Autism in Adults: How Trauma Affects Interoception and Anxiety

In Brief

• Autistic individuals experience higher rates of lifetime trauma exposure, with increased vulnerability associated with trait intensity, intellectual disability, and gender. 
• Trauma exposure is associated with higher risk of substance use disorder in autistic youth, who report using substances to help manage autistic traits, mental health symptoms, or the challenges of substance use in their environment. 
• Trauma may contribute to disrupted interoception in autism, which can be linked to anxiety, emotional dysregulation, and differences in pain and body awareness.
• Using gentle language, multimodal communication, safety education, and individualized therapies support better outcomes. 

Is Trauma Risk Higher for Autistic Adults and Teens?

Experts sometimes say autism is “the blind spot in mental healthcare”—perhaps because access to care can be difficult and mental health challenges are so common among autistic individuals. The prevalence of trauma may be another reason.

Research makes it increasingly clear that autistic teens and adults experience more traumatic events than their neurotypical peers do, including physical and sexual assaults. They are also more likely than the general population to experience income insufficiency and parental divorce (Wiggins et al., 2025).  

Studies show a strong connection between the intensity of a person’s autistic traits and the amount of trauma they’re likely to experience across the life span (Quinton et al., 2025). For those with co-occurring intellectual disability, the risk of experiencing maltreatment, including domestic violence, increases (Palmer & Dvir, 2024).

The risk of abuse is also higher for autistic girls and women, and for autistic people who are gender diverse. What makes the challenges of trauma even more difficult is that many are socialized to respond to maltreatment with “social desirability, superficial adaptivity, and dissociation” (Cooke et al., 2025). 

Infographic

Is it Autism, Trauma, or Both?

Discover how autism and trauma can overlap—and why understanding the differences matters—by exploring this evidence-based infographic designed for clinicians, educators, and caregivers seeking clearer diagnostic insight.

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How Does Trauma Affect Body Awareness?

When trauma and autism co-occur in childhood, the effects of chronic stress can persist into adulthood. One common result is a disruption in the ability to perceive, understand, and trust your own body’s signals. That could include anything from realizing your heart is racing because you’re anxious to sensing that you need to eat a meal or use the restroom.  

Just as autistic individuals can have unique needs when it comes to processing external sensory information, they may also process internal sensory information differently. Some people are less equipped to sense and interpret body signals. Others may be extremely sensitive to them. And still others may misinterpret body signals they perceive. These interoceptive differences might explain greater or lesser pain thresholds, for example. This field of study is emerging, and researchers are still learning about the pathways and mechanisms involved.  

In studies, people with a history of childhood trauma tended to disregard their body’s internal signals—a kind of body dissociation or separation. Researchers think this tendency to avoid or ignore internal states and needs could lead to emotional dysregulation (Schmitz et al., 2023).  In one small Japanese study, researchers found that autistic children who had experienced abuse had lower interoceptive abilities (and lower tactile sensitivity, too) (Ide-Okochi et al., 2024).  

Among autistic teens, interoceptive difficulties can lead to anxiety in two different ways. When teens are less attuned to their body’s signals, they may not recognize that they’re feeling anxious, and therefore they may be less able to regulate it. Teens who are overly sensitive to their inner states and signals may feel overwhelmed by the sensations, leading to anxiety (Kiera et al., 2025). The relationship between interoception and anxiety is a two-way street: just as disrupted interoception increases anxiety, anxiety can make it harder to detect and accurately interpret body signals.

Read more about interoception and neurodivergence here.  

Does Trauma Raise the Risk of Substance Use Disorder in Autistic Adults?

The short answer is yes. When an autistic young person has a history of trauma exposure, the risk of substance use disorders increases. If an autistic teen with mental health concerns is placed in an out-of-home care facility, the risk of substance use doubles (Garcia et al., 2025).  

In one study, researchers asked autistic teens to share the reasons they used substances. Of the teens who could identify a specific reason, many said they did so either to manage autistic behaviors or to cope with mental health symptoms, including symptoms related to trauma (Weir et al., 2021).  

For some, their own use of substances isn’t the problem; difficulties come from other people’s substance use patterns. Among autistic teens, conduct problems have been linked to living with someone who has an alcohol or drug use problem (Wiggins et al., 2025).  

Can Trauma Lead to Long-Term Anxiety and Depression?

It’s important to note anxiety and trauma are common among autistic individuals, even when they don’t have significant trauma histories. But when autistic teens experience violence, there are lasting effects—including brain changes and disruptions in daily functioning. Mental health challenges often increase.    

Researchers say “white matter disruption, mental health issues (e.g., anxiety, depression, PTSS, suicidal thoughts and behavior, and lower self-esteem), and behavioral concerns (e.g., conduct issues, noncompliance, and trauma-response strategies)” are more common in autistic teens who have experienced violent trauma (Cooke et al., 2025). 

How to Talk About Autism and Trauma

Clinicians who work with autistic teens and young adults with trauma histories recommend these communication strategies. 

1. When writing reports, consider gentler alternatives when referring to trauma. In one Australian study, researchers said clinicians replaced the word “trauma” with other terms such as “complex background,” “challenging family history,” “difficult family environment,” or “disrupted attachment” (Kalisch et al., 2025).
2. Develop social narratives as learning tools. These narratives present examples of social interactions as observational learning opportunities. Some practitioners recommend using them to build capacity for understanding other people’s non-verbal social communication. In a 2025 study, autistic adults got closer to the goals they set for themselves when they based their behavior on social narratives they recorded for themselves (Camilleri et al., 2025).
3. Explore a variety of communication methods. If you’re giving instructions or communicating important information, you may want to ask the individual to repeat things in their own words. Visual schedules, first-then instructions, and object symbols may be useful. Sarcasm and metaphorical language aren’t recommended.
4. Teach personal safety strategies. Because many autistic teens experience physical or sexual violence one or more times, early safety education should include teaching about boundaries and recognizing abusive behavior (Cooke et al., 2025).  
5. Support and promote interoceptive abilities. Researchers think this skillset could improve the mind-body connection for those who have had trauma (Ide-Okochi et al., 2024).
6. Consider recommending trauma-focused therapies. There is some evidence that cognitive behavioral therapy (CBT) or eye movement desensitization reprocessing (EMDR) can help restore some adaptive functioning if they’re pursued soon after traumatic events, as in the case of autistic survivors of traumatic experiences such as natural disasters (Palmer & Dvir, 2024).

Key Messages

From early childhood through adulthood, autistic individuals have a higher risk of exposure to trauma. For many people, trauma disrupts the ability to notice and accurately interpret their own body signals. Prolonged exposure to trauma can also lead to chronic stress, anxiety, depression, and substance use disorder.  

Practitioners can help by communicating gently in ways that work for each person, whether that’s through conversation or using visual aids and other assistive tools. Practitioners can help prevent maltreatment by educating teens and young adults about body awareness, personal boundaries, manipulation, and abuse, using social narratives and research-backed therapy when appropriate. 

Read parts one and two of this series:

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