Dissociation in

Autism Spectrum Disorders:

An Under-Recognized Symptom
by Katherine E. Reuben, MPH, and Ayden Parish

Autism is a pervasive neurodevelopmental disorder primarily affecting social

communication, cognition, and sensory perception. Autistic individuals tend to struggle with

nonverbal communication, and many struggle with verbal language as well. Cognitive

differences can include highly focused interests and executive dysfunction, and autism often

co-occurs with attention deficit hyperactivity disorder (ADHD) or learning disabilities.

Recently, attention has begun turning towards the sensory differences reported by autistic

individuals, which may include experiencing certain sensations as overwhelming or even

painful, having difficulty processing streams of sensory information, and seeking out certain

sensations as particularly pleasurable or fascinating. Autism can be diagnosed at any age, and

indeed, with the rising awareness of autism over the past decade, many adults are now

finding themselves with a new label for their lifelong feelings of alienation and difference. As

a difference in neurology, autism cannot be "cured," and many autistic individuals find the

idea of curing their neurological differences undesirable and offensive. Nevertheless, autistic

traits tend to lead to difficulties and disability in engaging with society.

There are reasons to believe that dissociation is a common experience for individuals

with developmental disorders and particularly autism. Several risk factors for dissociation,

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such as anxiety and trauma, are known to be elevated in autistic populations. Further,

dissociative symptoms are reported by many autistic adults in online forums, social media,

and blogs. Preliminary research supports that dissociation is a common experience for autistic

individuals, especially those that have experienced trauma. This may have important

implications for working with the symptoms and coping mechanisms that autistic individuals

find relevant to their daily life.

This chapter draws particular attention to the lived experiences of autistic individuals.

Often, research on autistic individuals comes from a neurotypical – that is, non-autistic –

perspective. Not only are these perspectives less likely to be relevant to the lives of autistic

individuals, but they may prove actively stigmatizing by presenting a deficit-focused model of

autism. Additionally, autism research and narratives have historically focused primarily on the

impacts on and reactions of neurotypical family members. This chapter strives to prioritize

the perceptions and needs of autistic individuals in a respectful and collaborative manner. To

that end, both authors are themselves autistic, and the chapter highlights the narratives

provided by other autistic individuals collected as part of a survey on autism and dissociation.

Risk Factors
ANXIETY
Anxiety is common among autistic individuals, affecting between 11% to 84% (see

Steensel et al., 2011). 20% to 57% of autistic youth have been reported to have symptoms of

social anxiety specifically (see Wood & Gadow, 2010). The true prevalence is hard to estimate

because of a lack of measures validated for this population (Wood & Gadow, 2010) and

because some anxiety diagnoses require that an autistic individual have anxiety beyond what

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might be considered typical for the disorder. General, social, and separation anxiety are to an

extent typical features of autism (Steensel et al., 2011).

Anxiety is often associated with dissociation. Depersonalization and derealization are

common when individuals with social anxiety disorder are under acute social stress

(Schweden et al., 2016) and can be found alongside anxiety in both clinical and non-clinical

populations, especially in cases involving panic (Nestler et al., 2015). In fact, anxiety has been

theorized to be a key component of depersonalization and derealization (Holmes et al., 2005).

Regarding autism specifically, depersonalization and derealization have been found to

accompany anxiety in 18% of autistic youth (Storch et al., 2012).

TRAUMA AND POSTTRAUMATIC STRESS

Trauma is known to be a possible cause or risk factor for all possible expressions of

dissociation. Severe or chronic trauma, especially child abuse, is recognized as a major or even

primary cause of the most severe manifestations of dissociation, such as identity alteration

and dissociative amnesia. Dissociation immediately following trauma is common and predicts

later symptoms of posttraumatic stress, and many trauma-focused researchers view

posttraumatic flashbacks as inherently dissociative (Holmes et al., 2005; Spiegel et al., 2011;

Steinberg, 2000; Van der Hart et al., 2006). Likewise, dissociation significantly correlates with

posttraumatic stress in autistic adults (Reuben, 2022).

Traumatic experiences are unfortunately very common for autistic individuals. Much

research has been done on autistic social isolation, lack of caregiver attunement, and peer

rejection and harassment. However, autistic adults and especially children are also at an

increased risk of neglect, abuse, and assault, including from parents, other family members,

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disability caregivers, peers, intimate partners, and unknown individuals (Baladerian et al.,

2013). This is especially concerning because interpersonal trauma is a better predictor of

posttraumatic stress than traumas such as natural disasters or accidents (Breire et al., 2016;

Lilly & Valdez, 2016) and is a particularly severe risk factor for dissociation (Holmes et al.,

2005; Spiegel et al., 2011; Steinberg, 2000; Van der Hart et al., 2006). This correlation between

interpersonal victimization and dissociation has also been found in autistic adults (Reuben et

al., 2021).

