Complex PTSD vs Aspergers

As I was researching the interplay between Asperger’s and complex PTSD, realize many people ask questions such as complex PTSD vs Asperger’s, and whether you can have complex PTSD and Asperger’s at the same time. So in this article, I am going to compare the similarities and differences between complex PTSD and Asperger’s syndrome.

Complex PTSD vs Asperger’s: Although complex PTSD sufferers and those with Asperger’s share similar difficulties in social interactions, they stem from very different root causes. Symptoms of Asperger’s syndrome are due to how the brain is wired, whereas complex PTSD stems from long-term multiple traumas.

Is Asperger’s a real condition?

Asperger’s syndrome is a real condition and Asperger’s continues to be recognized by researchers and medical professionals. But, many people are asking if Asperger’s is a real condition, mostly because the DSM-5 no longer defines Asperger’s as a separate condition.

Are people with Asperger’s more likely to suffer from complex PTSD?

Research Statistics

At the time of writing, there are only a handful of official research papers in this area, and the research statistics available are very mixed. They range from reporting 67% out the Aspies surveyed showed signs of PTSD to 2-3%, which is no different from the general population. And then we have all kind of numbers in between, such as 26% of the Aspies surveyed had a traumatic history and 17.4% met the criteria for PTSD.

Still, two more studies reported 30.7% Aspies surveyed had experienced physical or sexual abuse, and 40% had adverse childhood experiences such as physical and sexual abuse as well as severe neglect by parents or caregivers. Also, for the last 20-30 years, research demonstrated that the chances of Aspies suffering from clinical depression is 37.4%, and 84.1% for severe anxiety disorders.

Clinicial Presentations and Experiences

Clinicians who are working with people seeking therapy believe that Aspies are more likely to suffer from complex PTSD. Let’s look at a few case studies.

	Details	Clinician’s Comments
Case 1: School boy	As an infant: knowledge of being abandoned by mum At 3: sexually abused by a relative At primary school: being bullied At 10: almost drowned, a life-threatening experience At 10: heat stroke due to accidentally locking himself in a car, another life-threatening experience At 12: grandmother died, suicide attempted	Autism has clearly contributed to this child being vulnerable to: Horrific abuse Being bullied at school, and lacking a sense of danger.
Case 2: 103 college students	Students were surveyed for showing signs of autism and PTSD. Students with more signs of autism also show more signs of PTSD.	When focused not on diagnostic criteria, but only the behavioral symptoms, autism and PTSD are definitely closely linked.
15 Adult Aspies and 15 Caregivers	Participants were surveyed for how they view and define traumas in the lives of people on the spectrum Their version of traumatic events include: being autistic in a neurotypical world being excluded because of communications difficulties daily battles with sensory overload changes in daily routine moving away from a close member of the family losing a family pet of favorite toys regular bullying at school sexual and physical abuse	So we can see that just by being autistic alone, and having all the symptoms together with it can be very traumatic for them without the need of experiencing or witnessing the extreme traumatic events as defined in DSM-5.
Case 4: School boy	When very young, he experienced and witnessed severe domestic violence. As a result of that, he had to: live in a different place adapt to a new daily routine, and learn to live without the family pet which his father has kept When interviewed, the mother observations are: emotionally remote from the domestic violence that he had witnessed and experienced struggles with the new accommodation naturally reverted to old routines that don’t apply anymore, and extreme grief over the loss of his pet	This case shows that what might be traumatic for someone on the spectrum could be quite different to the general population. For this boy, the impact of his autistic traits are far more traumatic for him than severe domestic violence.
Case 5: School boy	fearful of school and refused to attend inpatient treatment for life-threatening deliberate self-harm behavior trauma history: loud sirens during fire drills	This is another case that shows what might be traumatic for someone who is on a spectrum can be very different to the general population. The impact of the fire alarm is so strong that it had resulted in life-threatening self-harm.

When we look at case studies such as those mentioned here as well as other personal experiences, it is clear that autism and traumatic experience are closely related, but what might traumatize an Aspie could be quite different to others. In fact, according to one research Aspies can be 3 to 4 times more likely to suffer adverse childhood experiences, which is also a significant indicator of suicide risk.

Some researchers firmly believe that Aspies are more vulnerable to abuse. Here’s why:

• Aspies have an already highly anxious state when interacting with others, so they may not be able to distinguish the difference between general social anxiety and anxiety is related to abusive behaviors
• not knowing commonly accepted interpersonal boundaries also mean that they may not be aware of the social inappropriateness which should have given them some warning
• given Aspies’ daily struggle in social settings, their complaints of abusive incidents may be interpreted as exaggerated reports or attention seeking behavior
• Aspies tend to have a need for intellectually theorizing social surroundings by painstakingly studying their environment and the personalities of significant others in their lives. This could mean that they do not have sufficient information to model and study early behaviors indicative of abusive intent
• if the perpetrator is a caregiver, that trust could be used to convince the victim that the abusive behavior is part of normal daily lives and lead the victim to believe that it’s their autistic sensitivity at fault
• generally speaking, those who have experienced trauma and yet resilient to PTSD usually have a stable childhood, good support network, and have multiple stress reduction strategies. However, these are also the things that Aspies are least likely to enjoy.

