Factors that contribute to experiencing anxiety

There are many proposed explanations for the overlap between autism and experiences of mental health and anxiety. 

No single factor provides a conclusive explanation, it is much more likely that an interplay of different factors contributes to higher prevalence of anxiety in autism.  

Environmental Factors 

Brede and colleagues (2020) propose the environmental and other contextual factors play a significant role in mental anxiety in autism.  

This explanation considers life experiences such as bullying, victimisation, trauma and isolation as risk factors rather than locating problems within a person. These adverse life experiences may increase anxiety experiences for autistic children and young people (Rigles, 2017).

  • Autistic children and young people are more likely to experience bullying and trauma across the life span (Cappadocia  et al 2012). 
  • Some children and young people may not be given opportunities to make choices or communicate their preferences. In addition, many children and young people experience unmet needs across social education and medical environments. 
  • One possible explanation suggests autistic characteristics such as sensory processing differences can cause higher levels of sensory overload and anxiety (Ozsivadjian, Knott, & Magiati, 2012).  
  • Sensory sensitivities combined with alexithymia (difficulties identifying and describing feelings) and social communication differences are associated with an increased chance of experiencing mental ill-health (Rai et al 2018; Chapman et al 2022). 

Sensory Differences 

Research suggests sensory prediction processes are linked to anxiety. The brain assimilates a mass of sensory information and input from the environment around us using all eight senses.  

This sensory input is often incomplete or ambiguous, we rely on sensory prediction processes to guess what is most likely going to be experienced. As the brain makes predictions about the sensory environment, it also continuously compares to the actual information that the senses receive.  

Any mismatch between the predictions and actual experiences tends to be associated with a mild sense of anxiety which helps a person to manage with the unexpected event until uncertainty is resolved (Sinha et al 2014). 

Interoception 

Interoception is the ability to sense what’s going on inside your body, both physically and emotionally. Autistic people may have less interoceptive accuracy, but can have more interoceptive sensibility and sensitivity. It is important to remember that autism is diverse, one autistic person may have reduced interoceptive awareness, while another autistic person may experience heightened interoceptive signalling. 

Image: Neurodiversityinsights.com

Here, Kelly Mahler explains what it is like to have too much interoception awareness.

Here, Kelly Mahler explains what it is like to have less interoceptive awareness.

Alexithymia  

Alexithymia is a term used to describe significant challenges in recognising, expressing, and describing emotions.

Many autistic children and young people experience differences identifying and describing their own emotions. Around 50% of autistic children and young people are thought to have Alexithymia.

Alexithymia has been linked to anxiety in two ways:

  • Differences in accurately sensing the internal signals of arousal or anxiety e.g. heart rate, change in breathing, adrenaline. This can make the experience of internal sensations confusing and unpredictable for the person  
  • Differences in ability to identify and describe own emotions which in turn can make it harder to regulate emotions using supportive co-regulation or self-regulation supports 

Communication – Double Empathy Problem 

Dr Damian Milton found that autistic and neurotypical individuals had difficulty understanding one another because of their differing outlooks and experiences in different contexts. 

Milton acknowledges that autistic people often lack insight about the perceptions and culture of non-autistic people, but he argues that it is equally the case that non-autistic people lack insight into the perceptions and culture of autistic individuals.  

Double empathy “refers to a breach in the ‘natural attitude’ that occurs between people of diverse dispositional outlooks and personal conceptual understandings when attempts are made to communicate meaning” 

Damien Milton, 2012.

For more information on double empathy you can listen to a podcast by Offord and Milton (2021) ‘The Double Empathy problem’. 

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