Lisa Morgan - Living with PTSD on the Autism Spectrum: Insightful Analysis with Practical Applications

Living with
PTSD on the
Autism Spectrum

Insightful Analysis with
Practical Applications

Lisa Morgan, M.Ed. and Mary P. Donahue, Ph.D.

Foreword by Tony Attwood

With respect to all the different ways people diagnosed with an autism spectrum disorder can describe themselves in print, we have chosen to use identity first language in our book. We also use the terms: ASD, autistic, non-autistic, neurotypical, NT, and neurodivergent throughout the book as needed to maintain the meaning and flow of the text.

Autism is known as a spectrum condition. We recognize the individuality of all autistic people and understand the shared lived experiences will not resonate with everyone. The book is autism friendly and we believe there are enough situations and circumstances covered to benefit all autistic people, as well as professionals, family, and friends.

This book features both personal and professional experience backed up by best practice research. We have shared parts of our lives in the hope of bringing awareness of living with the dual diagnosis of an autism spectrum/post-traumatic stress disorder. This book is in no way endorsing any particular type of professional mental health therapies or interventions.

Always, without exception, seek out the advice of your mental health provider or other qualified professionals if you need help or have any questions regarding your well-being.

Those who have autism live in a world that creates high levels of stress and anxiety for them. They feel confused and overwhelmed by social and sensory experiences, and have considerable difficulty accessing, regulating and communicating their emotions. Their developmental history may also include being rejected and abused by peers since early childhood, leading to a sense of loneliness and depression. In the adult years, the person may be greatly stressed by not obtaining the academic, relationship and employment success that might have been expected, considering their intellectual abilities; and often there is a continuation of experiences that are perceived as traumatizing.

The high levels of stress and anxiety can make the person overly sensitive and reactive to aversive events, causing hypervigilance, low resilience and an amplification of the depth of emotional response. The level of emotional trauma and stress due to specific, and often repeated, experiences can lead to the diagnosis of post-traumatic stress disorder (PTSD). In my extensive clinical experience, I have seen many children, adolescents and adults at all levels of expression of autism, with an additional diagnosis of PTSD.

Clinicians need to review a persons developmental history and current circumstances in order to screen for PTSD and recognize that some behaviors that appear to be almost random may be PTSD flashbacks and panic attacks. PTSD will also increase the signs and expression of autism, thus having a negative impact on social engagement and reciprocity, and the ability to read someones intentions; and there may be an accentuation of the need to maintain sameness for safety, heightened sensory sensitivity, and an increased desire to pursue interests to act as a thought blocker.

The origins of PTSD can be due to experiences at home and school, as well as those in government institutions, such as psychiatric wards or prisons. The key factor is the persons perception of a given event and subsequent trauma. Added to this is the autistic characteristic of having difficulty determining whether an action was, in fact, malicious or accidental, along with a tendency to ruminate on why someone would engage in the behavior that led to the trauma.

A typical person would be able to disclose their inner thoughts and feelings related to their experiences of trauma, with a natural eloquence and vocabulary to describe subtle and intense emotions. However, those who have autism have great difficulty converting thoughts and emotions into conversational speech. They also often do not want to communicate their suppressed feelings, as this would lead to re-experiencing the distress. They may be unsure that the other person would understand their emotional response to events that would not necessarily be perceived as traumatic by a typical person. Thus, conventional psychotherapy must accommodate the profile of abilities associated with autism in order to provide the necessary therapy for PTSD.

In my conversations with those who have autism, I frequently identify themes of trust and safety, social disconnection and a pervasive pessimism that their lives will always include traumatic experiences. They also identify a lack of literature on autism and PTSD. As I read the manuscript for Living with PTSD on the Autism Spectrum: Insightful Analysis with Practical Applications , I felt that, at last, we have a resource that will not only facilitate understanding from a personal and professional perspective, but will also change lives and lead to the effective treatment of PTSD in someone who has autism.

Professor Tony Attwood

This book was written from the perspective of two people who grew up and worked in the New England area of the USA. Though we have each traveled and lived in other cultures, our main developmental experiences were in the context of our respective rural towns and Puritanical exposure. In addition, the degree of access to services and providers has greatly influenced our individual views of this journey. Other cultural considerations such as low socioeconomic status, religious beliefs, gender, degree of education, family size, and social support should also be taken into account by the reader. Therefore, this book should be read as the specific journey of two peopleone considered neurotypical and the other neurodivergentwho seek to understand each other for their own sakes and for greater goals. For Lisa, she sought relief from the intense and overwhelming feelings resulting from a lifetime of trauma. For MaryD, who regularly practices in the area of trauma and domestic violence, learning how to work with spectrum women was a natural progression. Together, they hope to begin an earnest dialogue about the underserved issues resulting from the occurrence of PTSD prevalent in the ASD population.

Do you know what happens when post-traumatic stress disorder (PTSD) and autism spectrum disorder (ASD) meet in the same unfortunate person? I do. A symbiotic relationship forms and the symptomology of PTSD is enhanced by certain inherent characteristics of autism creating a life marred by the struggles of a dual diagnosis that works with, and against, the other.

Let me explain what I mean.

PTSD flashbacks are triggered and experienced over and over again by a couple of defining characteristics of autismperseveration and rumination.

PTSD nightmares are made more lucid by an autistic brain that thinks in pictures.

The emotions invoked by reliving trauma during flashbacks can create chaos in an autistic person who is not in touch with and/or does not understand their emotions. Strong emotions can become overwhelming quickly; and not knowing how to handle their emotions can cause an autistic meltdown leaving the autistic person in crisis.

PTSD panic attacks are exacerbated by the ever-present anxiety autistic people already live with and deepen the depression many autistic people suffer day after day.

Autistic people typically do not reach out to others for help, so an autistic person with PTSD can be very disconnected and alone using maladaptive coping skills.