CPTSD vs Autism: Similarities, Differences, and How to Get Support

Complex PTSD, or CPTSD, is a mental health condition people can develop after prolonged exposure to trauma. CPTSD is fairly common among autistic individuals, and shares a number of features with autism, like sensory sensitivity and emotional dysregulation. However, they are distinct diagnoses, differing in key areas like how and when they emerge during a person’s life and goals for treatment.

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Autism spectrum disorder (ASD) is a neurodevelopmental disability, meaning it affects the development of a person’s brain and nervous system. The autism spectrum is diverse, and autism can mean something different for each autistic person, including different support needs and different combinations of autistic traits. 

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Overall, autistic people exhibit differences from neurotypical peers in a few key areas:

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Social and communication approaches

For autistic individuals, neurotypical social norms and expectations don’t feel intuitive. Autistic people may interpret social cues differently than others, and they also tend to approach communication in a more literal and direct way than allistic (non-autistic) peers.

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Cognitive and sensory processing

Autistic individuals process information, including sensory inputs, differently than allistic people. They can be more or less sensitive to sensory stimuli and become easily overwhelmed by sensory input, such as bright lights or loud noises.

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Autistic individuals also exhibit differences in cognitive processing. They may be more visual thinkers and learners and tend to focus on details rather than the big picture. They often have excellent pattern recognition skills, too.

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Repeated/restricted behaviors and interests

Typically, autistic individuals have a strong preference for sameness and predictability. For some autistic people, this means sticking to a routine and repeating many of the same behaviors and activities. Autistic individuals can also have special interests–– intense, sometimes unique interests to which they may devote a great deal of time.

Complex post-traumatic stress disorder (CPTSD or complex PTSD) is a mental health condition resulting from repeated or prolonged traumatic experiences. It differs from post-traumatic stress disorder (PTSD), which emerges after an acute or limited-duration traumatic experience.

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History

CPTSD is a relatively new term, and while evidence supports its validity as a diagnosis separate from PTSD, it is still the subject of some debate among the scientific community.

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CPTSD was first proposed as a disorder in 1992, but it wasn’t included in the World Health Organization’s International Classification of Diseases (ICD-11) until 2018. However, it still isn’t included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

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Symptoms

People with CPTSD experience many of the core PTSD symptoms. These symptoms include:

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• Re-experiencing the traumatic event(s)
• Physiological responses to remembering or re-experiencing the trauma, such as an elevated heart rate, sweating or tightness in the chest
• Avoidance of people, places or activities that could trigger re-experiencing
• Persistent fear of and awareness of potential danger
• Sustained negative emotions and thoughts

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CPTSD is also associated with a few symptoms that may also present among people with PTSD, but are considered core features of CPTSD::

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• Emotional dysregulation, including intense moments of anger and irritability
• A negative sense of self, sometimes including feelings of shame and guilt
• Interpersonal challenges, including difficulty trusting others and maintaining meaningful relationships

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Causes

Several traumatic experiences can lead to CPTSD, which can include but are not limited to:

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• Emotional, physical or sexual abuse
• Domestic violence or intimate partner violence
• Neglect and emotional neglect
• Torture
• Human trafficking
• National and international crises, including war and genocide

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Sometimes, individuals with CPTSD may go undiagnosed and without support because they do not believe the trauma they have endured is “severe” enough to warrant a diagnosis of CPTSD or PTSD. This is not an uncommon way to feel, but many different kinds of traumatic experiences can contribute to the development of CPTSD.

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Prevalence

We aren’t certain exactly how many people CPTSD affects, but researchers estimate that between 1 and 8% of the population have or have had CPTSD. This is similar to the lifetime prevalence of PTSD, which is about 6%.

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Long-term impacts

Research has shown that exposure to complex trauma is associated with structural and functional changes to the brain, such as an enlarged amygdala, which is the brain’s fear center. However, there is evidence that brain changes associated with complex trauma can be reversed––perhaps a reflection of CPTSD’s high responsiveness to treatment.

Though they differ in nature, autism and CPTSD share a number of similarities, including the following.

