It is now known that people with autism have a higher likelihood of meeting the criteria for at least one other psychiatric condition, with one 2020 study finding 91% of children and adolescents, and 31% of young adults, were diagnosed with one or more co-occurring conditions. 

Here, we are exploring the comorbidity of autism and anxiety by looking at each condition individually, finding where their symptoms tend to overlap (including sensory challenges and social anxiety), their impact on daily life, implications for dual diagnosis and treatment, and where to seek help if you believe you or a loved one may have comorbid autism and anxiety.

“Dual diagnosis means when there is more than one mental illness that is co-occuring. In people with autism there is a higher prevalence of other mental illnesses than the general adult neurotypical population." - Dr Shakeel Islam, Consultant Psychiatrist

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about autism and anxiety, we can help. 

What is autism?

Autism is a neurodevelopmental condition that affects how a person understands and responds to sensory information around them, and how they interact with others. Autistic people commonly experience sensory issues that can lead to a negative reaction when they come into contact with certain triggers. These reactions can play a part in difficulties with social interaction, communication, forming repetitive or restrictive behaviours, having intense interests, having different ways of learning, and more. 

Some typical symptoms of autism in adults include: 

• Difficulty reading social cues
• Difficulty participating in conversations with others 
• Difficulty relating to others’ thoughts and feelings 
• Difficulty regulating emotions 
• Difficulty building and maintaining relationships 
• Difficulty reading body language and facial expressions of others 
• Using a monotone speaking pattern, which makes it difficult to convey emotions
• Difficulty maintaining eye contact in conversations
• Restrictive or repetitive behaviours  
• Difficulty with last-minute changes to plans or routines
• Fixation on a favourite subject they care a lot about or are particularly skilled in 
• Sensitivity to sensory input like pain, touch or sound

In children, the most common symptoms of autism often include:

• Repeating certain words or phrases 
• Lining up toys or objects, and getting upset if the order is altered 
• Playing with toys in the same way every time
• Focusing intensely on parts of an object 
• Obsessively following certain routines, and becoming upset by small changes
• Obsessive interest in specific things 
• Physical movements like rocking or spinning in circles
• Unusual reactions to triggers, such as specific sounds, smells or tastes

Although the above symptoms are very common, it is important to note that each autistic person experiences their own symptoms and traits, which is why one person’s autism diagnosis can sometimes look different to another – for some autistic individuals, anxiety could have a significant impact on their life.  

What is anxiety?

Anxiety is a fairly common feeling for everyone, and could arise in slightly different forms depending on the situation; social anxiety, fear, worries about the future, worries about the past, and so on. This is a subjective feeling that everyone experiences differently, ranging from a mild feeling of unease to a more intense panic. If someone experiences severe or consistent anxiety, this is usually considered a mental health condition that can cause debilitating symptoms in some cases. 

Data from the World Health Organization in 2019 found 301 million people (both adults and children) were thought to be living with an anxiety disorder, and research from the Mental Health Foundation suggests 60% of adults in the UK reported experiencing anxiety that interfered with their daily lives over the past 2 weeks, while 20% of people said they feel anxious “most or all of the time”. 

Anxiety is often characterised by excessive worry, fear, rumination, and could even cause some physical symptoms like increased heart rate. Those with generalised anxiety disorder (GAD), which is thought to be the most common type of anxiety disorder in the UK, may experience a feeling of anxiety or dread that affects their daily life. Some of the symptoms may include feeling restless or ‘on edge’, fatigue, difficulty focusing, feelings of irritability, difficulty controlling feelings of worry, sleep issues, a racing heart, panic attacks, headaches, stomach issues or other unexplained physical symptoms. 

Another common type of anxiety is social anxiety, which is a fear of social situations. This impacts a person’s ability to interact and communicate effectively in a social setting, and can occur in specific situations like when speaking in public, interacting in a big group, meeting someone new, dating, or another type of social event. It tends to cause symptoms such as profuse sweating, blushing or a shaky voice, and may occur due to a fear of doing or saying something embarrassing, inappropriate or that the person may perceive as unintelligent. 

In what ways do autism and anxiety overlap? 

Anxiety can have a major impact on the day-to-day lives of autistic people, and in fact, research has found autistic people to be around 4x more likely to experience anxiety. Some of the reasons they may feel anxious include things like social challenges, sensory difficulties, unpredictable situations, or difficulty regulating emotions, to name a few. It is crucial to understand the difference between the two–as well as where they overlap–in order to address any sources of anxiety and seek the appropriate treatment, if applicable. 

