When autism and psychosis overlap

Autism spectrum disorder (ASD), or autism, is a neurodevelopmental condition that can involve restricted interests and repetitive behaviors and cause challenges with social skills and communication. 

Psychosis, on the other hand, is an experience that alters a person’s perception of  reality. It involves symptoms like hallucinations (seeing or hearing things that aren’t there) and delusions (objectively false beliefs). Psychosis can be a one-time event or an ongoing symptom of a psychotic disorder like schizophrenia. 

While psychosis isn’t a symptom of autism, research suggests a potential link between these experiences. One 2022 study found that as many as 35% of people with autism will experience psychosis at some point. 

Because autism can significantly affect verbal communication in some people, it may be more difficult to recognize when an autistic person is having a psychotic episode. However, by receiving an accurate diagnosis and individualized support, people with autism can increase their stability and reduce the impact of psychosis on their daily lives.

Symptoms of psychosis in autistic people

The symptoms of psychosis in autistic people are similar to those in neurotypical people. However, the way symptoms present may vary. Here are some ways that autistic people may experience psychosis:

Delusions

Delusions are objectively false, fixed beliefs. They can lead to a sense of paranoia and suspiciousness for people with autism. Some examples of the most common delusions among this population include:

• Grandiose delusions: “I believe I have magical powers, and it’s up to me to save humanity.”
• Persecutory delusions: “I believe the government has installed a tracking device in my home and is monitoring my every move.”
• Delusions of control: “I believe a supernatural entity is controlling my thoughts and behaviors, so I can’t be responsible for them.”
• Delusions of reference: “I believe that when I watch the news, the hosts send me secret messages only I can understand.”
• Delusions of thought insertion: “I believe someone or something is planting ideas in my mind that aren’t my own.”
• Withdrawal delusions: “I believe someone is purposefully stealing my thoughts and ideas.”

Hallucinations

People experiencing hallucinations see, hear, feel, smell, or physically sense something that isn’t there. Research suggests that people with autism may be more prone to unusual patterns of sensation. However, since sensory sensitivities are common among autistic people, it can be difficult to distinguish whether a person is experiencing sensory overwhelm or a hallucination.

Negative symptoms

In this context, the term “negative symptoms” refers to things like blunt affect (limited emotional expression) and social communication challenges. Autism and psychosis can involve similar negative symptoms. But an experienced provider can conduct a thorough evaluation to ensure that a person receives an accurate diagnosis to shape their treatment plan.

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Differences between autism and psychosis

Although they can overlap, autism and psychosis are very different conditions. Many people with autism never have a psychotic episode, and plenty of people who experience psychosis don’t have autism. 

Some important ways that these experiences differ include:

• Age of onset: Autism is usually diagnosed in childhood, while psychosis tends to occur later in life.
• Co-occurring conditions: People experiencing psychotic episodes are more likely to be diagnosed with schizophrenia than with autism.
• Social communication differences: Autistic people may be more prone to misreading social cues, which can make it harder to understand others’ intentions. But people experiencing psychosis may have paranoid beliefs (delusions), like that someone is out to harm them. 

Can autism cause psychosis?

Autism isn’t considered a stand-alone cause of psychosis, and the relationship between these conditions remains unclear. However, some evidence suggests that if a person with autism experiences stressful events like those listed below, they may be more susceptible to psychosis. 

• The loss of a loved one
• Divorce (for children with autism)
• Being placed to live outside the family home (like in a group home)
• Sexual abuse 
• Low self-esteem
• Bullying
• Difficulty performing at work or school due to restlessness
• Family disturbance due to mental health or developmental challenges
• Exposure to community violence
• Inadequate access to resources due to socioeconomic status
• A family history of psychosis

Managing co-occurring psychosis and autism

Research shows that co-occurring psychosis and autism can be managed with clear, structured, treatment that uses various approaches. Typically, if a person is experiencing active psychosis, their provider will help them achieve stability before introducing other services or supports. 

Treatment for psychosis may include medications and therapy, such as a modified form of cognitive behavioral therapy (CBT) that can be tailored to the needs of people with autism. 

From there, a therapist might incorporate any of the following interventions* to help a person living with autism:

• Family therapy (if appropriate)
• Play therapy
• Social skills groups
• Occupational services to support daily activities
• Applied behavioral analysis (ABA) 

*Please note that autism doesn’t always require treatment. Many neurodivergent people live full, independent lives with minimal support. However, people experiencing psychosis typically need professional help to manage their mental health and stay safe. So, if you or a loved one is exhibiting signs of psychosis (like hallucinations or delusions), don’t hesitate to seek treatment.

Find care with Rula

Autism and psychosis are two distinct mental health conditions that frequently co-occur. While we don’t yet understand all the reasons for this overlap, it could be related to stressful life experiences. Fortunately, psychosis and autism can be managed with the right support. It starts with getting an evaluation from a mental health professional to determine whether you’re experiencing autism, psychosis, or both. From there, you and your provider(s) can co-create a treatment plan to help you achieve stability, strengthen your coping skills, and improve your quality of life.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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