Autism & Mental Health – Do ALL Autistic People Have Anxiety?

Many Autistic people also have co-occurring mental health conditions. When an Autistic person also has another health condition it’s known as a dual diagnosis.

Data on the prevalence of anxiety among Autistic people has varied widely (from 22 to 84% depending on the study) – Many Autistic people have clinically elevated levels of anxiety or at least one anxiety disorder – OCD, GAD, Social Anxiety, Separation Anxiety, or other Specific Phobia.

It’s estimated by the American Psychiatric Association that one in five (19%) adults in the United States has some form of mental illness. These numbers are higher among Autistic & NeuroDivergent populations, as is expected because (also according to the APA) minority groups often are at a higher risks for developing mental health conditions.  

Although not all Autistic people will have a diagnosable anxiety disorder, generalized anxiety disorder one of the most common comorbid conditions in Autistic people.

To the untrained (or even sometimes the trained medical eye, unfortunately) Anxiety may seem to be a prominent feature of Autistic people, even though it is not part of the diagnostic criteria.


Do all Autistic people have anxiety?

[00:00:08] I’ve heard people, even medical professionals, say things like, “Oh, anxiety. That’s just part of being Autistic. All Autistic people have anxiety.”

[00:00:21] If you’d like to hear my thoughts on this, stay tuned.

[00:01:00] First to be very clear, Autism and anxiety are independent conditions that sometimes can co-occur.

[00:01:11] Medical experts claim that it is not easy for them to recognize the presence of anxiety in Autistic patients, because of – I’m going to quote this “overlapping symptomology and altered presentations of symptoms”.

[00:01:28] They say they “can’t tell the difference between meltdowns caused by anxiety and those that crop up from other reasons related to being Autistic.”

[00:01:40] Meltdowns are often toted as signs that someone might be Autistic, but I’m going to say that they are not a by-product of being Autistic  because not all Autistic people have meltdowns and I’ll share more on this in just a minute.

[00:02:03] Many Autistic people have co-occurring mental health conditions. When an Autistic person has another health condition, it is called a dual diagnosis.

[00:02:15] Data on the prevalence of anxiety among Autistic people varies widely from 22 to 84%, depending on the study.

[00:02:26] Many Autistic people have clinically elevated levels of anxiety, or at least one diagnosable anxiety disorder, such as: OCD, generalized anxiety disorder, social anxiety, separation, anxiety, or another specific phobia.

[00:02:45] It is estimated by the American Psychiatric Association, that one in five adults, that’s 19% in the United States of America, overall, have a mental illness.

[00:02:57]These numbers are higher among Autistic and Neurodivergent populations, as is expected, because also according to the APA minority groups are often at higher risk of developing mental health conditions.

[00:03:10] I will list these links in the blog page at NeuroDivergentRebel dot com so that you can see this data as well.

[00:03:17] Although, not all Autistic people will have a diagnosable anxiety disorder, generalized anxiety disorder is one of the most common conditions that is diagnosed in Autistic people.

[00:03:28] To the untrained, and even sometimes the professional eye, unfortunately, anxiety may seem to be a prominent feature of Autistic people – even though it is not part of the diagnostic criteria for autism.

[00:03:48] When we dive into some of these symptoms of anxiety, it becomes clear where some of this confusion comes from.

[00:03:59]Here are some symptoms of anxiety: obsessive thinking, excessive worrying –  normal everyday situations over things that most people don’t even worry about in situations where worrying is not helpful.

[00:04:21] Another symptom of anxiety is being irritable and having trouble regulating your emotions. People with anxiety disorders struggle to reduce their arousal when they get anxious as quickly as people who don’t have anxiety disorders.

[00:04:38] And that means when people who have anxiety disorders are triggered, we may feel the effects of anxiety longer for longer periods of time than people who don’t have these more intense anxiety issues.

[00:04:56] Something else that really sucks about having anxiety is that it can impact your ability to concentrate and it can mess with your working memory.

[00:05:05] That’s not great. Anxiety can trigger severe and intrusive thoughts, depending on the individual. That can make it very difficult to concentrate and even accomplish daily tasks. Anxiety can also interrupt that working memory –  the memory that is responsible for holding short term information.

[00:05:28] My least favorite thing about anxiety is panic attacks – easily hand down.

[00:05:34]When you have a panic attack,  you have your flight, fight, freeze response and your brain has been triggered.  Anxiety is basically your body’s alarm system. It is there to protect you and keep you safe. 

