(Notes on) Autism and Complex PTSD

Still reading Pete Walker’s guidebook on recovering from Complex PTSD, I can’t escape the same eery sensation I had when reading Heller & LaPierre’s Healing Developmental Trauma – too many items on the C-PTSD (basically equivalent to developmental trauma) checklist are far too similar to too many of the typical autism spectrum “symptoms” (if we take them from a pathologising list) / traits / behaviours / coping strategies / perhaps experiences.

While I won’t document this in detail in this post, I’ve thought about this before and thought of two obvious explanations:

  1. A lot of autistic people have C-PTSD, so that the two are distinct but frequently seen together. I think especially if an autistic person receives or seeks a diagnosis – I imagine the people who have the additional C-PTSD issues (even unknowingly) are more likely to fall into both categories, while the relatively untraumatised ones perhaps just deal with life and never even label or diagnose themselves.
  2. Perhaps, also in part as a side-effect of (1.), the psychiatric categorisation isn’t really neat – what I mean is, perhaps the mental health professionals who get to define / describe the spectrum medically mostly get to see traumatised autistic people (I mean, who is more likely to see a mental health professional?) and what’s described commonly as autism (perhaps even in the neurodiversity community) is actually a mix of the two – it’s actually some autism + some C-PTSD entwined, because it’s rare to just see the former without the latter (and describe it).

Why do I care about these fine points? I guess because my natural traits pretty clearly fall on the autism spectrum, but one the other hand I’m also healing from C-PTSD. And it’s been confusing, based on external descriptions, to distinguish between the things – experiences, behaviour patterns, ways of thinking, perceptions, feelings, etc. – that are a legitimate subject for healing, and those that are just nature and I should leave them alone (and work around them rather than seek to change them).

To spell it out, I would like to over time minimise patterns that are part of my version of Complex PTSD, but I don’t want to be trying to “heal” my natural neurodivergent traits, which in my understanding would be both wrong and futile.

I’ve learnt that “healing” strikes an inflamed nerve with much of the US and UK autistic community and others subjected to or threatened/pressured with cruel autism “cures”, those who are otherwise victims of the psychiatric system, and generally all the self-advocating autistics with an underlying sense of “Leave me alone with enforced character improvement and let me be me!”.

As an autistic person who definitely had massive mental health problems on which I have done a lot of healing work, and also as someone who has benefited over the decades from many relatively diverse personal growth practices, I see the value of “healing” and know the change it can bring, I don’t have these painful associations with it. I think in this respect only learning properly about the concept of autism in my 30’s wasn’t that bad; I wonder if for example identifying it at school would have protected me, or just led to more trauma than coping on my own did – given what was available at that time and place.

Still, since I’ve learnt about autism from the autistic community itself (and acknowledged the obvious, that I obviously have something in common with it :D) and learnt that all the mental health issues were definitely influenced by and intertwined with being autistic (demonstrably different in my mindbodyemotions structure) while getting absolutely no adaptations for it and trying to function like everyone else, I have been asking myself what is what and also whether C-PTSD takes specific forms for autistic people, and whether the recovery process from this and other associated trauma issues also looks different, or has to have different priorities, or whether there are sources and approaches that have a better fit to autistic-specific C-PTSD, if there is such a thing.

Here are some of my first thoughts on this:

In general I tend to dislike black-and-white categorisations (yes, despite being autistic :D) and I like to see things along human continua … even autism itself, I like to see it just as an exceptional accumulation of specific traits and ways of perceiving that are always around but at rare times accumulate in one person to such a high degree that the person really feels different and functions differently from the average to such a degree that it is … hard. So well, on the other hand, I think a quantitative difference that at some point does become qualitative. But still, we’re not space aliens, ethereal beings or a separate species. => So I’d expect something similar for the features of “autistic” C-PTSD … that it’s the same animal, four legs, head and tail, but maybe the proportions or emphasis are shifted in significant ways.

One difference that I’m pretty sure of by now is that there might be a autism-specific flavour of C-PTSD which can arise even in relatively benign environments based on the empathy-mismatch between an autistic child and a non-autistic caretaker (or even an autistic one, but who has a really different sensitivity profile or not a lot of self-insight). See the double-empathy problem (random clarifying article that seems OK.)

A favorite aspect of Pete Walker’s work for me is how he makes clear that emotional abandonment – a lack of empathy or sharing feelings – is actually at the core of C-PTSD, and it’s not only the core reason why various other more visible forms of abuse leave lasting traces (because of the underlying sense of emotional betrayal) but it’s sufficient in and of itself to cause C-PTSD. To clarify: according to the trauma research I’m familiar with, a child (or adult) can go through major disasters without developing C-PTSD when there is empathy, emotional support, community – when it’s a challenge that we go through and in the end overcome together. On the other hand, everyday situations that present no physical danger nor even psychological threat can lead to C-PTSD if the child receives no emotional help in digesting its inner experiences.