"There are a number of things that lead to feeling anxious. This may be dealing with small changes cropping up during the day or larger life events such as starting at university, changing jobs or moving home. Life events can be anxiety provoking because we are dealing with changes in routine, meeting new people and having to develop new ways of adapting. Someone with anxiety with autism may experience more of the physical sensations of anxiety. They may feel their heart racing, find it difficult to catch their breath, lose their appetite and they may have problems getting to sleep." - Dr Shakeel Islam, Consultant Psychiatrist

Some of the ways in which autism and anxiety overlap include:

Sensory Sensitivity

Sensory sensitivities are a common feature of autism, causing heightened reactions to an overload of sensory inputs such as loud noises, bright lights or touching unpleasant textures. Depending on the autistic person’s individual triggers, certain sensory inputs may trigger anxiety for them by overwhelming the nervous system, leading to feelings of discomfort, confusion, and a sense of being out of control. 

When an environment feels unpredictable or overstimulating and the ability to filter or process sensory input is compromised, autistic individuals may begin to feel their anxiety levels rise, and this can be difficult to self-manage when the person is already feeling overwhelmed. 

Emotional Dysregulation

Emotional dysregulation is common in both autistic people and those with an anxiety disorder, and this can significantly impact both. Emotional dysregulation means a person may find it difficult to manage and respond to certain intense emotions appropriately. For autistic people (especially autistic females, according to studies), this may lead to intense emotional reactions to seemingly minor triggers. Those with anxiety require emotional regulation in order to manage their own anxious feelings, and if this does not happen as quickly or as easily as they would like, it can exacerbate feelings of fear or sadness. 

Both autistic people and those with anxiety may find it difficult to reach a place of calm where they are able to handle the situation in front of them, and may act impulsively as a result, withdraw from the situation, or experience burnout symptoms. Autistic people may also be susceptible to autism meltdowns. Emotional dysregulation can negatively affect daily functioning, personal relationships, and overall wellbeing in neurotypical and neurodivergent people alike. 

Social Challenges

Social challenges may be one of the biggest overlapping areas of autism and anxiety, as both may experience difficulties with social interactions for different reasons. In the case of an autistic person, this may occur if they have difficulty understanding social cues, understanding the emotional state of others, forming connections with others, performing in front of others (such as trying new things in public), and communicating effectively, all of which can lead to feelings of anxiety in social situations. 

For those with anxiety, social interactions and events may become extremely difficult if social anxiety disorder is at the core of their issue. This may cause fear and avoidance of social interactions, creating a cycle where social situations become increasingly stressful, and lead to further isolation and exacerbation of anxiety. Similarly for autistic people, increased anxiety could lead to behaviour changes, with studies finding anxiety in autistic people to be associated with more severe restricted, repetitive behaviours and abnormalities in social communication. 

Social anxiety can affect both neurotypical and autistic people in very similar ways, with one 2020 study of autistic men aged between 25 and 32 finding social anxiety can develop for similar reasons (such as negative social experiences) in both autistic and non-autistic people.

Difficulty with Change

Both autism and anxiety can cause difficulty adapting to new plans and changes in routines. Autistic individuals often rely on predictable routines for comfort and stability, while anxiety can make unexpected changes overwhelming and stressful for autistic and neurotypical people alike. 

When routines are disrupted and it is unclear what the future holds, this can trigger anxiety, leading to feelings of confusion and frustration. The overlap between autism and anxiety can make flexibility and adaptability particularly challenging, further intensifying the need for structure and predictability in daily life.

Rejection Sensitivity 

Rejection sensitivity is sometimes referred to as rejection sensitive dysphoria, which can lead to intense reactions to any sort of rejection or abandonment. This commonly occurs in both autistic people and neurotypical people with anxiety. Individuals with autism may struggle with social cues, making them more vulnerable to perceiving rejection, and may also experience increased rejection sensitivity due to not feeling like they are meeting neurotypical standards. This may also lead autistic people to develop anxiety, with studies confirming that autistic traits may affect depression or anxiety symptoms due to heightened rejection sensitivity. 