Disabled individuals in general experience higher rates of interpersonal trauma

(Baladerian et al., 2013; Cohen et al., 2006; Hughes et al., 2011; Mitra et al., 2011; Roberts et

al., 2015; Smith, 2008). Child maltreatment may be increased because of high levels of

parental stress, frustration with the child’s disability, or financial strain. Peer rejection and

harassment can occur in response to cultural disability stigma. As an adult, the disabled

individual may be at higher risk because of their lower socioeconomic status and reduced

independence. Predatory individuals may also perceive the disabled individual as more

vulnerable and therefore an appealing target (Fisher et al., 2013; Hoover & Kaufman, 2018;

McDonnell et al., 2019; Pfeffer, 2016; Roberts et al., 2015; Weiss & Fardella, 2018).

Autistic individuals face additional risks. Due to differences in social communication,

autistic individuals often have a difficult time forming close friendships which might otherwise

be protective. They may also struggle to recognize when a predator means them harm.

Intellectual disability or uneven cognitive profiles, which are common in autism, may worsen

difficulties recognizing ill intentions and increase perceived vulnerability. Other emotional or

behavioral challenges may also increase the individual’s alienation from potential sources of

protection, perceived vulnerability, and likelihood of ending up in risky situations. This is true

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even for individuals who do not meet the full criteria for an autism spectrum disorder (ASD)

diagnosis but have autistic traits or other associated risk factors (Chan et al., 2018; Fisher et

al., 2013; Haruvi-Lamdan et al., 2020; Hoover et al., 2018; Holtmann et al., 2007; Kerns et al.,

2015; McDonnell et al., 2019; Paul et al., 2018; Roberts et al., 2015; Rumball et al., 2020;

Schroeder et al., 2014; Weiss & Fardella, 2018).

The types of interpersonal trauma that autistic individuals are vulnerable to are varied.

44%–97.8% of autistic children are bullied; contrary to common perception, this victimization

may be complex and involve prolonged harassment, property theft or destruction, or group

assault. It is also commonly repeated, with almost half of autistic people reporting being

bullied 10 or more times (Baladerian et al., 2013; Chan et al., 2018; Griffiths et al., 2019;

Hellstrom, 2019; Maïano et al., 2016; Paul et al., 2018; Rose et al., 2015; Schroeder et al.,

2014; Weiss & Fardella, 2018). Autistic children are more likely to have reported and

substantiated maltreatment (50.4%–80%) compared to neurotypical children, especially

autistic children with co-occurring intellectual disability. They have been found to have higher

rates of physical abuse (18.5%–57.8%), emotional or verbal abuse (62.2%–79%), and sexual

abuse (2.8%–30%) (Baladerian et al., 2013; Chan et al., 2018; Gotby et al., 2018; Griffiths et

al., 2019; Hellstrom, 2019; Mandell et al., 2005; McDonnell et al., 2019; Pfeffer, 2016).

Conventional crime victimization is also a problem for many autistic children (56.4%–90.9%),

as is witnessing violence (30%) (Hellstrom, 2019; Weiss & Fardella, 2018).

Autistic adults also report high rates of sexual violence (24.4%–78%), physical assault

(34%–56%), bullying (60%–70%), and emotional abuse from partners (39%) (Brown-Lavoie et

al., 2014; Griffiths et al., 2019; Haruvi-Lamdan et al., 2020; Reuben et al., 2021; Weiss &

Fardella, 2018). In particular, Brown-Lavoie et al.’s (2014) study of autistic adults found that

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they were 2 to 3 times more likely to report unwanted sexual contact, sexual coercion, and

rape compared to neurotypical adults. Another study by L. Platt et al. (2015) surveyed 350

developmentally disabled adults and found that 63.7% of men and 68.2% of women reported

having experienced abuse as an adult. Reuben et al. (2021) also found that autistic women

and gender minorities reported especially high rates of sexual victimization.

Because of the high rates of trauma that autistic individuals experience, it should be

no surprise that they also describe high rates of posttraumatic stress. Studies have found that

16% to 19% of autistic adults report being diagnosed with posttraumatic stress disorder

(PTSD; Griffiths et al., 2019; Reuben et al., 2021), and between 32% and 60% of autistic adults

meet criteria for PTSD when screened (Haruvi-Lamdan et al., 2020; Reuben et al., 2021;

Rumball et al., 2020). Autistic children have also been found to have more severe

posttraumatic stress compared to neurotypical children (Paul et al., 2018; Mehtar &

Mukaddes, 2011), although this is not always the case for studies that rely on parent reports

(see Brenner et al., 2018).

