Psychosis Is 3x More Common In Autistic People Than In The General Population. Why?

Psychosis is 3x more common in autistic people than in the general population. Why?

This is a question that scientists are trying to answer. There’s not enough research on the comorbidity of autism and psychosis to be sure exactly what all of the reasons are for this overlap, but there are some interesting facts about it that I’ll outline here.

Psychosis is a symptom, which is composed of a constellation of smaller symptoms. Psychosis can be caused by schizophrenia spectrum disorders, but it can also be caused by mood disorders, stress, illness, and substance abuse. And research seems to be showing that autism might be a factor in developing psychosis as well.

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I have always been interested in the connection between psychosis and autism. One of my uncles has a schizophrenia spectrum disorder, which was diagnosed after he went to a psychiatrist to be evaluated for autism- the reason he went in being that he saw himself in me, and wondered if he might be autistic, too. Turns out, he has psychosis.

Within the past few years, I have also been experiencing symptoms associated with psychosis. It would be very difficult for me to accurately identify any “negative” symptoms of psychosis, given that I already experience executive dysfunction, fatigue, sleep & appetite changes, etc. due to my ADHD and physical health problems. However, what I have been noticing are “positive” symptoms of psychosis. Namely: hallucinations, delusions, and paranoia.

My most frequent auditory hallucinations are of my alarm clock, and the cricket alarm on my iPhone. I hear them clearly, as if they’re coming from outside my head, at random periods throughout the day and in different locations, when the actual alarms aren’t going off. Around two years ago, I hallucinated a stranger’s voice calling me into another room. I was extremely confused and disoriented by this, as I got up to look around but nobody was there. I haven’t heard any voices since then, which is good.

I often hallucinate scents associated with significant people, places, and memories, even when those people aren’t present and I’m not in a location where the smell would naturally occur. At first I thought this could be chalked up to migraine aura or something like that, but I don’t get migraines.

I’ve also had extreme “sensed presence” hallucinations where I feel like someone is watching me even though there’s nobody else in the room. At times, this hallucination has fed into paranoid thoughts that there are cameras in my shower drain, etc.

My main delusion in episodes I’ve had in the past has involved the extreme significance of certain numbers and symbols. At the time, I didn’t think anything was wrong. In fact, I was convinced that I was on track to uncover the pattern that organizes everything in the universe, and all of my interpersonal relationships. As part of this delusion I would vocally repeat certain numbers (as a strategy to figure out what they meant), and spend copious amounts of time writing down all of my “findings” in Google documents and notebooks. At one point, I ended up writing down a bunch of dates in a row and adding up all of the digits to discover how they were connected to the numbers 4, 5, and 7, which I had decided were the most important numbers in my life. Looking back on the Google document I stored the data in, I have absolutely no clue what my thought process was at the time.

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So, I’ve been wondering what all of this means.

When I start putting the pieces together to examine my own life, things start to make some sense.

First, as I mentioned earlier, autistic people are 3x more likely to develop psychosis than the general population. Obviously, that statistic is relevant to my situation, since I’m autistic.

But I’m not just autistic. I also have a decent handful of mental illnesses, each of which overlap and carry their own risk factors for psychosis. The main ones I’ll be talking about here are severe generalized anxiety/panic disorder, OCD, and BPD (Borderline Personality Disorder). I consider my OCD and BPD to be ~spicy spinoffs~ of anxiety, because they have the same root cause: my anxious, socially traumatized brain. We’ll get to that in a bit.

For now, here are some statistics:

A study conducted in 2012 found that psychotic symptoms were present in 27% of people with anxiety and/or depression.

A study conducted in 2014 found that people with OCD are around 5x more likely to develop schizophrenia than the general population.

A study conducted in 2017 found that 43% of people with BPD experience hallucinations, and stated that other studies have found prevalence rates of hallucinations in BPD ranging from 26% to 54%.

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So alright, great, I’ve got a lot of risk factors. But what caused me to have those risk factors/mental illnesses in the first place? Let’s look at this specifically from an autistic lens. I’ve already talked about a lot of this in my “Autism and Mental Health” post on our Instagram, but these statistics are worth repeating in this context:

Around 40% of autistic people meet criteria for one or more anxiety disorders at any given time, compared to only 15% of the general population.

Autistic people are 4x more likely than neurotypicals to be clinically depressed at some point in their lives.

Autistic people are 4x more likely than the general population to experience severe loneliness.

Autistic people are 3x more likely than the general population to experience maltreatment (a catch-all term for various forms of abuse).

A study conducted in 2012 found that 63% of autistic children had been bullied, and were 3x more likely to be bullied than their neurotypical siblings.

And what does the research say about the long-term effects of bullying and abuse?

According to a 2012 study, children who are bullied by their peers are at an increased risk of developing Borderline Personality Disorder. And BPD is, as previously established, a risk factor for developing psychosis.

According to a 2014 study, people who were bullied in childhood are 11x more likely to develop anxiety disorders in adulthood, but especially OCD. And, as previously mentioned, people with OCD are 5x more likely to develop schizophrenia.

But the link between bullying and psychosis gets even more explicit than that.

A 2013 study found that children who had been bullied were 2x more likely to experience psychosis symptoms than typical controls, and that children experiencing first-time psychotic episodes were 2x more likely than typical controls to report having been bullied in the past.

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This is not to say that being bullied and abused is the only reason why autistic people sometimes develop psychosis. There are obviously a great deal of different factors, some genetic & biological, that lead to the development of mental illness. But the role of trauma and other social/environmental factors can’t be discounted.

If two people are exposed to the same negative experience, it’s possible that one will become traumatized and one won’t. That’s because one person may have been genetically/biologically predisposed to have heightened fear responses to environmental stimuli, while the other person didn’t have the same predisposition. Yet, the genetically predisposed person would not have been traumatized if they had not experienced the negative event.

I was bullied as a child. I was also abused. Both of those things deeply affected me, because I’m autistic and therefore hypersensitive. The trauma caused me to develop BPD and severe abandonment anxiety, which often feeds into paranoia. My generalized anxiety also morphed into OCD, which caused me to have disturbing intrusive thoughts, and compulsions. All of this predisposed me to develop psychosis. And in the past few years, *surprise*, I’ve started having psychotic symptoms.

When I look back on my life experiences and how they interacted with my autistic brain & positive family history of psychosis, none of this is surprising. It actually makes perfect sense. And because it makes perfect sense, in a way I’m reassured. My hallucinations and delusions fit the pattern, so there’s no need for me to be scared. I know why this is happening. The trajectory is predictable. And if I keep taking care of myself and monitoring symptoms, I know I’ll be alright.

~Eden🐢