PTSD in autistic adults: Correlates of meeting DSM-5 criteria and predictors of professional diagnosis

Psychol Trauma. 2022 Sep 29. doi: 10.1037/tra0001365. Online ahead of print.


Objective: Although many autistic adults show high posttraumatic stress, PTSD is underdiagnosed in this population. This study aims to examine correlates of autistic adults screening positive for PTSD (PTSD +) and predictors of a professional PTSD diagnosis (Diagnosis +) in the PTSD + subgroup.

Method: Self-identified autistic adults (N = 677) completed an online survey on their demographic characteristics, mental health symptoms, and trauma history. T tests and chi-squares were used to compare subgroups, and logistic regression was used to predict diagnosis status.

Results: PTSD + participants were less likely to be employed or to identify as cisgender men, had more mental health symptoms and worse functional impairment, and had experienced a higher number of traumas and more interpersonal trauma. The same was true for Diagnosis + participants, who were also older and more likely to have a marginalized racial/ethnic identity. Among participants who were PTSD +, older age, being a woman or gender minority, being unemployed or on disability, having increased posttraumatic stress, having more co-occurring conditions, and having lower functional impairment predicted being Diagnosis +. The final model explained 35% of variance in diagnosis.

Conclusion: PTSD is associated with significant impairment in autistic adults, but it often goes unrecognized. In particular, autistic cisgender men might be underdiagnosed with PTSD because of gendered stereotypes. High functional impairment may also increase barriers to obtaining an appropriate diagnosis. Future research should include participant treatment history as a potential factor. Clinicians should be aware of these potential signs of PTSD and diagnostic barriers when working with autistic clients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).