Even though mental illness can be more common for people with autism than in the general population, the mental health of people on the spectrum is often overlooked. Here we look at anxiety, OCD and depression.
By Dr Anastasios Galanopoulos, Dr Dene Robertson, Ms Debbie Spain and Dr Clodagh Murphy. This information is drawn from an article that first appeared in the Mental Health supplement of Your Autism Magazine, Vol 8(4), Winter 2014.
Anxiety disorders
Anxiety disorders are very common among people with autism. Roughly 40% have symptoms of at least one anxiety disorder at any time, compared with up to 15% in the general population. Understandably, this can lead to sadness or depression – one reason why a mixture of anxiety and depression is common.
It is thought that a combination of factors, leading to vulnerability to stress, is likely to explain why anxiety disorders are so common in people with autism. Biological differences in brain structure and function, a history of social difficulties (leading to decreased self-esteem and a tendency to think of threats as greater than they are) and problems with finding flexible responses to apparent threats are all likely to contribute.
Many people on the autism spectrum may have difficulty describing the symptoms they experience. A sudden change in behavior could mean they have developed an anxiety disorder, even if there is no complaint of the typical symptoms.
Treating anxiety disorders
Most of the time we learn to cope with difficult situations, whether or not we have autism – often by “sitting it out” and learning that we have not come to harm from the situation that worried us.
However, if we have an anxiety disorder, we are more likely to try to escape from the difficult situation. This leads to a greater fear of the same situation and an even earlier escape the next time it occurs. In other words, anxiety tends to build on and reinforce itself. It is important to try to break this vicious cycle, and this is why cognitive (to do with thoughts) and behavioral psychological treatments are often as important in treatment as medication.
Usually these treatments involve forming a working relationship with a therapist, building up any necessary skills, and deciding to work through a set of challenges (involving exposure to an aspect of the feared situation) one step at a time that are anxiety-provoking but not intolerable. This way both the mind and the body learn that the feared situation isn’t as dreadful as was thought, and this leads to a gradual reduction in anxiety. Such an approach is often very effective. Mind’s website has further information about common anxiety disorders.
Obsessive compulsive disorder
OCD is an anxiety disorder. If someone has OCD, it means that they experience repetitive thoughts and behaviors that are upsetting to them. OCD occurs in about 2-3% of people who don’t have autism and is more common in people with the condition. It is thought that our genes (DNA) and our psychological predisposition can make us vulnerable to developing OCD, which can run in families. OCD can be distressing, exhausting and can get in the way of everyday life for the person who has it and their families. However, it is treatable.
There are two main parts to OCD: obsessions (thoughts) and compulsions (behaviors). OCD can be overlooked in people with autism as it may be mistaken for repetitive behavior. However it is very different. If you think that you have OCD, let your GP know about your concerns. They will help you think about what to do and can refer you for a specialized assessment to help work out what may be OCD (or not) and what may be autism. Although there is increasing awareness of OCD, it is still under-recognized and therefore under-treated. If you have autism and think that you may have OCD, it’s best to get an assessment and treatment by a team that specializes in both autism and OCD.
Treating OCD
There are two recommended treatments for OCD: Cognitive Behavioral Therapy (CBT) and medication. CBT gives you tools to help you change the way you think and act. As the most researched psychological treatment for OCD, there is now evidence that specialized CBT is effective for treating OCD and anxiety in people with autism.
Medication can be used either alone or in combination with CBT. Some people with autism can be vulnerable to side-effects from medication . Information about autism and OCD (psychoeducation) and social skills work can also form part of a helpful package of individualized care for people with autism and OCD.
Depression
It is very common to have times in our lives when we feel a bit sad or low. But when these feelings last for more than a few weeks and get in the way of day-to-day functioning, this can indicate a period of depression. This is no different in a person with autism to someone without the condition. It is estimated that at least 20% of the population will experience a period of depression at some point but it is even more common in people with autism. People who are depressed can experience a range of symptoms which vary from person to person in their combination, and can be mild or severe.
It may be especially hard for depressed people with autism to seek help because they might find change daunting and anxiety-provoking, feel worried that they will be blamed, or feel unsure about how to describe their symptoms. Anxiety and depression can also make people more generally introverted, withdrawn and isolated. All people with depression may have difficulty sharing their thoughts and feelings. But because people with autism can have difficulty labeling their feelings, it can be especially hard to communicate symptoms or concerns.
Treating depression
Treatments for depression can be psychological or medical, regardless of whether a person has autism. The most important step to getting help is for the person with autism to tell someone they trust, such as a family member, a close friend, their GP or another professional. Some people need a referral to a specialist service, either because they would benefit from psychological therapy adapted for people with autism, or due to a more complex set of problems.
Anxiety disorders, OCD and depression are just a few of the mental health problems people with autism may experience.