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Emotional dysregulation

Autistic people and those with CPTSD can find it difficult to regulate emotions. Both groups are more likely to experience intense feelings. They may also be more irritable and experience intense bursts of anger.

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Sensory differences

Both autistic individuals and people with CPTSD may be more sensitive to sensory inputs like noises, lights and movement. For autistic people, these inputs can cause sensory overload and contribute to autistic burnout. For individuals with CPTSD, similar sensory inputs could trigger flashbacks to traumatic experiences or fear responses associated with their trauma.

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Interpersonal differences

For individuals with CPTSD, it can be challenging to maintain healthy, stable relationships, often because of difficulties with trust, emotional regulation and intimacy. People with CPTSD may also communicate differently from others, especially if they have experienced interpersonal trauma that has taught them certain communication styles are unsafe.

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Autistic individuals also exhibit interpersonal differences, though it is often because they do not find neurotypical social norms and behaviors intuitive. They may interpret social cues differently and behave in ways neurotypical individuals don’t expect. Autistic people also tend to exhibit different communication styles than others, typically communicating in a more direct, literal way.

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Co-occurrence

In addition to the overlap in traits between autism and CPTSD, the two diagnoses also frequently co-occur. Research on CPTSD among autistic people is currently limited, but studies show between 32 and 45% of autistic adults have PTSD, compared to only about 4% of non-autistic adults.

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Autistic individuals are more likely to experience trauma. It is not uncommon for autistic people to confront traumatic events like social trauma, often due to stigma, sensory sensitivities and a large-scale failure to accommodate autistic needs. The repetition of these experiences often constitutes complex trauma, and it stands to reason that as research on CPTSD and autism grows, it will provide more evidence of their co-occurrence.

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Though autism and CPTSD share some features, they are distinct conditions. The most major difference between the two is how they are classified. Autism is a neurodevelopmental disorder, while CPTSD is a mental health condition.

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Neurodevelopmental disorders like autism affect the development of the brain and nervous system. Signs of a neurodevelopmental disorder typically first present during early childhood and remain present throughout an individual’s lifetime.

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On the other hand, mental health conditions are acquired, and symptoms often show up later than early childhood. Symptoms of CPTSD can emerge at any time during a person’s life after they have experienced complex trauma, although CPTSD is most often associated with childhood trauma.

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CPTSD is not necessarily a lifelong diagnosis. Treatment can greatly reduce symptoms, and in some cases, it can continue until an individual no longer meets the diagnostic criteria.

Autism and CPTSD are both diagnosed by a mental health professional like a psychologist or psychiatrist. A clinical interview is the main component of both diagnostic processes, though an autism assessment may incorporate additional tools like questionnaires and interviews with people close to the individual.

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How is autism diagnosed?

During an autism assessment, a clinician will ask questions structured around the diagnostic criteria for autism from the DSM-5, focusing on:

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• Potential social and communication differences
• Sensory processing differences
• Repeated behaviors
• Limited interests

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The clinician will also likely ask additional questions to determine whether a medical or mental health condition is causing relevant traits and behaviors. As an additional diagnostic tool, individuals may be asked to complete questionnaires regarding their potential autistic traits.

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Clinicians also typically interview people close to the individual to validate their self-reported behaviors and traits. They may also provide these close contacts with questionnaires to complete in lieu of an interview. Most often, clinicians will interview or survey a loved one who was close to the individual during their early childhood so they can attest to the presence or absence of autistic traits during the individual’s early development.

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How is CPTSD diagnosed?

CPTSD is diagnosed via a clinical interview that evaluates a person’s symptoms and history of trauma. Like in an autism assessment, clinicians typically also ask questions about an individual’s medical and mental health history to rule out any other potential diagnoses that could be causing their symptoms.

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Clinicians use the criteria laid out in the ICD-11 to diagnose CPTSD. These include diagnostic criteria for PTSD, as well as symptoms associated specifically with CPTSD, including:

• Emotional dysregulation
• Negative sense of self
• Difficulties in relationships

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Because CPTSD is a newer recognized diagnosis, it can sometimes be missed by clinicians. If you believe you have CPTSD and are seeking a diagnosis, it is best to make sure you work with a trauma-informed provider who’s familiar with the signs of CPTSD so they can effectively diagnose and treat it.