[00:05:53] If your brain believes you’re in danger, it is supposed to prepare you to react to that danger so it’s going to  prepare your systems to go into a dangerous situation.

[00:06:09] The problem is, when you have an anxiety disorder, your brain is telling you that there is danger when there is no danger and your brain is being triggered by things that are not actually a threat to you.

[00:06:30] Panic attacks produce feelings of extreme fear, panic, and dread accompanied by unpleasant physical sensations, such as nausea, sweating, flushing, shaking, rapid heartbeat, dizziness. You may find it hard to breathe. It is just a horrible, horrible situation.

[00:06:54] These panic attacks can really seem to come out of nowhere sometimes, and that makes them even worse and can lead even more anxiety about when the next one might come on.

[00:07:07] Similarly, an Autistic person may have a meltdown if they are overwhelmed. Autistic meltdowns can be triggered by overwhelming sensory experiences, emotional experience, sudden change, or surprises. At least with the meltdowns, I’ve found it’s a bit easier to determine what my triggers are.

[00:07:30] I want to stay, specifically, with anxiety disorders  before we go more deeply into autism.

[00:07:36] Another symptom of anxiety can be increased sensory sensitivity. Anxiety also will increase your heart rate and it heightens your senses. That’s part of this body and brain preparing for danger that I was talking about just a minute ago – heightening your senses. This could potentially be helpful if you were about to go into the fight of your life. If you were actually in danger.

[00:08:10] If you feel like you are about to go into the fight of your life frequently. You feel like you are always about to fight. Everything is about to be a fight. You are ready to battle. That’s exhausting and you may feel agitated or restless.

[00:08:32] These are other signs of anxiety, restlessness, and agitation.  You’re tense. You’re, you’re tight. You’re restless. You’re ready to go in case you have to run.

[00:08:45] People with anxiety disorders, often, report feeling restless quite frequently, which makes a lot of sense if you feel like you may have to run or fight at any minute.

[00:09:01] Then there are the physical signs of anxiety, muscle tension, because  your muscles are tense if you’re always ready to go and ready to run from danger, and then you don’t actually run  -because there was nothing to run from. You’re just like a spring, loaded, and ready to go at all times.

[00:09:20]Digestive issues and stomach problems are one of the most common symptoms of stress and anxiety. I unfortunately know this one from a lot of personal experience.

[00:09:34] Sleep problems are very common in people who have anxiety.  When you have anxiety and you manage to treat your anxiety, a lot of times people will report that their sleep does improve.  A lot of Autistic people also have sleep problems too.

[00:09:53] Another physical symptom of anxiety can be headaches, heart palpitations, and dizziness.

[00:10:02] Headaches -they suck and they’re actually a lot more likely for people who have anxiety.

[00:10:12]So how does this relate to autism?

[00:10:15] Autistic people are more likely to have specific anxiety around a few things:

[00:10:21] Anxiety around sensory processing, because there is a constant assault from a world that isn’t designed with Neurodivergent sensory processing systems in mind.

[00:10:35] We sometimes may have anxiety around communication.  We are likely to experience social anxiety.

[00:10:44] This is actually a diagnosis I  received when I was diagnosed Autistic. Because people are constantly telling you that you are socializing wrong or they’re misunderstanding you, or you’re misunderstanding other people – vice versa, back and forth. It’s a two way thing.

[00:11:07] You can become very nervous around those social situations because some of us we’ve experienced, repeated, painful, social failures over and over again in our lifetimes.  Then  we can develop anxiety around social situations because of it.

[00:11:27] We may also develop anxiety around change and not knowing the future.

[00:11:33] In general, I am someone who needs a lot of structure. When I am anxious, I do experience a lot more resistance to minor changes,  especially to my routine or my plan.   If I’m going through a hard time, my plan might be the only thing I’m hanging on to and  I need to have  control over that plan and that can become really important to me. Sometimes I can make my plan a little bit more loose, but it just depends on how much control I’m really needing over my life in that moment.

[00:12:06] When I am anxious, I am more likely to be irritated, agitated, and short with other people.

[00:12:16] I am more likely to withdraw socially or shut down and require a lot more solitude. I  may become more avoidant of  eye contact, and more in my own space to where I tune out other people more, even when I am around other people, I just kind of tune them out and am in my own little world.

[00:12:46] When I am more anxious, I may engage in more “repetitive behaviors” as they’re called in the diagnostic criteria.

