. It's a fairly well known fact in the autism community and in autism research that if you're autistic, you probably also have PTSD or a history of having PTSD. And I'm not using PTSD as a euphemism for having had some difficult times. I'm talking about the real clinical diagnosis of post traumatic stress disorder, and all that that entails. A recent study by Golan and their team looking at rates of PTSD in autistic versus non autistic populations, found that 32% of the autistic population met the criteria for PTSD, while only 4% of the non autistic population did. Note that they were looking at one specific period in time and whether the participants had symptoms during that one day they completed the psychological assessments. They also found that autistic individuals who were born female were at significantly greater risk for both experiencing traumatic events and developing PTSD. One would maybe assume from that, that it's because women experience more interpersonal trauma that they then have more symptoms of PTSD. 

We know from the last episode on narcissism and autism, that interpersonal trauma is especially associated with developing PTSD and especially complex PTSD. Since PTSD is a term that's often thrown around quite loosely these days, I think it's really important to start with a solid definition of PTSD. So what does it entail? Well, there are four categories of PTSD symptoms and to receive a formal diagnosis, you need one or more symptoms from each of the four categories. Some experts talk about five categories, and they talk about having experienced trauma as the first category. I'm going to assume that the person in question, let's say going in for an assessment or evaluation, has had trauma. So that's a given. 

The main categories of symptoms are as follows: The first category is intrusive symptoms, such as unwanted memories or thoughts, recurrent nightmares about the trauma, reliving the trauma experience over and over again, and not being able to control it, distress or troubling body sensations when reminded about aspects of the trauma, and so on. In short, there's a real lack of control to these intrusive symptoms. It's more like the trauma is controlling you or has somehow hijacked parts of your brain. So even if you want to avoid these intrusive thoughts and nightmares and so on, it's really impossible or nearly impossible to do anything about it. The second category is avoidance. Symptoms of this can include avoiding certain thoughts, feelings, or memories related to the trauma or refusing to talk to or even go anywhere near people who remind you of the perpetrator, if a person was the cause of the trauma. It can also mean avoiding places that remind you of the trauma, and really just keeping yourself away from any reminders of the trauma or the traumatic experience. The third category is negative changes in thinking or mood, such as forgetting or blocking memories of the trauma, decreased interest in activities that you'd normally find interesting, feeling detached or distant or even emotionally numb, and so on. And the fourth category is hyper arousal, such as angry outbursts at even little things, being easily startled, having trouble sleeping, trouble concentrating and similar types of symptoms. 

Now for autistic people, PTSD is extra complicated. For us, PTSD is also associated with an increase in autism related symptoms, such as an increase in stimming, an increase in meltdowns or shutdowns, an increase in self injurious behavior, or maybe we've never self injured but suddenly start to once that PTSD sets in, increased hyperactivity, loss of self care skills or sometimes a loss of communication abilities. This can make it more challenging to get the social support we need and social support is helpful in the management and alleviation of PTSD. I've actually read that people who experience trauma that have like a huge social support system or social support network are less likely to develop PTSD as a result of the trauma. So social support is such a huge thing. What's more, it seems like when autistic people are treated for PTSD, if they do receive treatment, they tend to develop it again. For some, their trauma can build on trauma on trauma on trauma for several years or decades, leading to what's been called Complex PTSD. 

Complex PTSD has some differences in symptoms compared to PTSD and is believed to be more difficult to treat. Or I guess it's probably more accurate to say it's like PTSD plus. You have to have the PTSD symptoms, but then there's more to it. It's more complicated, it is more definitely complex, literally. Complex PTSD, often shortened to C PTSD is typically associated with repeated or ongoing trauma, usually of an interpersonal nature. This means that the trauma is often the result of human mistreatment, as opposed to, let's say, natural disasters, accidents or other kind of external events that happen to a person. This is person to person aggression, violence, abuse, and so on. It's often repeat trauma, although I have read that it doesn't necessarily have to be repeat trauma, it can just be quite severe. It's important to know that C PTSD is not yet a formal diagnosis in the DSM, which is short for Diagnostic and Statistical Manual of Mental Disorders. It's what our psychologists use to diagnose mental illness and mental health conditions. However, C PTSD is a formal diagnosis in the ICD 11, which is short for the International Classification of Diseases version 11. The ICD is developed and updated by the World Health Organization. 

In 1988, Dr. Judith Herman proposed the concept of complex PTSD to describe a diagnosis that encompasses all the symptoms of PTSD, but includes severe and persistent problems in emotional regulation, which can sometimes, I think, make it look a little bit like borderline personality disorder. There are definite - I don't want to confuse the two because there are definite differences, but from the outside, I think it can make a person look like perhaps they have borderline personality disorder, when in fact, it's PTSD or complex PTSD. Complex PTSD also includes very negative beliefs about oneself as worthless, along with feelings of shame or guilt in relation to the trauma, and it includes significant difficulties in building or sustaining relationships. As with PTSD, these symptoms must cause impairments to important areas of life, such as personal, familial, social, educational, occupational spheres. The person is potentially quite different than they were in the past. 

With Complex PTSD, it's almost like the symptoms of PTSD turn into a kind of personality type, if that makes sense. The trauma symptoms have been so deeply ingrained and part of the person's life for so long, that they become deeply foundational to the person's psychological makeup, and I'd even say to their physiological makeup. It really colors everything about their lives and their ability to trust others, relate to the world, be in touch with themselves and their bodies, and so on. I think this aspect of C PTSD can actually lead to the common confusion between autism and PTSD. It's common for people on their journey to diagnosis - so we're talking prediagnosis of late diagnosed autism -  to be like, Hey, I have these symptoms and traits. Is it autism or is it PTSD? My answer? It's probably both. In this world and with our brains the way they are, I think it's very unlikely to be autistic and not have have some experience with PTSD. 

So do autistic people experience more trauma? Or are they more susceptible to developing PTSD as a result of trauma? Well, as we've sort of glossed over earlier, it's likely both. As I mentioned with that one research article by Golan and team, we know that autistic women definitely experience more trauma and the resulting PTSD, but autistic people and other neurodivergent individuals are more likely to be bullied and abused compared to neurotypicals. We're often seen as easy targets, we're often naive and overly trusting - especially as children and teens, we're very prone to protecting others, and we're also prone to being people pleasers. And this is the case whether or not people know we're autistic, or whether or not we ourselves know we're autistic. Bullying and abuse are associated with trauma and the development of PTSD, but not all who experience bullying and abuse or other interpersonal trauma go on to develop PTSD. In fact, only about 20% of people who experience trauma develop PTSD. 

So why do so many, if not most, autistic people develop PTSD in response to trauma? The answer appears to be in our brains. The connection between our right and left hemispheres is smaller or operates in a different way than it does in neurotypicals. This means that information, including trauma information, does not get processed the same way or potentially as quickly. While this attribute is associated with some of the very positive aspects of being autistic, such as being able to deeply focus on certain subjects and maybe contemplate a subject for a long time, it's not great when it comes to trauma. Additionally, we have more connectivity between neurons in each brain hemisphere, which is associated with fixating or perseverating on traumatic events or experiences initially right after they happen, which is often one of the necessary conditions for developing PTSD in the first place. 

That concludes our topic for today. Next time, I'll talk about eye movement desensitization reprocessing or EMDR, and why it might be a great treatment for PTSD, especially for autistic people. If you found this episode interesting or enjoyable, I invite you to leave a review wherever you listen to your podcasts and share this episode with a loved one. If you have a question that you would like answered, potentially in a future episode, I invite you to send an email. The email address is in the show notes.

Until next time, bye.