Numerous highly effective supports are available for autistic individuals and people with CPTSD. Supports for these two diagnoses differ primarily in their goals. CPTSD treatment focuses on reducing or potentially eliminating symptoms. On the other hand, support for autistic individuals should prioritize coping skills, self-advocacy and self-acceptance rather than reduction of autistic traits. Supports for CPTSD and autism share the goal of improving an individual’s quality of life.

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What support is available for autism?

Psychotherapy, or “talk therapy,” is the primary intervention used to support autistic individuals’ well-being. Rather than changing or reducing autistic traits, the goal of psychotherapy is to support autistic individuals’ sense of self and mental health, including treating symptoms of an anxiety disorder or depression, which commonly co-occur with autism.

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Cognitive behavioral therapy (CBT) is widely considered the gold standard for psychotherapy and can be an impactful intervention for autistic people. CBT works by helping an individual recognize unhelpful or harmful patterns of thinking and behavior, like negative beliefs about oneself, and replace them with more supportive alternatives. CBT can also help some autistic individuals recognize their emotions, develop coping skills and navigate social situations.

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Accommodations are also an important form of support for autistic people. Often, one of the goals of psychotherapy for autistic individuals is to support their ability to identify and advocate for accommodations they need. These can be adjustments to their work or school environment that improve their ability to function and thrive, such as remote work options and sensory adjustments to the workspace, like a quiet space, softer, warmer lights and flexible seating options.

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Some autistic people also benefit from medication to treat symptoms of co-occurring conditions like anxiety and depression. Often, clinicians prescribe antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) to treat these symptoms. These medications are taken daily and slowly build up in a person’s system over several weeks before they take effect.

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For autistic individuals who experience severe anxiety or panic attacks, clinicians may also prescribe anxiety medications that are meant to be taken only during or in anticipation of moments of intense anxiety, like beta blockers or benzodiazepines.

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What support is available for CPTSD?

Psychotherapy is also considered the primary treatment for CPTSD. Like with autism, CBT can be an incredibly impactful intervention. CBT can help individuals with CPTSD identify negative beliefs they hold about themselves or consistent expectations that something bad will happen––helping them challenge and replace those beliefs.

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Sometimes, a type of therapy called eye movement desensitization and reprocessing therapy (EMDR) is used to treat CPTSD. EMDR is a type of psychotherapy that was created specifically to treat PTSD and can be adjusted to treat CPTSD. During EMDR, an individual focuses on memories of their trauma in a safe environment while receiving bilateral stimulation, which can include moving their eyes side-to-side or tapping a device with both hands. This is believed to change how traumatic memories are stored in the brain and reduce their intensity.

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Medication can also help some individuals manage and reduce certain symptoms associated with CPTSD, like anxiety. These can include antidepressants (like SSRIs and SNRIs) and anti-anxiety medications. 

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Accommodations in the workplace or school can also greatly benefit people with CPTSD. These accommodations address an individual’s specific needs and can include adjustments like a flexible schedule, remote work options and changes to one’s workstation to minimize potential triggers.

If you are autistic or think you might be, Prosper Health can provide the support you need. Prosper Health offers autism assessments specifically for adults, which are covered by insurance and conducted entirely via telehealth. Getting evaluated and receiving a formal diagnosis can be an incredibly meaningful step toward an individual’s long-term well-being.

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Through psychotherapy, Prosper Health can provide long-term support to autistic adults, including those with complex trauma histories. Prosper Health therapists specialize in working with autistic adults. They are well-versed in experiences common among autistic adults, as well as diagnoses that commonly co-occur with autism, like CPTSD, depression and anxiety.

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In addition to receiving a formal autism diagnosis from Prosper Health, my Prosper therapist was the first therapist I have worked with to diagnose me with CPTSD. Today, we focus primarily on unpacking a still relatively new diagnosis and co-piloting the long-term work of healing from complex trauma. Our work together has felt dynamic, impactful and always responsive to my needs.

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CPTSD can feel lonely and incredibly hard, but it doesn’t have to stay that way. With support from mental health professionals who understand your unique experiences, you can chart the path towards a happier life.