Even at non-clinical levels, autistic traits predict posttraumatic stress following a

trauma (Haruvi-Lamdan et al., 2019, 2020; Roberts et al., 2015). The same social

communication differences that make autistic individuals vulnerable to interpersonal trauma

can also leave them without support to assist with their healing. Cognitive differences can

make the trauma harder to understand, and mental health and emotional regulation

difficulties can also exacerbate posttraumatic stress (Chan et al., 2018; Haruvi-Lamdan et al.,

2020; Hoover et al., 2018; Holtmann et al., 2007; Kerns et al., 2015; McDonnell et al., 2019;

Paul et al., 2018; Roberts et al., 2015; Rumball et al., 2020; Schroeder et al., 2014; Weiss &

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Fardella, 2018). However, this is an under-recognized connection, and PTSD is not often

assessed for in autistic individuals (Kerns et al., 2015; Kildahl et al., 2019).

DISABILITY STIGMA AND SHAME

Trauma is not the only risk factor that can arise from societal responses to autism.

While threats to survival and wellbeing are important, there are other more common (and

commonly overlooked) experiences that can also heavily shape the autistic individual’s view

of the world and themself. Disability stigma is one such experience that can be communicated

either independently or as part of traumatic experiences (e.g., bullying that is focused on an

individual’s autism). An important outcome of disability stigma is shame.

Unlike fear, which may result from violence and threats of harm, shame is strongly

associated with degradation, boundary violations, and social isolation. Individuals may feel

shame not only for what others have done to them but also for who they are. Shame, along

with dissociation, is a key symptom of complex PTSD, which results from interpersonal trauma

(Dorahy et al., 2013; Herman, 2011; Van der Hart et al., 2006), and both shame and

dissociation are predictors of posttraumatic stress severity. Additionally, individuals with

clinical levels of dissociation have more trait and state shame (Dorahy et al., 2013).

In addition to reducing the pain and disruption associated with posttraumatic stress

itself, dissociation has also been theorized to reduce posttraumatic shame. However,

dissociation may additionally co-occur with shame to shift an individual’s focus away from

traumatic events (e.g., to direct attention and blame internally). This can help to preserve

functioning, especially when the trauma is high in betrayal and the relationship with the

perpetrator is one that the individual needs to preserve (M. G. Platt et al., 2017). Although

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not necessarily traumatic, disability stigma may create a similar incentive to focus inward and

dissociate, particularly when the shame originates from caregivers.

Overt and Covert Discrimination. A majority of autistic individuals experience

bullying during childhood and adulthood. Some of this bullying is likely focused on the traits

and behaviors of the autistic individual, while some of it may be motivated by the ASD

diagnosis itself. Aubé et al. (2021) found that when shown short videos of autistic children

and typically developing children, elementary school children rated the autistic children more

negatively and wanted to interact with them less. While this effect decreased in higher

grades, the desire to avoid autistic children as measured through an implicit attitudes task did

not, which the authors thought might be a particular risk for anti-autistic microaggressions.

In addition to peers, autistic individuals may face discrimination from caregivers,

teachers, medical professionals, and even strangers. Griffiths et al. (2019) report on a variety

of forms of discrimination experienced by professionally diagnosed autistic individuals,

including schools refusing requested accommodations, employers overlooking the individual

for employment or promotions despite the individual’s qualifications and training, and

acquaintances tricking or pressuring the individual into breaking the law or giving someone

else money or possessions. While some of these experiences may have happened regardless

of the individual’s diagnostic status (i.e., may have been motivated by perceived traits of the

autistic individual as opposed to knowledge of the individual’s ASD diagnosis), others may

have been directly motivated by stigma.

Laina Eartharcher, an autistic woman writing under a pseudonym, has used her blog

to discuss experiences that she and others have had in which their competence was

questioned or others talked down to them only after their autism was disclosed. One of her

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blog posts also discussed how autism is often described with pathologizing language, such as

calling it a “disease” or “devastating,” which can lead autistic individuals to perceive that

others view them as – or that they are – broken or defective. Comments under the post

revealed that many autistic adults related to her statements and shared similar experiences

(Eartharcher, 2017).

The Double Bind of Diagnosis. There is a surprising lack of literature on the impact

of an ASD diagnosis for the affected individual. The few existing studies on this topic highlight

immediate reactions of relief, anger, fear, and denial. On one hand, being diagnosed can

provide an explanation for one’s experiences and therefore reduce confusion and shame.

