- Autism is often linked with ultra-low self-esteem, depression, anxiety, and eating disorders.
- Low self-esteem in autistic people correlates with interpersonal trauma and masking behaviors.
- Neurodiversity-affirming spaces are key for autistic mental health.
As a person who has always seen the world a bit differently, my formative years were riddled with curiosity, creative mishaps, and misunderstandings.
I often wondered if I belonged. My fears felt particularly clear when the words, "lacks common sense," appeared on my third-grade report card, and later, in the sixth grade, when a psychiatrist and counselor gave me a diagnosis of "Asperger's Syndrome"—a now outdated term.
I read this as a deficit. Something wrong with me. As I read about "Asperger's Syndrome," the information available at the time only furthered my low self-worth. Learning about the now-debunked concepts of "mind-blindness" and a lack of empathy among those with Autism left me feeling incomplete.
I had few friendships, maybe because I wasn't a full human. I had felt alien for some time and would fantasize about the mothership coming back to beam me back to my home planet. But even my imagined alien self had a deep affinity for others' experiences. Compassion and empathy were two of my strengths.
Groups that focused on neurotypical social skills only further drained me. The information for the most part was not new. What I couldn't explain is those skills didn't work for me. This alien struggled with eye contact, not because she didn't know people wanted her to make eye contact, but because eye contact left me with so much sensory, emotional, and social information that it would be difficult to concentrate. I felt like I needed alien social skills training. Which didn't exist.
I withdrew and developed deeper mental health concerns and ultra-low self-esteem. Hospitalizations. More diagnoses. My friend count dropped from 1 to 0. I stopped going to school.
And I was given an opportunity to attend a therapeutic high school. This is where things changed. In a space that greeted my strange ways with an attitude of "How can we create a way for you to do what matters to you," rather than "How can we make you more normal?"
Self-Esteem, Anorexia, Belonging, and Suicide
Autism has been associated with low self-worth (Cooper et al., 2017). Recent research has shown that this self-esteem deficit often correlates with negative social experiences and hiding one's true self to behave more neurotypically (Evans et al, 2023). This is understandable. When someone has repeatedly experienced bullying, rejection, and an overall message of exclusion, as well as a message that this is because there is something wrong with them, their self-worth would suffer.
This low self-esteem has also been associated with greater levels of anxiety and depression in autistic people when compared to neurotypical peers (Cooper et al., 2017). As well, autistic individuals are more vulnerable to developing conditions associated with low self-worth, including anorexia nervosa (Westwood, & Tchanturia,2017), and those living with anorexia have a similar cognitive profile to autistic people (Oldershaw et al., 2011).
Again, this makes total sense. Our society has a deeply unfortunate focus on weight and image as equivalent to worth, particularly for women. When someone has felt excluded, sees themselves poorly, and has had difficulty changing these things in a world that values neurotypical strengths, there is comfort in deducing worth to a number, such as weight on a scale. As well, the tendency toward rule-governed thinking in autism coupled with high levels of self-control, places an autistic person at particular risk in terms of eating disorder behaviors and the thinking behind these. It's a desperate way to cope.
Autism is also associated with a higher risk for suicidal ideation, suicide attempts, and mortality by suicide (Hedley, 2018). Thomas Joiners' Interpersonal Theory of Suicide postulates that a combination of thwarted belongingness, perceived burdensomeness, and capability combine to create a space of high risk of suicide. The messages autistic people have traditionally received, coupled with the common experience of isolation, often place an autistic person in this place.
What Can We Do
It doesn't have to be this way. With an appreciation for neurodiversity, we can accept neurodivergent people as having brains that are wired differently, rather than individuals with a deficit. It has been found that identifying with an autistic social identity and connection to neurodivergent-affirming spaces is linked to less depression, less anxiety, and higher self-esteem in autistic people (Cooper et al., 2017).
Unmasking and celebrating different ways of being in autistic adults is also linked with higher self-esteem and more positive mental health outcomes (Evans et al, 2023). In terms of intervention, neurodiversity-affirming practices, such as social connection groups that encourage a person's natural self in place of social skills groups focused on neurotypical social norms, give a much more robust chance at assisting outcomes in neurodivergent people.
The more impactful changes are those that occur outside any clinical setting. Rather than separating autistic youth within resource rooms and special-education classrooms to teach them how to act more neurotypical, maybe it is time we do more educating of the entire school—students and faculty alike—about neurodivergent communication patterns.
Many workplaces, particularly in the tech industry, are already beginning to adopt a neurodiversity-friendly work environment with positive gains not only for neurodivergent people but for everyone. Because when someone feels free to be themselves, they can share the best of who they are with everyone.
Accepting neurodiversity is about more than effective intervention or social justice. It is about saving lives.
Cooper, K., Smith, L. G., & Russell, A. (2017). Social identity, self‐esteem, and mental health in autism. European Journal of Social Psychology, 47(7), 844-854.
Evans, J. A., Krumrei-Mancuso, E. J., & Rouse, S. V. (2023). What You Are Hiding Could Be Hurting You: Autistic Masking in Relation to Mental Health, Interpersonal Trauma, Authenticity, and Self-Esteem. Autism in Adulthood.
Hedley, D., & Uljarević, M. (2018). Systematic review of suicide in autism spectrum disorder: current trends and implications. Current Developmental Disorders Reports, 5, 65-76.
Oldershaw, A., Treasure, J., Hambrook, D., Tchanturia, K., & Schmidt, U. (2011). Is anorexia nervosa a version of autism spectrum disorders?. European Eating Disorders Review, 19(6), 462-474.
Westwood, H., & Tchanturia, K. (2017). Autism spectrum disorder in anorexia nervosa: An updated literature review. Current Psychiatry Reports, 19, 1-10.