Autism and Co-occurring Mental Health Conditions
If you're autistic, you probably already know that your brain works differently from neurotypical people. What you might not realize is that autistic individuals experience mental health conditions at significantly higher rates than the general population. This isn't because autism itself is a mental health disorder, it's not. Rather, it's because living as a neurodivergent person in a neurotypical world creates unique stressors and challenges that can lead to anxiety, depression, and other mental health struggles.
At Be Seen Therapy, we provide neurodivergent-affirming care that understands autism as a difference, not a deficit. We recognize that mental health treatment for autistic individuals needs to be adapted to honor how your brain works rather than trying to make you fit a neurotypical mold. Whether you were diagnosed in childhood or are discovering your autism as an adult, understanding the relationship between autism and mental health is crucial for getting the support you need.
Understanding the Connection
Research consistently shows that autistic people experience mental health conditions at much higher rates than non-autistic people. Studies suggest that up to 70-80% of autistic individuals will experience at least one mental health condition in their lifetime, with anxiety and depression being the most common.
Why is this? It's not because there's something inherently wrong with autistic brains. Instead, it's largely due to the chronic stress of living in a world that wasn't designed for you. Imagine constantly having to translate between your natural way of being and what's expected of you. Imagine sensory environments that feel assaultive, social rules that seem arbitrary and confusing, and the exhaustion of "masking" (hiding your autistic traits to appear more neurotypical) just to fit in or keep your job.
This constant stress takes a toll. The hypervigilance required to navigate a neurotypical world, the sensory overwhelm from environments designed without neurodivergent needs in mind, and the repeated experience of being misunderstood or rejected for being yourself all contribute to mental health struggles.
Additionally, there are diagnostic challenges. Autistic people may present mental health symptoms differently from neurotypical people, which can lead to misdiagnosis or underdiagnosis. Anxiety in an autistic person might look like increased stimming or a need for routine rather than typical worry. Depression might present as increased difficulty with tasks requiring executive function rather than visible sadness. Our neurodivergent-affirming therapy understands these unique presentations.
Common Co-occurring Conditions
Mental health conditions can look different in autistic individuals, and understanding these variations is crucial for getting proper support. Here are the most common mental health challenges that co-occur with autism:
Anxiety Disorders
Often, autistic people experience anxiety disorders, including generalized anxiety, social anxiety, and panic disorder, often stemming from sensory overwhelm, difficulty predicting social situations, and the stress of masking.
Depression
Many autistic adults also experience depression, often linked to chronic stress, social isolation, unemployment or underemployment, and the exhaustion of constantly adapting to neurotypical expectations.
ADHD (Attention-Deficit/Hyperactivity Disorder)
A large portion of autistic individuals also have ADHD, with overlapping traits in executive function challenges, difficulty with transitions, and sensory processing differences.
Obsessive-Compulsive Disorder (OCD)
While autism includes repetitive behaviors and intense interests, some autistic people also have true OCD, which involves intrusive thoughts and compulsions done to relieve anxiety rather than for pleasure or regulation.
Post-Traumatic Stress Disorder (PTSD)
Autistic people experience trauma at higher rates due to bullying, abusive "therapies" aimed at making them appear less autistic, medical trauma from repeated evaluations, and general invalidation of their experiences.
Eating Disorders
Autistic individuals, particularly women and non-binary people, have elevated rates of eating disorders, sometimes related to sensory issues with food, need for control, or co-occurring body dysmorphia.
Sleep Disorders
Many autistic people experience sleep difficulties, including insomnia, irregular sleep-wake patterns, and difficulty with sleep transitions, which can exacerbate other mental health conditions.
Recognizing these co-occurring conditions is essential because they require treatment alongside an understanding of how they interact with autism. Our individual therapy services are designed to address the whole person, not just isolated symptoms.
Anxiety and Autism
Anxiety is perhaps the most common mental health challenge for autistic people, and it makes sense why. The world is unpredictable, overwhelming, and often doesn't accommodate neurodivergent needs. Social interactions require constant analysis and translation. Sensory environments can be painfully overwhelming. Changes to routine can feel deeply destabilizing. All of these factors contribute to chronic anxiety.
For autistic individuals, anxiety might manifest differently than it does in neurotypical people. You might experience increased stimming (self-stimulatory behaviors like hand-flapping, rocking, or repeating sounds), greater need for routine and sameness, heightened sensory sensitivities, or more difficulty with tasks that require executive function. Some autistic people shut down or go non-verbal when anxious, while others might have meltdowns when overwhelmed.
It's also important to distinguish between autism traits and anxiety symptoms. For example, preferring routine and sameness is a core autism trait, but when change causes extreme distress that interferes with daily functioning, that's anxiety. Stimming is a helpful self-regulation tool for many autistic people, but if it's driven primarily by fear or panic, anxiety might be the underlying issue.
Treating anxiety in autistic individuals requires understanding these nuances. Traditional exposure therapy, for instance, might not be appropriate if the anxiety is due to genuine sensory overwhelm rather than an irrational fear. Instead, accommodations (like noise-cancelling headphones, sunglasses for bright lights, or clear schedules) might be more effective than trying to habituate to painful stimuli. Our anxiety treatment adapts evidence-based approaches to work with neurodivergent brains.