Understanding oneself as autistic provides a path for self-acceptance, whereas a lack of

diagnosis leaves room for negative self-assessments such as being “weird,” “flawed,” “failed,”

or somehow “wrong.” Similarly, a diagnosis may lead to increased support and understanding

from family members, teachers, and peers, and having a diagnosis provides the opportunity

to access necessary services and accommodations. Late-diagnosed adults in particular, who

likely sought out assessment based on their own suspicions, may experience the diagnosis as

a relief (Arnold et al., 2020; Humphrey & Lewis, 2008; Jones, 2001; Powell & Acker, 2015;

Reed & Osborne, 2012; Smith et al., 2018).

On the other hand, stigma associated with an autism diagnosis can lead to negative

feelings about oneself and the world, particularly if it leads to rejection by neurotypical loved

ones and professionals (Arnold et al., 2020). How others react to one’s autism is important to

self-conception and acceptance. One study of 20 autistic youth found that several had

negative perceptions of autism prior to their diagnosis, but others developed negative

perceptions over time because of bullying, ostracism, or being treated differently by teachers

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(Humphrey & Lewis, 2008). Concerns of stigma can lead to disidentification with the diagnosis

or attempting to hide it from others. Conversely, peer support and acceptance can lead to a

positive autistic identity (Humphrey & Lewis, 2008; Smith et al., 2018).

Unfortunately, as commonly highlighted by autistic individuals, messages about

autism come from many sources – including professionals, family members, peers, media,

and educational resources – and these messages are often very negative (Eartharcher, 2017).

Worse, these messages are often aimed at the family of autistic individuals and rarely

acknowledge the views or needs of autistic individuals themselves. For example, one woman

described a book titled Living with Autism – that was in fact aimed at neurotypical parents –

which made autism seem like an “unwanted houseguest.” She described how she thought

that the book “personified Autism… [the autistic child] has become the ‘disorder’ and is

entirely identified by it” (“Little Sparrow”, 2017). An ASD diagnosis may lead to identifying

with and being shamed by stigma towards autism, but little is known about how this impacts

autistic individuals in the long term.

More research exists on caregiver reactions to the diagnosis and highlights feelings of

frustration with the diagnostic process, fears of stigma against themselves and their children,

and fears about how autism might impact their family (Smith et al., 2018). Only half of

caregivers are satisfied with their child’s diagnostic process and the subsequent support and

information provided, and the associated caregiving stress can negatively impact the autistic

child (Reed & Osborne, 2012). In some cases, caregivers may delay disclosing the ASD

diagnosis to their autistic child, which can contribute to denial and further shame surrounding

being autistic (Smith et al., 2018; Jones, 2001). A stumbling block for both caregivers and

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autistic individuals is coming to terms with autism being lifelong (Powell & Acker, 2015; Smith

et al., 2018).

Even in the absence of a cure, many autistic people and their caregivers desire

treatment for the most difficult or distressing symptoms (Arnold et al., 2020; Humphrey &

Lewis, 2008; Jones, 2001; Powell & Acker, 2015; Reed & Osborne, 2012; Smith et al., 2018). A

late diagnosis means years or decades without support, and many struggle to get the help

that they need even with a diagnosis (Arnold et al., 2020; Powell & Acker, 2015). This, too,

may contribute to self-alienation and dissociation. However, an early diagnosis of ASD may

lead to the child undergoing applied behavioral analysis (ABA), which many autistic people

have reported contributed to their sense of shame, self-alienation, and self-loathing.

Although ABA can be combined with other therapies to help autistic individuals cope with

stressors without resorting to potentially dangerous behaviors, it is often used to train autistic

children to look more “normal” (i.e., neurotypical). This involves using intense behavioral

conditioning to discourage unconventional but harmless autistic traits as well as to encourage

behaviors that society privileges but which may be experienced as extremely aversive or even

painful to the child. Some autism researchers have theorized that ABA might interfere with

identity formation because of tension between the conditioning and the individual’s natural

self. An emphasis on compliance may also leave the autistic child unable to say no and

vulnerable to future abuse (Kupferstein, 2018; McGill & Robinson, 2020; Wilkenfeld &

McCarthy, 2020).

Masking. Stigma and internalized shame cause many autistic individuals to try to

camouflage or “mask” their autistic traits. They may copy neurotypical individuals’ speech,

dress, body language, and facial expressions as well as try to hide their reactions to

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overwhelming or aversive sensory stimuli in an attempt to be accepted by others. Masking

can contribute to feeling disconnected from or confused about one’s true self. It is exhausting

and may require engaging in dangerous behaviors (e.g., disordered eating or substance

misuse) to maintain. At worst, it may result in suicidality (Bradley et al., 2021; Miller et al.,

2021). Masking may be closely related to dissociation for some autistic individuals.