In neurotypical people, different types of anxiety (including social anxiety) can also cause a heightened fear of rejection due to the emotional reaction it causes. When this happens, the person experiencing it will often take actions to avoid any perceived rejection and ultimately protect themselves from negative feelings, which can lead to avoidance of situations, social isolation, and ultimately, more anxiety. 

A combination of autism and anxiety can result in a person avoiding most or all social interactions, or becoming overly self-critical. A fear of rejection can also impact self-esteem and contribute to social isolation, further complicating the emotional experiences of autistic people or those with anxiety.

Comorbid Depression

It is understood that autistic people have a higher risk of developing depression, with a 2019 review of studies estimating around 14% of autistic people are thought to experience depression at some point in their lives. In addition, those with anxiety can also experience depression alongside their anxiety symptoms, with studies finding that of those with generalised anxiety disorder, 24% were also diagnosed with depression.

In both autistic people and those with anxiety, depression could occur as a reaction to chronic stress from social challenges, sensory sensitivities, and difficulties adapting to change, which can exacerbate feelings of hopelessness and low self-esteem. In those with co-occurring autism and anxiety, depression is a symptom that should be carefully managed to avoid escalation, since severe depression and suicidal thoughts are more likely to occur in those with autism. 

Can autism and anxiety be considered comorbid conditions? 

A comorbidity is when an individual has more than one illness or condition at the same time, either coincidentally, or because one condition directly causes the other. In the case of autism, this is known to be linked to varying levels of anxiety, and although research is limited, it is reasonable to believe that anxiety and autism may regularly coexist – a survey carried out by the National Autistic Society found 47% of autistic people could be diagnosed as having generalised anxiety disorder based on the GAD diagnostic criteria, suggesting a high prevalence of comorbid autism and anxiety. 

However, it is also possible that a person with anxiety who is unaware of their potential autistic traits could continue to seek a diagnosis and treatment only for anxiety. Similarly, an autistic individual can also live life free from anxiety, just as a person with anxiety may not be autistic. 

Research on this comorbidity is extremely limited, and more is required to find out exactly why anxiety appears to be common in autistic people. Theories include the idea that anxiety may occur due to the same combination of genes and environmental factors autism stems from, as well as the idea that certain areas of the brain could be involved – one 2020 study suggests the amygdala, which is involved in functions such as feeling and expressing fear, could be linked to the co-occurence of autism and anxiety. 

The clearest connection seems to be that autistic people typically experience anxiety as a result of the everyday challenges they face, such as navigating social situations, or masking their symptoms to appear neurotypical. 

How is comorbid autism and anxiety diagnosed? 

Diagnosing comorbid autism and anxiety usually depends on the person’s existing diagnosis. For example, is the person already seeking treatment for anxiety and believes they may have autism? Or does the autistic person believe that what they are experiencing is an anxiety disorder? 

Misdiagnosis is prevalent for autistic people, with a 2024 study finding personality disorders to be the most commonly perceived misdiagnoses. Anxiety disorders were also frequently misdiagnosed, followed by mood disorders, chronic fatigue syndrome or burnout-related disorders, and attention-deficit/hyperactivity disorder (ADHD). It was also found that autistic women tended to be misdiagnosed more often than men.

Diagnosing comorbid autism and anxiety can be challenging for healthcare professionals, as many of the most common autism traits can often resemble symptoms of anxiety. For example, stimming behaviours like rocking, pacing back and forth, being more comfortable with certain routines, and avoiding social interaction could all be signs of an intense anxiety disorder in a neurotypical person, but they could also indicate potential autism.

You can begin the process of obtaining a diagnosis by reaching out to your GP for advice and an initial conversation about a potential autism diagnosis through a comprehensive assessment. Often people in the UK find wait times for autism assessments to be extremely long, so you could also choose to seek a private assessment instead if your circumstances allow. 

You can learn more about what to expect from an adult autism assessment here, but essentially this means meeting with a team that usually consists of psychologists, mental health nurses, and/or psychiatrists specialising in autism. With them, you will undergo an assessment lasting between 90 minutes and 3 hours, and be observed to assess your behaviour, interactions and responses to various tasks. 

