How are autism and anxiety related?

Generally, research estimates that around half of people with autism also have anxiety. The explanation for this connection is multifaceted, but it often has to do with the way that living with autism in a neurotypical world can be stressful and exhausting. In addition, brain differences in people with autism may play a role.

It’s important to understand how anxiety and autism overlap and are different. The way anxiety is treated in neurotypical people can be ineffective for people with co-occurring autism and anxiety and, in many cases, can even make them more anxious.

Where anxiety and autism overlap

Research shows that anxiety disorders are one of the most common types of mental health conditions that co-occur with autism. One study found that more than 20% of people with autism had a co-occurring anxiety disorder. (It’s important to note that this study included obsessive-compulsive disorder, which is not an anxiety disorder). 

Studies have also found that people with both autism and an intellectual disability have a lower risk of having co-occurring anxiety than autistic people without an intellectual disability.

Having autism doesn’t automatically mean you’ll also develop an anxiety disorder. The risk of developing a co-occuring disorder along with autism is linked to several different factors, including:

• Genetics and family history
• Brain structure and function
• Trauma and stressful life events

Research has found that brain biology may play an especially large role here. One study found that autistic adults with co-occurring anxiety experienced higher brain-function differences. Specifically, it found a weaker link between the amygdala and the dorsal/rostral anterior cingulate, two areas of the brain that play a role in fear and emotional monitoring and regulation.

Can autism cause anxiety, and vice versa?

Anxiety does not cause autism. The causes of autism are highly complex, but there’s evidence to suggest that it is, in large part, genetic.

Living with autism can be challenging, especially if you live in an area with a lack of resources, support, and knowledge around autism. The real-life challenges that can sometimes come along with autism — including difficulties at school or work and relationship challenges — can make you feel more anxious. Autistic people often face bullying, which can also be a major risk factor for anxiety.

In addition, as we’ve already mentioned, autism can lead to differences in the brain, including in the areas related to emotional monitoring, emotional regulation, and the fear response. This may also make you more likely to develop anxiety if you already have autism.

Recognizing symptoms of autism and anxiety

As is the case with any co-occurring conditions, living with both autism and anxiety can pose additional challenges. 

In addition to the unique symptoms of each condition, some additional or worsened symptoms you could experience if you live with both include:

• Social anxiety and isolation: Even if you don’t have social anxiety disorder, you might experience heightened anxiety in social situations if you live with both autism and anxiety. You might have a harder time developing close relationships and worry excessively about making “mistakes” in social situations.
• Fear of leaving your home: Studies have found that agoraphobia is one of the most common anxiety disorders that people with autism face. You might worry about being in places where you can’t easily return to the comfort of your home. You may feel safest when you’re in familiar, predictable places. 
• Sensory sensitivity: Both autism and anxiety can cause sensory sensitivities, which means you could become more easily overwhelmed by sensory input. For example, you might have a harder time in noisy places or places with bright lights.
• A need for strict routines: Some people with autism might need more predictability in their routines when they’re feeling anxious. Autism can make you more sensitive to routine changes, and predictability in your routine can sometimes be a way you try to cope with anxiety.
• Repetitive behaviors: You might engage in repetitive calming or self-stimulating behaviors (also called “stimming”) when you’re feeling more anxious. 
• Separation anxiety: Separation anxiety is also a factor. Although this mostly affects children with autism, adults can experience separation anxiety too. For example, you might feel safe and comfortable when your partner is around but find it more difficult to cope when they’re away.

How is anxiety diagnosed in people with autism?

In the beginning, it may be difficult to tell the symptoms of autism and anxiety apart. For example, you might naturally get anxious or uncomfortable in certain places if you have autism, and it can be hard to tell which effects are a natural part of living with autism and which are signs of an anxiety disorder.

It’s important to consider the ways in which anxiety, specifically, gets in the way of your functioning. It’s natural not to feel exactly the way neurotypical people do in certain situations. For example, if loud noises make you feel uncomfortable, this may not be a sign of anxiety but rather a reflection of how the world is designed for neurotypical people who don’t have the same sensitivities.