[00:12:55] More echolalia, talking to myself, more self-soothing. I may be visibly stimming a lot more – things that are a bit more obvious to outsiders,  and that is because, like we were saying earlier, when you’re anxious you’re constantly like feeling like you might need to get up and move all of that energy has to go somewhere.  I am more physically active  when I have anxiety coursing through my veins. I have to get that out.  So that becomes more visible.

[00:13:27] I’m also more likely to listen to one song on repeat versus listening to an entire album on repeat or listening to an entire playlist on repeat.  Going back and watching old familiar movies and shows from when I was younger, and things like that that are very comforting and very soothing.

[00:13:51] There are some  darker sides to this.

[00:13:54] If my anxiety flares up and gets really bad, I am more likely to have intrusive thoughts.

[00:14:01] When I’m anxious, and I’m not doing well, it is more likely that I might engage in more harmful,  repetitive behaviors, like in the diagnostic manual – like biting my nails and my lips and chewing my lips, and chewing my tongue, picking  my cuticles, and my skin.  If I have like a scratch or something, picking at it just mindlessly.  I don’t even realize I’m doing it. I’m more likely to do that if I am in a period of anxiety or low mental health.

[00:14:33] When I’m anxious, I’m even more sensitive to sensory input than I  normally am and things that wouldn’t normally bother me, might be too much.  I may even be drawn to more sensory soothing activities than normal, if I am feeling anxious, to try and counteract some of that overwhelming energy.

[00:14:59] My digestive system stops working properly when I’m anxious. I will drop weight because I often stop eating because I’m just not hungry and food doesn’t seem or tastes appetizing.  If I do eat, the food will go right through me. 

[00:15:20] I also tend to have more headaches and insomnia flares. All of these things tend to build up, having compounded impacts on one another, further hindering my ability to function as expected in this world.

[00:15:40] My anxiety has had ups and downs throughout my life.  I feel very lucky to be in a period of very low anxiety right now . I’m so grateful and I really hope it lasts, but I am not going to take it for granted  just in case.

[00:16:00] Mental health can be a fragile thing and I’m working hard to keep things under control, but I already know, through lots of painful experience, that things with mental health aren’t always that simple.

[00:16:23] When my mental health is good, a lot of these problems that I listed become lessened.  

[00:16:29] It’s a delicate balance.  When something tips the scales and it becomes too much, then all of the dominoes can, suddenly, come crashing down and one by one, I see myself progressing, burning out spiraling, as I shut it on myself.

[00:16:55] What’s autism? What’s the anxiety ? What’s an Autistic person with anxiety look like?

[00:17:01] What’s an Autistic person who’s not anxious look like?

[00:17:05] We don’t see enough of that. We’re not asking these questions.

[00:17:10] After I spiral, I’ve found myself, many times, left picking up the pieces, rebuilding myself.

[00:17:18] That’s why  these static functioning labels are not helpful to Autistic people. Our functioning can fluctuate greatly sometimes from day to day, week to week, or even year to year, depending on the different situations, circumstances, and medical conditions, that we have throughout our lifetime.

[00:17:45] For many years, over an extended period of time in my life, I had been doing very well, until one change happened and it was more than I could handle without help.

[00:18:00] For an extended period of time, no help was available.  So I found myself in a steady spiral of decline.

[00:18:12] I was at a low point in my life when I was diagnosed Autistic at the age of 29.  It’s taken me four and a half years to rebuild myself after that event and I’m still building.

[00:18:32] All right everyone that got serious real quick.

[00:18:36] Thank you so much for hanging out this week, as we dove deeply into the question that is asked, more frequently than I feel it should be, ” do all autistic people have anxiety?”

[00:18:51] No, I don’t believe all Autistic people are anxious or that all Autistic people, naturally, come with anxiety.

[00:19:00] Although, I am an Autistic, anxious, human being… there are actually periods where my anxiety is getting pretty good. Maybe I’ll be an Autistic person without anxiety someday. Prove the naysayers wrong.

[00:19:15] Thank you all so much for coming back to watch these videos and hang out every Wednesday. I put out new content each and every week.

[00:19:26] An extra special thank you to my Patreon supporters and Facebook subscribers for being a big part of supporting the production of this  high quality, educational, content. I could not do it without you.

[00:19:44] Thank you so much! As a very small piece of gratitude towards those of you who do subscribe through those other channels, you gain access to videos like this one, early, before it is released to the general public.

[00:19:58] Those subscribers probably had this video about four weeks to a month early. It’s just a very small way I can say thank you for being the wind beneath my vlog’s wings.

[00:20:11] I couldn’t do it without each and every one of you.

[00:20:14] I will see you all next week. Bye.


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