If you are diagnosed with autism, the primary psychiatrist on your team will put together a plan to support you in any areas of life you find particularly difficult, so this would be a great time to speak to them about diagnosing and treating anxiety alongside autism. Doctors usually go by the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria when diagnosing anxiety or other mental health concerns, and for generalised anxiety disorder, this usually means you are experiencing: 

• Excessive anxiety and worry most days about many things for at least six months
• Difficulty controlling your worry
• Three of the following six symptoms: restlessness, fatigue, irritability, muscle tension, sleep disturbance, and difficulty concentrating
• Symptoms that significantly interfere with your life
• Symptoms that are not being caused by direct psychological effects of medications or medical conditions

Clinicians will also take into account whether or not your anxiety symptoms are due to another disorder, for example anxiety about oncoming panic attacks with panic disorder, anxiety due to a social disorder, or of course, anxiety due to underlying autism. If this is suspected, they will typically work to address these simultaneously. 

If you are looking for information on diagnosing autism in your child, you may find our article helpful: Diagnosing Autism: Understanding the Complexities of Identifying Autistic Traits in Children

How might comorbid autism and anxiety be treated? 

"Understanding what the underlying cause for the anxiety is can be very important. This can be supported by talking based therapy. Medication can treat anxiety but it doesn't get to the trigger." - Dr Shakeel Islam, Consultant Psychiatrist

To help with co-occurring autism and anxiety your medical team may recommend a specific combination of treatments, such as:

• Psychoeducation
• Different types of therapy (including the likes of Cognitive Behavioural Therapy)
• Local support groups
• Medication to help manage difficult symptoms 

Due to a lack of research and understanding in this area, treatments for alleviating anxiety in autistic individuals currently appear to be less effective than the treatments offered to neurotypical people, which highlights a need for better understanding of this comorbidity. It is clear that treatments for anxiety in autistic people should always be adapted to fit the specific needs and traits of the autistic individual, to help them develop recognition and understanding of their emotions. 

Certain coping strategies have been found to have a positive impact on anxious neurotypical people. Since many root causes of anxiety are similar for both autistic and neurotypical people, these strategies may have the potential to help autistic people effectively manage their anxiety symptoms. These include: 

• Moving your body: Studies suggest physical activity helps to prevent anxiety, and has been used in the treatment of anxiety disorders. Even gentle, low-impact exercises a few times a week can change the level of anxiety you may be feeling. Try incorporating gentle yoga, swimming, a long walk, or something similar into your weekly routine, and experiment with the types of exercises that will keep you moving consistently.  
• Eating a balanced diet: Research has identified eating more healthy foods could alleviate symptoms of anxiety in some people. This might look like minimising your sugar intake, cutting out foods high in salt, and eliminating processed foods from your diet.  
• Talking to someone you trust: Opening up about the anxiety symptoms you feel could help you to process emotions more easily, ensure your worries have less power, and gain new solutions to the problems you are experiencing. 
• Taking time away from social media: It is well documented that social media can lead to feelings of comparison, depression and anxiety, so avoiding social media could help you to reduce feelings of anxiety. Try installing app timers, or get into the habit of putting your phone away if you do not need it.  
• Trying mindfulness exercises: Exercises like deep breathing, meditation, journalling and others could help to calm your body and mind when your anxiety levels are high, and doing them proactively could help to address anxiety before it takes hold. You may find some ideas in our article: 8 tried and tested ways to calm your mind

If you have an autism diagnosis and are trying to manage your own anxiety, asking for help from a loved one can also be a great support. By letting them know the situations where you feel most anxious, they can help you to address these feelings when they arise. For example, they may be able to reduce any uncertainty you have if plans or routines change at the last minute, or take other actions to remove the root cause of your anxiety where possible. 

If you know someone struggling with anxiety, you may find our article helpful: 5 tips on how to support someone with anxiety

Where can someone with comorbid autism and anxiety seek support? 

Studies show having peer support could help to alleviate feelings of anxiety, so talking to people you know could help you start to feel better. Whether a family member, a teacher, or a friend, find the person you feel most comfortable reaching out to for help. 

As well as support from your loved ones, the significance of getting a professional diagnosis and tailored treatment plan from an autism specialist cannot be overstated, and will help to effectively manage both conditions without one form of treatment (such as a particular medication or a therapy option) negatively impacting the other. 

At Augmentive, we believe advice and support for autistic people should always be bespoke and tailored to the individual to help with their specific symptoms and traits. So whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private adult autism assessment to help finding an autism specialist near you.

If you have a question about mental health, like if reflexology for depression really works, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.