Complex Post-Traumatic Stress Disorder (CPTSD) and autism (you can read why I don’t refer to it as a disorder here) can have many overlapping characteristics. In fact, many undiagnosed autistics who seek out therapy get misdiagnosed with CPTSD. In this essay I’ll explore the overlapping characteristics and how to distinguish the differences.
Before I dive in here, I want to be clear that the list of symptoms for CPTSD are negative impacts that individuals experience. This is how the characterization of disorders work. They pull together the undesirable impacts. Thus, my comparison between CPTSD and autism will look at these negative symptoms. However, autism does not consist solely of negative impacts. You can read a more balanced view of autism in my essay The Joys of Autism.
With that caveat aside, let’s get started.
Individuals with CPTSD experience sudden, unwanted thoughts about the traumatic event. Autistic individuals also experience intrusive thoughts. However, they’re not tied to traumatic events. An autistic mind has neural pathways that fire more frequently and in conjunction with other pathways. This means that something benign can cause an autistic person to experience an explosion of thoughts. That random flower that a person mentions in a story may activate a chain of thoughts in a person’s mind and suddenly they’re thinking about the molecular structure of a chair. It may seem completely unrelated, but if the chain of thoughts could be slowed down, we could see that one thought triggered another that triggered another and so on. These thoughts can feel intrusive when you’re just trying to be present in a conversation or just go about your life.
Individuals with CPTSD can experience nightmares. These nightmares may or may not be about the traumatic event, but the emotions are tied to the emotional aftermath. Many autistic individuals I know experienced frequent nightmares as children, myself included. I don’t have any scientific evidence to point to on this, just a guess that an overactive mind can lead to the brain trying to process all of those thoughts and emotions at night. Again, the difference being the CAUSE.
Individuals with CPTSD will avoid people, places, and things related to the traumatic event. Autistic individuals also avoid people, places and things that are uncomfortable. This is primarily tied to sensory perception. Most autistic people experienced enhanced sensory perception. This can lead to the senses getting overwhelmed, such as in noisy places or with chemical smells that create headaches. Autistics may avoid places that are overwhelming to their senses.
Memory loss is a common symptom of CPTSD. The traumatic event can impact the functioning of the hippocampus, amygdala, and other structures of the brain that encode memory. Researchers also note that autistic individuals frequently have poorer memory of past events than neurotypicals. Furthermore, an event is more likely to be remembered when tied to an emotional experience. This can lead an autistic person to feel like they only remember the bad things. In reality, there is so much happening in an autistic mind that it has difficulty discerning what to remember and what to prune (not remember). One way to distinguish between CPTSD and autism is the onset of memory differences. An autistic person will have experienced difficulty with memory their entire lives, whereas someone with CPTSD will experience an onset of memory difficulty after their traumatic event.
Negative Thoughts about Self and World
After a traumatic event, individuals often see themselves and the world differently. They can begin to feel great amounts of shame, anger, low self worth, and more. Autistic individuals frequently struggle with these same emotions due to being different from neurotypicals. They often feel “weird” or like they don’t belong in a world designed for neurotypicals. Many have difficult experiences with bullying and othering that leave them feeling that others are unsafe. Many internalize these difficulties and feel personal shame or disgust with themselves. This is especially poignant for unidentified autistics, who can sense they are different but don’t really know why. They can feel they are a hopeless cause and that things will never get better.
Because individuals with CPTSD experience so many negative thoughts about themselves and the world, they often self-isolate. Autistic individuals can self-isolate for similar reasons, but there is also another side to self-isolation. Many autistics prefer solitude because they can whole-heartedly dive into their special interests. Furthermore, many autistics need solitude to recover from sensory overwhelm. While the outside world might negatively label it as “self isolation,” solitude can provide positive experiences such as joy, relief, and comfort.
Individuals with CPTSD often remain in a state of hypervigilance to protect themselves. It leads to a level of extreme awareness of others and the environment around them. This is similar to autistic individuals who are also hypervigilant. One of the key ways to distinguish if hypervigilance is due to CPTSD or autism is to examine the onset of the hypervigilance. Another distinguishing factor is what a person’s awareness is drawn to. An individual with CPTSD will be more aware of things associated with safety (noises similar to gunshots, people suddenly showing up, etc.). An autstic person will be aware of these things AND other other factors unrelated to safety, such as the humming of an AC or an interesting butterfly floating about the space.
Many individuals with CPTSD struggle with irritability. This is tied to their body being in a constant state of hyperarousal, which can lead to feelings of agitation, frustration, and anger. Autisitics are also frequently in a state of hyperarousal. They may also express levels of agitation and frustration when their sensory systems are overloaded. However, the level of external response and expression varies far more amongst autistics. Many autistics internalize their irritability and do not verbally or physically show their agitation. Others may choose to self-isolate instead of lash out.
Startle response is tied to tied to hypervigilance and irritability. Both autistic individuals and those with CPTSD will experience an exaggerated startle response to unexpected changes in the environment. To differentiate between autism and CPTSD, an individual would need to investigate the root cause of the hypervigilance as mentioned above.
Difficulty Feeling Positive Emotions
Researchers note that CPTSD can decrease a person’s ability to experience positive emotions. Many unidentified autistics experienced a lifetime of being misunderstood and othered. They frequently were taught to stuff their emotions and needs for the sake of conforming to appropriate social behavior. This frequently leads to high levels of anxiety and depression. In these states, autistics experience difficulty feeling positive emotions. Thus, it is not autism itself that leads to a decrease in positive emotions, it is a culture and system of behavior designed for neurotypicals. When allowed to be their full selves, many autistic individuals experience great levels of joy, fascination, peace, and happiness.
Misdiagnosis and Minimally Educated Clinicians
A clinician who is minimally educated about autism would have difficulty making the above distinctions between CPTSD and autism. Furthermore, unless an individual displays the stereotypical external characteristics of autism, autism may not even be on the radar for the clinician. To further complicate matters, autistic individuals experience higher levels of trauma than neurotypicals (we’ll have to save that explanation for another essay). As a result, an autistic person may experience CPTSD and be autistic. It takes a truly skillful, educated clinician to catch this.
How Do We Resolve This Problem?
The more autistic individuals we have sharing about what autism is actually like, the more clinicians and educational institutions will have an accurate portrait of autism. My essays about autism and my presentations at conferences are my personal effort to educate mental health professionals.
Furthermore, we can also educate ourselves as a community. Many individuals are choosing to bypass the harmful system of diagnoses and instead self-identify. The more we can speak to our experiences through whatever mediums we prefer (Tik Tok, essays, podcasts, etc.), the more people will hear echoes of themselves and be able to develop accurate understandings of themselves.
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