Autistic Burnout. Discrimination and attempts to mask can contribute to “autistic

burnout,” an experience often described by autistic adults in which an accumulation of life

stressors and insufficient support lead to chronic exhaustion, loss of skills, and reduced

tolerance to sensory stimuli. A key precursor of autistic burnout seems to include

unattainable expectations placed on the autistic individual, such as demands that the autistic

individual camouflage or mask their autism, expose themself to aversive sensory stimuli, or

engage in unwanted amounts of socialization. All of these may be driven by society’s refusal

to respect the needs of autistic people and the subsequent internalization of the idea that the

autistic person is not allowed to maintain boundaries (Raymaker et al., 2020).

Many autistic people report that a lack of ability to maintain previous levels of

functioning induces shame (Raymaker et al., 2020). This may be associated with dissociation,

which may in turn worsen burnout by making it difficult for the individual to connect with and

respond to their emotional and physiological needs. On the other hand, dissociation may also

be a coping mechanism utilized by some autistic individuals to create distance from intense

feelings and overstimulation that could otherwise lead to a loss of functioning.

Attachment Disruptions. Autistic traits may be recognized as early as 12–18 months

(Szatmari et al., 2016), and severity of autism symptoms predicts lower attachment security,

fewer prosocial responses to caregivers, and poorer parent-child interactions. Secure

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attachment, which 47% of autistic children do achieve, is conversely associated with improved

behavior. Both parental sensitivity and insight into their child’s needs promote secure

attachment. Unfortunately, not only can autism make it more difficult for the child to

understand their parent, but the child’s atypical communication can make it harder for the

parent to understand and respond to their child. Additionally, parents may feel disconnected

from their autistic child due to the child’s difficulties with eye contact, conversation, and

physical contact as well as due to the stress of raising a disabled child (Teague et al., 2017).

Parents of autistic children often face discrimination and exclusion by their

communities (Gray, 2020; Kinnear et al., 2016; Liao et al., 2019). Additionally, a lack of

sufficient support and resources for coping with their child’s symptoms can lead to high levels

of stress and depression (Zaidman-Zait et al., 2017). These stressors can increase the

perceived difficulty of parenting, reduce parenting quality, increase child behavioral

problems, and potentially interfere with the parent-child relationship (Kinnear et al., 2016;

Osborne & Reed, 2010; Zaidman-Zait et al., 2017). This is troubling because even subtle

emotional unavailability and attachment disruptions as early as infanthood are important

predictors of dissociation later in life (Lyons-Ruth et al., 2009).

Unfortunately, the disconnection between parent and child may not remain subtle.

When increased parental stress is combined with anti-autistic stigma, this may lead to

parental embarrassment, social withdrawal, and associating the child with public shaming, all

of which the child might internalize. The child might be further negatively affected if the

parent expresses covert resentment or openly blames the child for making their life more

difficult. Given the high rates of maltreatment experienced by autistic children, it is likely that

for many parents, these stressors lead to a cycle of the parent taking out their frustration on

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their autistic child, the child’s behavioral problems escalating as a result, and the parent

responding with more frustration and maltreatment. This cycle might be very hard for the

family to break without external help, which is generally not available.

ABSORPTION AND FANTASY PRONENESS

Absorption refers to one’s ability to become “absorbed” in fantasy and imagination.

While it is unclear to what extent absorption may itself be considered an inherently

dissociative experience (see Holmes et al., 2004), studies point towards an association

between absorption and other more centrally dissociative factors, such as

compartmentalization, as well as with psychopathology more generally (Levin & Spei, 2004;

Soffer-Dudek et al., 2015). Fantasy proneness, a related construct, refers to the trait of being

drawn to immersive inner fantasy, with highly fantasy prone individuals being inclined

towards spending long portions of time engaging in daydreaming or other fantasy-based

activities like roleplaying. This, too, shows some correlation with dissociative experiences

more generally (Merckelbach et al., 2021).

The stereotypical image of autism is one of a “genius without imagination” (Quirici,

2015). That is, autistic individuals have been typically viewed as having a somehow deficient

capacity for imagination and creativity. However, attention to autistic individuals’ own

narratives uncovers the important role of fantasy and imagination for many. In her study of a

summer camp for autistic youth, Fein (2020) argues that these youth identified strongly with

fictional characters from literature, video games, and their own creation, to the extent that

these fantasies organized how they related socially to one another. These fantasy worlds can

further prove deeply personally meaningful for the individual (Visuri, 2018). It may be the

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case, then, that an interest in fantasy could mediate a relationship between autism and

dissociation. Early research also indicates that autistic traits may be specifically associated

with pathological absorption in the form of maladaptive daydreaming (West et al., 2020).