For me this was essentially the missing piece on why on earth I have had glaring and intense C-PTSD symptoms over years and decades in the first place. Before I figured out that I’m on the spectrum, and before I learnt about what Pete writes (and a couple of other trauma researchers as well), I couldn’t figure out why on earth I even have it – no beatings, no insults, no natural disasters, but a life of non-stop emotional flashbacks, nightmares, obsessions, a persistent, every-present looming sense of doom and subcutaneous expectations of imminent apocalypse that activate at the simplest occasion (such as being hungry or tired – again, something Pete describes as a common trigger). For me learning about the double empathy issue and the fact that “mere” lack of adults adequately, intelligently empathising with a kid causes C-PTSD feels like it solves the mystery.

This has stopped being coherent now and is more like a list of disconnected ideas, but another aspect I wanted to touch on is the relation between the concept of a “meltdown” in the autism language and the concept of an “emotional flashback” in the complex trauma literature. I’ve thought for a while about whether it’s really different, or kind of the same thing, or whether most instances of “it” are a mix of the two.

Again, why am I interested in the fine print? Because flashback management is different from meltdown management, at least according to the Credo. It seems smart to be able to figure out which one it is => how to react on the level of behaviour and inner attitude.

I think I’ll leave my observations on this for a future post. Meanwhile I’m curious if any of the autistic readers specifically have any opinion or observations on this.

13 thoughts on “(Notes on) Autism and Complex PTSD

  1. Thank you. This feels like the key that might make everything about me make sense.:
    “[E]motional abandonment – a lack of empathy or sharing feelings – is actually at the core of C-PTSD, and it’s not only the core reason why various other more visible forms of abuse leave lasting traces (because of the underlying sense of emotional betrayal) but it’s sufficient in and of itself to cause C-PTSD. To clarify: according to the trauma research I’m familiar with, a child (or adult) can go through major disasters without developing C-PTSD when there is empathy, emotional support, community – when it’s a challenge that we go through and in the end overcome together. On the other hand, everyday situations that present no physical danger nor even psychological threat can lead to C-PTSD if the child receives no emotional help in digesting its inner experiences.”
    (I will have to digest a little more before I write more — I hope some of your other readers will share their thoughts too.)

    1. Hi, not sure you’ll still see this (I have a turtle tempo here :), but thanks for the comment. I think for me any reading related to the topic of C-PTSD takes a really long time to digest (maybe that’s why I only take up the topic again almost a year later).

      I think reading, learning, and changing in this area really happens on a slow and somewhat unpredictable / non-linear timeline (then sometimes it seems fast when you look back!). Small insights sometimes make a huge difference for me though.

      All the best, wherever you are this year!

  2. This is really interesting and super important to bring awareness to this subject❤️ Please feel encouraged to check out my recent blog post regarding PTSD awareness day (today, June 27th) or just the overall PTSD awareness month of June! Thank you❤️

    1. Thx! I’ve seen this, and also read a lot about PTSD before. I sometimes wish there had been more awareness / publicity around C-PTSD, because in my opinion it’s very hard to identify that one is dealing with a form of PTSD when flashbacks take a vague, emotional (pr “existential” or “psychic”) or somatic form.

      I read all this stuff about PTSD for a reason, probably, sensing it’s somehow relevant, but at the same time not fulfilling the criteria for it. The C-PTSD stuff can get mistaken for so many other things; and I think far more people have it than are aware of it. — On the other hand it’s so helpful to identify it and apply adequate healing strategies.


  3. Thank you for this post! I also often question why I seem to have C-PTSD symptoms while not having experienced “traditionally” traumatising events. I’ve had nightmares pretty much every night since I can remember, and yet anyone would say I’ve had a relatively happy childhood.
    I have one peculiar trigger for deep emotional discomfort and anxiety that has been the same since I was a kid, and there has definitely been a lack of empathy by adults at least on that point (I apologise for being so vague, but I can’t do otherwise).
    My hypothesis is that despite having caring parents, the fact that I had emotional reactions to “weird”/unexpected things made me more likely not to receive proper empathy and support when I needed it, which messed me up.

    1. Thanks for the comment and sorry for me tempo with replies.

      What you say sounds very relatable to me. When I read it, my first thought in the context of autism (I don’t know if you identify with that) was that I suspect it’s even enough if caretakers (parents, school, etc.) don’t understand sensory overload and punish for meltdowns.