Depression in Autistic Adults
Depression in autistic adults often stems from years of being misunderstood, rejected, or forced to suppress your authentic self. Many autistic people describe the exhaustion of "masking," constantly monitoring and adjusting your behavior to appear more neurotypical. While masking can sometimes be a useful skill, doing it constantly is unsustainable and contributes to burnout and depression.
Autistic depression might look different from typical presentations. Instead of appearing visibly sad, you might experience increased executive dysfunction (difficulty with tasks that were previously manageable), loss of interest in special interests that usually bring joy, increased sensory sensitivities, or greater difficulty with social interactions. Some autistic people describe their depression as a flatness or numbness rather than sadness.
There's also the issue of "autistic burnout," a state of physical, emotional, and mental exhaustion that results from the cumulative stress of navigating a neurotypical world. Burnout can look a lot like depression but may require different approaches to recovery, including reducing demands, increasing accommodations, and allowing yourself to be more authentically autistic rather than constantly masking.
Social isolation contributes significantly to depression in autistic adults. Many autistic people struggle to find community and genuine connection, especially if they were late-diagnosed and spent years feeling like they didn't quite fit anywhere. The good news is that connecting with other neurodivergent people, whether in person or online, can be incredibly healing. Our depression treatment helps autistic clients address both the symptoms and the underlying causes of depression.
Treating Mental Health in Autistic Individuals
Mental health treatment for autistic people needs to be adapted to honor neurodivergent ways of processing, communicating, and experiencing the world. Here are essential approaches for effective, neurodivergent-affirming mental health care:
1. Start with Neurodivergent-Affirming Principles
Therapy should view autism as a difference, not a disorder to be fixed, focusing on building skills while honoring your authentic autistic self rather than teaching you to appear more neurotypical.
2. Provide Clear Communication and Structure
Many autistic people benefit from direct, literal communication, clear expectations about therapy structure, written summaries of sessions, and explicit discussion of therapy goals rather than abstract, ambiguous conversations.
3. Address Sensory Needs in the Therapeutic Environment
Creating a sensory-friendly therapy space means offering options for lighting, comfortable seating, fidget tools, and understanding if you need to stim, move, or look away during sessions.
4. Adapt Cognitive Behavioral Therapy (CBT)
Standard CBT can work well for autistic people when modified to account for concrete thinking styles, including more visual tools, worksheets, and clear examples rather than abstract concepts.
5. Incorporate Special Interests
Using your special interests as a bridge to discuss difficult topics, as motivators for practicing skills, or as regulation tools honors what brings you joy and engagement.
6. Address Masking and Authenticity
Good therapy helps you understand when masking serves you versus when it's harming you, developing sustainable strategies that honor your neurodivergent needs while navigating a neurotypical world.
7. Include Practical Support and Advocacy
Effective therapy for autistic adults often includes help with executive function strategies, workplace accommodations, communication with family members, and connecting with the neurodivergent community.
At Be Seen Therapy, our therapists understand that what works for neurotypical clients may need significant adaptation for neurodivergent individuals. Our evidence-based therapies are modified to work with autistic brains rather than against them.
The Impact of Late Diagnosis
Many people, especially women, non-binary individuals, and people of color, don't receive an autism diagnosis until adulthood. This late discovery can be both validating and destabilizing. Suddenly, your entire life makes sense in a new context. All those times you felt different, struggled socially, or couldn't understand why things that seemed easy for others were so hard for you finally have an explanation.
Late diagnosis often brings a complex mix of emotions: relief at finally understanding yourself, grief for the accommodations and support you didn't receive, anger at a system that missed your autism (often because you were "too smart," "too social," or "too female" to fit stereotypes), and confusion about what this means for your future.
Processing a late autism diagnosis is important work. It often involves reframing your entire life story through a neurodivergent lens. Experiences you blamed yourself for, relationships that failed, jobs you couldn't keep, all of these can be understood differently when you recognize that you were an undiagnosed autistic person trying to navigate a neurotypical world without support.
Some people experience what's called "diagnosis grief" or the "mourning period" after a late diagnosis. This might include grieving the childhood you didn't have, the support you deserved but didn't receive, or even the neurotypical life you thought you were supposed to be living. This grief is valid and deserves space to be processed with support from someone who understands.
Late diagnosis also raises questions about disclosure. Do you tell people? How do you explain it? What accommodations do you need now that you understand yourself better? These are individual decisions with no right answers, but having support as you navigate them is helpful. Our therapists provide compassionate support for processing late diagnosis and all the changes it brings to your self-understanding.
Honoring Neurodivergence in Mental Health Care
Mental health challenges are common among autistic individuals, but they're not inevitable or untreatable. With neurodivergent-affirming care that addresses both your autism and your mental health needs, healing and thriving are absolutely possible. The key is finding providers who understand that autism isn't something to be fixed but rather honored while addressing the mental health conditions that may co-occur.
At Be Seen Therapy, we're committed to providing care that sees and celebrates your neurodivergent identity while supporting your mental health. Whether you're dealing with anxiety, depression, trauma, or navigating couples therapy where one or both partners are neurodivergent, we offer LGBTQ+ affirming and neurodivergent-affirming care that honors all aspects of who you are. You deserve mental health support that works with your brain, not against it.
At Be Seen Therapy, we believe that you are meant to be seen, heard, and validated on your healing journey. If you're ready to take the next step toward growth and transformation, we're here to support you; contact us today to schedule your consultation.
