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Is PTSD Inevitable for People with Asperger’s ?

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A senior clinician who also works with Asperger’s and NLD clients told me that he feels most of his clients have PTSD. That sounds like an extreme, even surprising statement, but it’s probably true. PTSD results from trauma, and most people with spectrum social, sensory and processing traits experience childhood trauma – bullying, rejection and the constant message that they’re wrong and inadequate. For many, the trauma of these repeated experiences can be extreme.

There is what’s called a “double empathy” problem – people who consider their processing normal (neurotypical)  don’t “get” people with different ways of processing and communicating their experiences; those with Asperger’s or those who have neurodivergent ways of processing don’t “get” neurotypical communication. There’s a 2 way gap of understanding. Most people expect those with Asperger’s to put in all the effort of making communication work. People with Asperger’s are taught “normal” social skills and social understanding so they can use neurotypical behavior. They are told that their expressive communication and behavior are wrong and they must change themselves to fit in. Many people with Asperger’s or who are neurodivergent in other ways are made to feel like they’re broken and unskillful “normal” people. 

Asperger’s individuals are deeply sensitive and committed to truthfulness; having to fake responding goes against their very nature. The pressure to conform is enormously stressful and takes constant self-checking. Even when they try to fit in, many with Asperger’s can still seem quirky and different and experience harassment and rejection. Behavior such as lacking expected facial expression, missing social cues and nuances, misunderstanding interpersonal dynamics and stimming all can be evident. Most people with Asperger’s don’t “get” small talk, jokes, teasing and the “white lies” considered normal. “Nice to see you” is simply confusing; many with Asperger’s say they never know where they stand with those whose behavior is neurotypical. Their truthfulness and task orientation is seen as blunt and rude. 

Peers, teachers, employers and coworkers can all be experienced as bullying. This experience of rejection  and even threat has physiological as well as psychological effects. Stress is the perception of a situation that is beyond one’s coping skills.  There is a strong innate physiological response to stress, called the fight or flight response, that involves not only emotions but also the entire autonomic nervous system. Chronic stress results in what’s called a pathological stress response, when the autonomic system never returns to baseline measures and reactions become more pronounced over time. Repeated high levels of stress and the psychological perception of threat can be similar to the experience of abuse. High rates of depression and suicidality among autistics are common, related both to their past experiences and to their negative anticipation of the future.

Changes are beginning to happen, although change doesn’t happen as quickly as we would want. Rejection in school is a significant early trauma that needs to be addressed. There is increasing focus on the importance of social and emotional learning in schools, an awareness that the way the school community interacts in supporting each other has a significant effect on not only the mental and physical health of students, but also on academic achievement.  Hopefully, understanding and support of neurodiversity will be a part of this increased awareness and the level of trauma experienced by those with Asperger’s or who are neurodivergent in some way will be reduced.

Some colleges have programs providing support for students with autism. In specialized colleges and in academic majors students with Asperger’s can find common ground with other students who share their interests. Students with autism can excel in the areas of study reflecting their strengths if accommodations are made for social and academic differences. Some colleges welcome students who are “quirky” but creative. Differences of all kinds, whether racial, ethnic, gender or neurodiversity, are all gradually finding increased levels of acceptance.  The graph portraying acceptance is not a straight line of improvement; our political and national cultural variations obviously have an impact.

Increasingly, employers are valuing having Asperger’s employees. According to several articles, a number of large employers have initiatives to hire individuals on the autism spectrum. SAP, Microsoft, EY, and JPMorgan Chase belong to the Autism @ Work Employer Roundtable. These companies have put in place autism hiring programs for over a year and have seen their businesses benefit from spectrum employees. They want to work together to increase the employment rate for individuals on the autism spectrum (Reuters, 2019). HP, Salesforce, Towers Watson, Deloitte, Dell, and Google are among the other corporations that have programs in place. While individuals on the autism spectrum have strengths in many fields, most of these recruiting efforts have concentrated on technical positions. Positions that benefit from employees’ expertise in areas of interest, attention to detail, high standards, commitment and creative insight can all benefit from Asperger’s employees.

The training of mental health professionals can be better attuned to diagnosing autism and to potential PTSD as a result of early experience. Treatments for PTSD such as EMDR can be researched to see the benefit for patients on the autism spectrum. Certain types of cognitive work focus on trauma, although the process needs some modification for patients with Asperger’s. Neurobiofeedback is showing some promise in research involving autistic patients. Recognition and support from better educated mental health professionals could play a significant role in helping Asperger’s individuals understand and value themselves. And understanding and acceptance from general society could also reduce the trauma these individuals experience, so that they can share their unique perspectives and skills.




Is PTSD Inevitable for People with Asperger’s ?

Marcia Eckerd, Ph.D.

Psychologist since 1985, serving on CT ASD Advisory Council, Professional Board SmartkidswithLD

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APA Reference
Eckerd, M. (2019). Is PTSD Inevitable for People with Asperger’s ?. Psych Central. Retrieved on August 4, 2020, from


Last updated: 27 Jun 2019
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