Previous Research
Despite these reasons to believe that autistic individuals are at a higher risk of

experiencing dissociation, there is minimal existing research on this topic. Three studies have

examined dissociation symptoms in autistic youth, and two have surveyed autistic adults. Two

of the youth studies found that somatic dissociation is elevated in autistic children (Mahan &

Matson, 2011; Sukhodolsky et al., 2008). 18% of autistic youth were also found to experience

dissociation as a response to anxiety (Storch et al., 2012).

Zdankiewicz-Ścigała et al. (2021) surveyed 79 autistic adults and 126 neurotypical

adults. They found that for both groups, stronger autonomic reactivity predicted higher

somatoform dissociation, and alexithymia (specifically difficulties identifying and describing

feelings, but not a bias for external focus) mediated this relationship. This relationship was

stronger for autistic individuals, who additionally reported higher somatization.

Reuben et al. (2021) surveyed 687 autistic adults and found that 94% had at least one

clinically elevated scale on the multiscale dissociation inventory. Emotional disengagement

was the most commonly endorsed symptom, affecting 85% of participants. This was followed

by depersonalization (72%), emotional constriction (60%), derealization (59%), and memory-

related dissociation (53%). Identity disturbances were least common but still endorsed by

26% of participants. Additionally, 32% of participants scored above 35 on the 20-item

somatoform dissociation questionnaire.

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Dissociation was more severe in autistic adults who had experienced physical assault,

sexual assault, or another unwanted or uncomfortable sexual experience, which were

endorsed by 72% of the sample. 91% of the autistic adults reported having directly

experienced any kind of trauma, for an average of 3.54 unique types of traumas. Additionally,

44% of the adults screened positive for PTSD, including half of those who had experienced

assault or sexual victimization. Using the same sample, Reuben (2022) found that autistic

adults who met criteria for PTSD had significantly elevated dissociation overall and elevated

scores for each unique type of dissociation assessed. These findings support that high rates

of trauma exposure and interpersonal victimization increase the risk of dissociation in autistic

adults.

Autistic Descriptions of Dissociation

In the survey from Reuben et al. (2021), 351 autistic adults provided further narratives

about their experiences of dissociation and/or their understanding of its potential causes or

correlates. The participants were given descriptions of different types of dissociation and then

specifically asked how they felt that their experiences of dissociation might be influenced by

or interact with their autism, other neurodevelopmental disorder symptoms, anxiety, or

trauma history. They were also provided the opportunity to share anything else that they

wanted known about their dissociative experiences. These responses are still being analyzed

and will be presented in more detail in a future study; however, a preliminary analysis is

possible and highlights several key areas of interest.

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EXPERIENCES OF DISSOCIATION
Firstly, many individuals described some set of experiences that are very similar to

current understandings of dissociation’s phenomenology. That is, these autistic adults indeed

reported – not only in standardized measures but in prose – the full range of dissociative

experiences, from depersonalization and derealization to somatoform dissociation and

identity alteration. For example, one individual reports:

“It just feels like I withdraw from experiencing the outer shell of my body…

and retreat into the inside of my body that is unaffected by the outside world.

Like a little room behind my eyes, or curling up behind my heart. And I push

away too strong sensations or emotions or thoughts. I use my brain to put a wall

between myself and the harm. This happens automatically and I really struggle

with understanding how I feel.” (Cisgender woman, age range 22–25)

Others provided examples of specific, acute dissociative episodes:

“I just recently, within the month, spoke at a national conference about suicide

and I remember the beginning of my speech, my hands looking like they

belonged to someone else- and can’t remember anything after that, except for

pieces here and there of anything the rest of that day, that night and all the next

day until evening. I am told my speech was fine, I took a bus tour, had ice cream

with people, walked back to my hotel in unfamiliar streets, took a taxi to the

airport, had a lay-over and made it back to my children safely and that’s when I

can remember again.” (Cisgender woman, older than 51)

That is, dissociative experiences in autistic individuals are not radically different from

neurotypical experiences of dissociation. This may have important implications for

understanding the etiology and treatment of dissociation for autistic individuals.

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Nevertheless, responses spoke of a number of particularities to autistic dissociation, namely

the effect of autism in trauma and victimization, the influence of conflicting social

expectations, coping with sensory and/or emotional overstimulation, and possible overlaps

with typical autistic symptoms such as executive dysfunction and face blindness.