      I definitely have very caring parents, but they didn’t get that my meltdowns e.g. on family trips or while shopping or even from loud TV were a sign of over-stress, and attributed it to some kind of egoism: not being able to wait a bit longer or accommodate others, trying to boss others around – I was a super sensitive child (and I think pro-social and altruistic, trying to not upset and help others ,,, the kind that gives pocket money to charity :D) so these kind of remarks were so hurtful , shaming and confusing that it still makes me cringe to re-type that decades later.

      And frankly, I also suspect that my parents had no idea that I’m so sensitive that I then acquire lasting paranoia whether I’m really such a bad and bossy and selfish person. I’ve also heard this from others, the experience of being punished for (sensory) pain can leave deep traces, and it usually happens because others don’t understand that *pain* is what is happening. In my view it’s as confusing and traumatising as being systematically punished for example for getting a migraine (and being spaced-out or irritable because of it), rather than getting help.

      And I do think this applies to non-autistic kids and to stuff other than sensory overload, too – to anything that others don’t perceive as an issue but that is really serious for the child, like unseen physical pain and unseen serious emotional pain. The problem is then that we accept this level of pain as normal, or even mentally punish ourselves for feeling it (we copy the attitude of our caretakers). This can give rise to much mess; on the other hand, understanding this point, registering true pain/discomfort levels and slowly arguing oneself out of this attitude (“you are *bad* for feeling pain”) helps a lot.

      Belatedly all the best on your journey.

  4. Hi, I just wanted to let you know that your piece was mentioned here: https://quantumlivingpsychology.wpcomstaging.com/2021/01/26/complex-ptsd-trauma/
    I love your insights about emotional abandonment. I’ve never thought about it that way, and it makes so much sense. When you consider the double empathy problem and the way autistic people are often judged instead of supportive, the high rates of complex PTSD are less surprising.
    I hope you’re able to heal from complex PTSD while staying true to your autistic self!

  5. Hi Jenna, thanks for the spot-on comment.

    I’ve actually linked back to your article in another post on C-PTSD, as I think you explain the concept clearly and concisely – while I guess my more personal articles are only for people who are already familiar with the topic. It’s cool to have found a good reference to cite 🙂

    And yes, I do think the double empathy problem is at the heart of it. It impacts us far more as children, when we are dependent on others’ empathy skills to get our physical and emotional needs met and avoid pain.

    I also think it’s broader than that though and can apply to any situation where the child is really different from the available caretakers, and the latter don’t get extra support.

    I’ve recently read books on certain communal indigenous societies, where children are raised by the whole village, and mentors from other villages are brought in if there is no one around who is a good match for the young person’s skills and/or problems (if they are quite rare). When I read this, it struck me how much this would have helped in my youth – I did not have access to adults matching/understanding first-hand my ability profile. I keep thinking that engagement with a much wider diversity of adults / older youth and actually paying attention to individuality would avert so much mess.


    1. I read your piece and came to the comments to say “This collection of thoughts has rung every single bell that could possibly ring in my head at once” AND BOOM HERE YOU ARE IN THE COMMENTS RINGING ANOTHER ONE OH MY GOD ;-; truly, deeply thank you for sharing your observations – I was not expecting to feel so utterly SEEN in my cursory googling to find out what my neurodivergent peers had to say about Laurence Heller, hahah. It’s brought an unexpected peace to my afternoon. Cheers!

      1. Hi Caty,

        thanks for bothering to put this in words! So people actually do know Heller’s work? I’d actually be curious about in which context you googled that – I haven’t seen the two topics connected before. How did you come up with a connection?

  6. I can’t recall if I commented before but I wanted to say that this article is brilliant. I feel I’m not alone. My Autism therapist suggested C-PTSD and Yes, this is my problem. NOT being autistic. That bit can be kinda cool. What I’ve learned causes PTSD is:(may trigger you so if down don’t read today)
    * Being in discomfort, pain having no control to stop.
    *When You scream to the world (in your head even) for help and non comes.
    *When you feel trapped and can’t escape your problems.
    *When those that are supposed to understand or care let you down.
    *Others insisting that your feelings aren’t real, you’re acting up, over reacting, being difficult, only for those pain messages to scream louder, so you stop listening to them, conditioning yourself to continually push through til burnout.
    * when you trust unworthy people and can’t tell firend from foe
    * Believe being good and honest is the best you can be, yet being two faced is how you succeed.