But if anxiety itself is causing life to be difficult — for example, if you’re having a hard time sleeping because of racing thoughts or you have excessive worries about the future — then you may be diagnosed with a co-occurring anxiety disorder and require treatment to reduce those symptoms.

Most of the time, co-occurring anxiety is diagnosed through a clinical interview. A therapist or another health professional may ask you questions about your anxiety symptoms and how they relate to your experiences with autism. There are also diagnostic instruments available that can help health professionals differentiate between the two.

Helpful strategies for coping with autism and anxiety

Although getting treatment for co-occurring anxiety can be very helpful, there are also coping strategies you can use to try to manage anxiety on your own. 

• Find ways to self-soothe. Whether it’s stimming, using fidget toys, practicing breathing techniques, or engaging in another pleasant activity, it can be helpful to understand how to calm yourself down when you’re feeling anxious. How do you self-soothe, and how can you incorporate these strategies into your everyday life
• Connect with your community. When you’re autistic, it can cause anxiety to try to force yourself to behave like neurotypical people. It can help to build a community of autistic and other neurodivergent people to understand that there’s nothing “wrong” with you — your brain simply works differently than others. These communities can also provide a safe place for you to be your full self without the anxiety of trying to fit in.
• Adapt your environment. Sometimes, it may be your physical environment that’s causing anxiety for you. Consider adapting your environment as much as you can. For example, you can get dimmer, warmer lighting or wear noise-canceling headphones. In addition, keep in mind that both anxiety and autism are eligible for reasonable workplace accommodations under the Americans with Disabilities Act.
• Practice basic self-care. When you neglect basic self-care — like getting enough restful sleep every night, exercising, and eating nourishing meals — you’re more vulnerable to the effects of anxiety. Even though it might not make you feel better immediately, it’s important to build healthy habits. 

Specialized treatment for anxiety and autism 

Treatment for co-occurring anxiety and autism can be complex because professionals typically approach these two conditions in different ways. Anxiety is a mental health condition that, by definition, causes emotional distress. Autism, on the other hand, is a neurodevelopmental condition. It typically causes distress because of the way other people respond to people with this condition and the way the world is set up for neurotypical people.

Anxiety is often treated using exposure therapy, a treatment that aims to reduce people’s fears by gradually exposing them to uncomfortable situations. But functional MRI studies have found that autistic brains don’t adapt to anxiety triggers, like sensory sensitivities, in the same way neurotypical brains do. In fact, trying to force someone with autism to get used to to uncomfortable experiences typically only increases emotional distress and makes them even more anxious.

These findings have rightfully led autism advocacy groups to fight to keep exposure and aversive therapies out of treatment for autistic people with (or without) anxiety. 

On the other hand, research shows that some therapy methods that may support people with co-occurring anxiety and autism include:

• Cognitive behavioral therapy (CBT): This type of therapy can help you examine thinking patterns that might be causing you to feel more anxious and reframe these thoughts to be more helpful and accurate.
• Mindfulness-based therapies: Mindfulness is an evidence-based approach to reducing stress and anxiety. It can help you stay in the present moment, approach strong emotions with self-compassion, and learn new strategies (like breathing techniques) to calm yourself down.

Some people with co-occurring anxiety and autism take medication. Medications should never be used to try to diminish symptoms of autism (rather than directly addressing the anxiety). Any treatments that are used for co-occurring autism and anxiety should recognize that, unlike anxiety, autism isn’t a “disorder” that requires treatment. Rather, it’s a normal variation of the human brain.

Find care with Rula

Co-occurring conditions, like anxiety, can make navigating the world even more challenging for autistic people. But it’s important to understand that autism itself isn’t a mental health condition — it’s an important part of your identity that deserves to be celebrated. However, if you also have underlying anxiety that’s causing you emotional distress, these symptoms can be addressed with therapy. A therapist can also help you develop more self-acceptance and confidence around being neurodivergent.

With Rula, you can use our therapist-matching platform to find a provider who understands you and your unique experiences. Plus, you can find someone who takes your insurance, and online appointments are available as soon as tomorrow.

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