CORRELATES OF DISSOCIATION
Dissociation as a Response to Trauma. In line with previous research on

dissociation, many respondents connected their dissociation to various kinds of trauma.

“I dissociated near-constantly during a lot of my incredibly traumatic childhood.

It's hard for me to even recognize it sometimes because it feels so normal that

sometimes I would just completely blank out and not be able to think or

remember where I am or what I'm supposed to be doing or how to do basic

things. It's like moving through gel, like my brain doesn't work right.”

(Cisgender woman, age range 26-30)

Notably, several provided their understandings of how their autism led to or made

them more vulnerable to victimization:

“I feel that having undiagnosed ASD made me more vulnerable to domestic

abuse, which in turn led to dissociative amnesia and identity confusion.

Constantly being bamboozled in social situations and trying to adapt myself to

fit in has led to identity confusion and alteration. It all ties together - autistic

traits lead to me getting into traumatic situations, trying to repress/ change who

I am, getting confused... and the situations are more difficult because I'm

autistic…” (Cisgender woman, age range 22–25)

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Some further described dealing with social isolation, discrimination, and stigma as

forms of trauma that led to their dissociative symptoms:

“Strang[e]ly, the big trauma that I've had doesn't play in as much as the every

day little traumas. The isolation of being a [neurodevelopmentally disabled]

person. The little times I know I did wrong socially, but didn't have the ability

to do right. The times I've messed up at work despite my putting 110% into

being correct. Those are the situations that haunt me and make me "flash back"

or "go into the bubble.”” (Cisgender woman, age range 41–45)

Dissociation as a Response to Social Expectations. Dealing with stigma and

discrimination – whether understood as traumatic or not – often leads autistic individuals to

put great effort into masking their autistic traits. Further, autistic difficulties in understanding

social norms can make interaction with others feel confusing and unpredictable. Responses

attributed a range of dissociative symptomatology to these social difficulties. For example,

the need to suppress one’s natural behaviors and consciously present a “false front” was

highlighted as a particularly potent cause of depersonalization and derealization:

“I feel like I have to ‘fake’ a lot to appear ‘normal’, and interacting with humans

is a role playing game. This probably contributes to the feeling that none of this

is real…” (Gender unknown, age range 31–35)

“The real person I a[m], was unacceptable and punished in many ways from

many sources so I had to learn to put on appropriate personalities, retreat into

myself and watch myself “behaving appropriately” as if it was a play that I was

putting on... Most of the dissociative symptoms and post-traumatic symptoms

I’ve experienced from childhood stem from my autism being unacceptable, and

further traumatic experiences (domestic violence, unwanted sexual behaviour)

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arose because I had learned to dissociate from my real feelings and needs and

behave how other people found acceptable. Autism, and a lack of knowledge or

tolerance of it, is central to my experiences with dissociation.” (Cisgender

woman, age range 31–35)

Others described feelings of identity confusion and even identity alteration due to

never being allowed to connect with their “true self” or due to constructing “personalities”

to match others’ demands:

“I have spent many decades working hard to mask my odd behavior. This may

account for some of the [dissociated] experience[s] I have had and still have---

my simulated / emulated personality impinging on my authentic one.”

(Cisgender man, age range 51+)

“I believe my alters experience my autism to different degrees and in different

regards. For instance, one alter may be nonverbal and stim by chewing and

pulling hair and rocking, while another alter may be very charismatic,

abnormally intelligent, and only do small stims (like playing with a spinner

ring). Usually, I switch whenever a specific alter seems better-fitted to a task,

so one alter might be great for managing emotional distress, while another one

is better for socializing with peers, while another one is better for socializing

with family." (Trans man, age range 22–25)

Of note, similar experiences with identity confusion and alteration were described by Polly

Samuel (“Donna Williams”), a well-known autistic advocate who was diagnosed with

dissociative identity disorder related to the traumas she experienced as part of and in

response to her autism (Samuel, 2012).