    * when at school age your diagnosis is used to explain your defficiencies and why you are difficult or no one wants to play with you. Later, why people don’t want to hire you, live with you, socialise you, date you.
    *When there isn’t even accessible mental health support ro treat your PTSD.

    But my question is, what can we do about our residual “Complex-PTSD” ? Dealing with the causes, coping strategies go someway like a plaster (UK)
    (Bandex), but that’s it, to continue with the metaphor, Bandex won’t mend a broken . An ex soldier may choose to hunker down on bonfire night or independence day to avoid fireworks triggering memories of his war, but what if you can’t avoid it, what if you’re triggered everytime you go to work, have to speak to people, get your needs met. What if working and socialising means being misunderstood, dismissed, being uncomfortable, being allowed to be autistic within ‘reason’. And you have to endure the ‘unreasonable’ aspects that adjustments wouldn’t be made for, and knowing they were refused. These don’t dissappear and you can now see past their thin veneer of ‘inclusivity’.
    Should the Autism spectrum also be overlayed with a shade chart that the NT world, employers will consider ‘reasonable’.

    Does my view of the pain I have from living with Autism make sense to anyone else?
    If so, I want to do something about it. We NEED the world to wake up if we’re going to make any inroads into the tragic Suicide and Employment outcomes for Autistic people.

    Please feel free to reply by simply saying YES

    1. Yes, it totally makes sense to me, and I’ve seen multiple stories in real life like the one you’re telling (about workplaces, for example).

      Also to put it frontal, I’m not employed – self-employed sort-of, but it’s below my potential and doesn’t earn enough – and it’s related to the reasons you mention. Though in my case, I never really tried – I knew a single full day at school or uni kills me, so I didn’t even consider (for example) working 40 hours (or even 30 hours) in a setting where I have to adapt like that.

      Well, not really “adapt” – cause I can’t adapt my physiology – there’s nothing I can do to not be burnt out for example by office air or lighting or just the fact of being in a room with many people for many hours, or the fact of not being able to move around naturally. More dissociate and repress.

      I’m totally familiar with your point on ongoing trauma – and I’ve been asked this question multiple times actually (if I understand your question correctly – in various conversations about this: how can you heal if daily life continues to be re-traumatising.

      I think my answer sucks because it is “you can’t” – at least I couldn’t before I got myself into a safer situation where I can control more of my environment and schedule. And where I’m not living in incessant anxiety about basic stuff like housing and access to food that my body works well on.

      I actually blogged about this before somewhere – I think here – https://autisticnaturalhealth.wordpress.com/2019/12/11/the-sad-truth-about-autistic-mental-health-material-conditions-matter/
      – when I got decent conditions and it really, really, really pissed me off that I’d been trying to “fix myself” with meditation, therapy, blah, for so many years, when frankly the “solution” to mental health can be material security (via money, or otherwise reliable community support). I think every textbook and article on mental health should start by stating this fact :p

      That leads over to the second answer I’d offer, which is basically social justice. The more often I’ve seen this exact story repeat (people unable to work or getting to burnout for similar reasons) the more anger I built up beyond that, seeing that it’s not just me, but it’s systematic (or systemic). In short, it’s “always the same story”, painfully happening to people to whom it really shouldn’t.

      If I knew how to do effective activism on this issue, I would definitely give it at try (I’ve tried a bunch of other activisms before, to limited effect because of my limited ability to stay in groups). Feel free to comment more or write me if you have any ideas or want to talk.

      Also thanks for your list of PTSD causes, some I wasn’t aware of, and it’s overall a neat clear summary – good for me to see it mirrored externally. Personally I probably check another few boxes that I didn’t realise were a thing.

      Probably pessimistic that I wrote above you can’t heal without having the external conditions – it’s not that binary, I think aiming to move the conditions can to some degree be healing. And good company can compensate for some. But still … not just in autism, but in other “diversity” topics as well (e.g. trans rights) I think there is no way out without social change, it’s unfair to put pressure on individuals and expect them to cope with this – it’s a totally ridiculous expectation.

  7. Yes I’ve also read Healing Developmental Trauma by Heller and Lapierre! It was the first book on trauma healing that I read, at the recommendation of my former autistic gifted coach Silver Huang. It sparked a long-term interest in the subject and I’ve read many more books and articles in it since, even considering becoming a SE practitioner myself at one point before my second burnout.

    This is an excellent post and I agree with everything you said! I’ve heard that before, how no we don’t know what an un-traumatized autistic looks like because the diagnostic criteria are all trauma-traits based!

    And YES so much on the systemic issues ❤️❤️❤️ (as you know already from our conversation on Facebook)

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