Dissociation in Autism Spectrum Disorders: An Under-Recognized Symptom (Reuben et al. 2022)
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ISSTD News 2023
Co-occurring Autism and trauma, Posttraumatic Stress and Dissociation ( Reuben et al. 2022)
"Self-identification can complicate the picture.
There has been a lot of discussion around clients self-identifying as having DID/OSDD and/or autism, correctly or incorrectly. These disorders being “popular” or “trending” on social media, extensive information being easily accessible online, and personal or community stigma around alternative diagnoses complicates the problem (Cumin et al., 2022; Giedinghagen, 2022; Haltigan et al., 2023). Many have wondered if autism might make youth more vulnerable to incorrectly self-identifying as having DID. There are some potential reasons this might occur. Masking might result in prolonged identity confusion and a sense of being separate from one’s true self. Some autistic people have well-developed internal characters and worlds as a coping mechanism, and maladaptive daydreaming in general can be confused for DID/OSDD. Finally, literal or rigid patterns of thinking might make it more difficult for autistic individuals to make sense of confusing and contradicting information online, leading to over-identification with labels that might not be the best fit.
Conversely, people who “self-diagnose” with DID/OSDD are also more likely to self-identify as autistic. The COVID-19 pandemic may escalate the risk of autism mis-identification in part due to many youths experiencing high levels of stress and increased social isolation during key developmental periods. This might be an especially prominent risk for those with genuine DID/OSDD, many of whom already have social differences due to neglect and interpersonal victimization; it might feel less confronting to label these social differences as autistic rather than confront their traumatic origins. Additionally, autistic traits might be unconsciously introjected from others. As more and more individuals in communities for those with DID/OSDD open up about their self- or professional- autism diagnoses or identifications, some might even feel pressure to also identify as autistic in order to fit in.
The same may happen in reverse. Autistic youth in particular may be extremely socially isolated and desperate for a community, and they may be vulnerable to identifying with DID/OSDD because survivor communities accept them. It’s important to remember that many individuals with autism are actually less receptive to social pressures and peer group influences, but those who are not aware of the extent to which they mask might accidentally mirror those with DID/OSDD in a way that leads them to truly believe their experiences are the same. Finally, autistic individuals who genuinely have parts-based dissociation may still present a muddled picture of DID versus OSDD due to difficulties reporting or understanding very abstract and metaphorical concepts related to the degree of separation of self-states or what qualifies as parts-based amnesia.
Ultimately, it’s important to remember that autism is associated with higher rates of trauma (Reuben & Parish, 2022). This does include the stereotypical bullying, but it also includes contact physical and sexual abuse as well as higher rates of emotional abuse, neglect, insecure attachment with caregivers, community rejection and shaming, and disability-related abuse. Many autistic individuals are socially isolated, have a low socioeconomic status, and are blocked from meaningfully contributing to their communities through skilled employment or volunteering. All of this is in addition to unique stressors such as sensory overwhelm, social overwhelm, and difficulties coping with life changes, and it can be compounded by intersecting marginalization for women, racial and ethnic minorities, LGBT individuals, and individuals with other co-occurring disabilities (Kerns et al., 2022; Reuben & Parish, 2022). Accordingly, in my own research of autistic adults, I found very high rates of interpersonal trauma, posttraumatic stress, and all types of dissociation, and these experiences were strongly connected (Reuben et al., 2021, 2022). Other researchers have found that degree of autistic traits, not an autism diagnosis per se, predicts the risk of victimization and increases the likelihood of posttraumatic stress following a trauma (Haruvi-Lamdan et al., 2019, 2020; Roberts et al., 2015). Not only should an autism diagnosis or self-identification not decrease suspicions of DID/OSDD, it may in some cases indicate a higher risk."