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Dissociation as a Response to Sensory and Emotional Overstimulation. Autism is

associated with sensory processing differences such that the world is experienced by many as

overwhelmingly bright, loud, or otherwise chaotic. Emotions may also be felt as particularly

intense, and many autistic individuals struggle with emotion regulation (Mazefsky et al.,

2013). Autistic individuals describe self-stimulatory behaviors, such as rocking and pacing, as

ways to control and cope with such overwhelming sensations. Survey responses suggest that

dissociation may be another – often maladaptive – coping strategy:

“Whenever I am in sensory overload it feels like my bodily functions like

walking, reacting to people in a crowd, watching out for objects in the way while

walking are sep[a]rated from my personality so that I don't have to make

conscious decisions about it because my working memory cannot process these

AND the sensory overload. I feel dismember[ed] from my body then and can

have normal thoughts while my body functions unconsciously… I have a lot of

switches in perception of dream-like states, become unaware of my

surroundings in dissociative hyperfocus situation, I forget to eat and drink and

become overly self-absorbed.” (Nonbinary, age range 26–30)

Certain respondents further pointed towards the derealizing effects of having

different sensory experiences than those around them – especially when those experiences

were then invalidated by others:

“The world is too much and at the same time distant. I think I dissociate to cope

with the "too much" part. Also I've been denied my experiences a lot ("it can't

feel that bad") so it feels like I feel things that can't be real since nobody believes

them.” (Cisgender man, age range 36–40)

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“I feel like I'm stuck inside a body that doesn't belong to me and I struggle to

recognise as mine and I want to learn how to embody it properly, but the fact

that people won't explain to me how to use it to communicate… I have no idea

what signals this body is sending out to people.” (Nonbinary, age range 31–35)

Dissociation as Overlapping with Autistic Traits. While the survey asked

participants to reflect on the influence autism had on one’s dissociation, some respondents

seemed to struggle with disentangling these two concepts. That is, some described ways in

which autistic and dissociative symptoms seemed to overlap and complicate one another. For

example, difficulties in shifting focus between activities are understood as a symptom of

executive dysfunction, yet one respondent suggested a dissociative tint to their struggles:

“I never really thought about this until reading the "staring off into space without

thinking" item in this questionnaire earlier. At times when I'm preparing to

transition to doing some other activity, such as after waking up or when

returning to my work from a break, I sometimes do that for a minute or two. I

never considered that it might have something to do with [Asperger’s].”

(Gender unknown, age range 22–25)

Another described face blindness (an inability to recognize faces) as interwoven with their

experiences of depersonalization:

“I think my issues with depersonalization are complicated by the face blindness

issues I have--I can't recognize my face to start with, and when I'm [dissociating]

there's an added layer of su[r]reality layered over it that can make trying to look

in the mirror difficult. When looking at other people it's sort of funny--people's

face to body p[ro]portions swim in and out and look cartoonish.” (Nonbinary,

age range 31–35)

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Given the lack of research on dissociation in autistic individuals, it is difficult to say

how exactly these experiences should be classified. Further research into this topic will no

doubt uncover further intersections and elucidate the potential dissociative mechanisms

behind these individuals’ experiences.

Clinical Implications
Dissociation is common globally, especially among psychiatric patients (Cattell &

Cattell, 1974). Specific dissociative disorders can be found in 8.6% to 18.3% of individuals

within the general population (Martinez-Taboas et al., 2013). Somatoform dissociation has

been found to be especially common (Sar, 2006). However, outside of contexts in which

professionals have been specifically trained to recognize and treat dissociation, it is often

missed. A lack of awareness about dissociation in the general population, lack of professional

education about dissociation, and high rates of comorbidity with other mental health

pathology all pose major barriers to the diagnosis and treatment of dissociation (Spiegel et

al., 2011; Steinberg, 2000).

Barriers to the recognition of dissociation may be especially likely for autistic

individuals. Autism can interfere with one’s awareness of and ability to communicate about

internal states and can cause a variety of more recognizable symptoms which clinicians may

be more inclined to notice and treat. These have been recognized as barriers to diagnosing

PTSD (Kerns et al., 2015; Reuben, 2022). Additionally, Baladerian et al. (2013) found that only

55.4% of their autistic sample reported the abuse they experienced, with even lower rates of

reporting among survivors of sexual or physical violence. Although research supports that

autism increases the risk for interpersonal and complex victimizations – the traumas most

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closely associated with dissociation – this is under-recognized in practice. Finally, the lack of

knowledge of dissociation in autism may itself contribute to dissociation being overlooked in

this population, as this potential comorbidity may not even occur to clinicians.

Unfortunately, due to the lack of existing studies on dissociation in autism, it is

unknown what the most effective treatments are. At the moment, the most important clinical

recommendation is that providers who serve autistic individuals should increase screening for

trauma, posttraumatic stress, and dissociation. Additionally, trauma professionals in turn

should consider screening more clients for autism. Only once a sufficient number of

dissociative autistic individuals have been identified in clinical contexts can treatment best-

practices be established. Until then, recognition of the autistic individual’s dissociative

experiences may in and of itself be helpful through providing space for the individual to be

heard and potentially learn other ways to cope with their stressful and traumatic experiences.

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