Also, after reading tonnes of Aspie forums, here are some of the things other Aspies have said

• Aspies could be more sensitive to traumatic events that involve stimulus that they are particularly sensitive to
• Aspies are on the spectrum but not cognitively impaired, so do not typically receive the same amount of support and guidance as their lower IQ counterparts. As a result, they may have a lower sense of dangers or understand what is socially acceptable to have happened to them. Yet it is generally not spelled out to them that certain things are not meant to happen.
• Aspies can also be intensely focused on the pragmatic issues resulting from traumatic events such as adapting to new routines or living environment. So much so that the effects of trauma only shows up at a much later stage in life.
• The lack of social interaction and communication skills in Aspies may also increase the chances of being targeted for man-made traumas such as severe bullying, physical and sexual abuse.

Is it Complex PTSD or Asperger’s?

	Initial Observations	Further Observations	Clinician’s Comments	Diagnosis
Case 1: Boy (7-8yrs)	Poor behavior at school uncontrollable temper difficulties in making friends at school reluctant to interact with other children deliberate destructive behavior such as damaging properties of others and disrupting group activities would suddenly run and hide when feeling insecure	A high awareness of his surroundings and what others are doing He is a recent immigrant to a new country with no knowledge of the local language spoken was rejected, abandoned and put in an institution and a very early age is accustomed to self-reliance in times of danger	At first, the challenging behaviors may seem to indicate that boy may be autistic. But then it is unusual for someone on the spectrum to be highly aware of his surroundings or what others are doing. When we take his historical background into account, it may well be that his heightened awareness is actually a form of hypervigilance in PTSD. PTSD would also explain his tendency to run and hide as opposed to simply running away from a situation. Also, complex PTSD sufferers often find it difficult to trust others and are reluctant to interact with others for fear of harm.	CPTSD:Y, Asperger’s:N
Case 2: Boy (7yrs)	general communications difficulties aggressive and violent behavior towards others sleep disturbance extremely anxious very restless Recent immigrant to a new country with no knowledge of the local language spoken was at one time a very loving and affectionate child with good development of social skills suffered physical and emotional abuse from his father at a very young age	Was capable of interacting with the therapist after sometime able to play imaginary games games are repetitive and centered around how a mother figure protects a child from great danger able to use eye contacts and gestures to overcome language barriers evident desire to engage with the therapist during assessment	Autism diagnostic tools were used and the only match was communications difficulties, but this can easily be explained by not being able to speak the local language Other composite signs of autism such as social anxiety and reluctance to engage with others were absent. Although repetitive games and habits could indicate potential autism, the fact that the games consistently re-enact earlier traumas shows that this is more likely to be caused by PTSD rather than autism.	CPTSD:Y, Asperger’s:N
Case 4: Woman (30+yrs)	Existing PTSD diagnosis a habit of repeating dialogues from movies loves to spin in circles flaps her hands as a self-soothing technique hypersensitivity to noise inability to adapt to change your routine schedule severe tantrums no sense of danger inappropriately familiar or distant from strangers or people she knows doesn’t like being with other children a long history of being bullied at school Mother has a family history of autism witnessed domestic violence at a very young age	Biting as a sign of anxiety was observed developed relationship with the therapists and assessors very quickly showed extreme concern that everyone is okay foregoing personal needs until the needs of others are fulfilled no disruptive or destructive behavior observed during the assessment but was reported by parent good social interaction and communication skills effective use of eye contact, words and body language showed creativity and imagination when playing with toys	Clear evidence of PTSD symptoms and traumatic events earlier in her life social communication and interaction skills demonstrated was appropriate for her age which would not be expected for those on the spectrum there was no difficulties in creativity and imagination which would be expected for an autistic child the inappropriately distant or overly familiar relationships could be because of being separated from her father following a long period of domestic abuse. The ability to be overly familiar is in itself an indication that she is not on the spectrum	CPTSD:Y, Asperger’s:N
Case 3: Girl (6yrs)	Attended treatment clinic for PTSD a clear history of past traumas suffers from flashbacks and hypervigilance easily startled and high levels of stress	Extremely anxious in social settings suffers from sensory overload in terms of sensitivity towards lights, sudden noises, and movements. Communications tended to be very literal uses repetitive movements as self-soothing techniques a strong need for routines and difficulties to adapt to changes	In this case, a clear history of past traumas along with the associated flashbacks gives a clear indication for a diagnosis of PTSD. However, the secondary observations also provide indication for a probable diagnosis of Asperger’s. It is evident that PTSD treatment alone would not help to address issues such as social anxiety, sensory overload, and communications difficulties. But dealing with autism on its own and neglecting the PTSD symptoms would mean no support to handle flashbacks and hypervigilance	CPTSD:Y, Asperger’s:Y

Can you have complex PTSD and Asperger’s at the same time?

Researchers generally agree that Asperger’s is to do with how the brains are wired and function. Whereas complex PTSD is due to multiple traumatic experiences over a long period of time. Although both result in social awkwardness or anxieties, there are subtle differences between the two. Also, there are other accompanying signs that are unique for each condition.

Clearly, Aspies are more vulnerable to traumatic events. So why is it that some research reports show only about 2 to 3% of PTSD occurrence?

What makes it difficult for Aspies to be diagnosed with complex PTSD?

The way professionals catergorize Aspergers and Complex PTSD

Aspies tend to be thought of as a childhood thing, and professionals know what Aspies are like as a child. But then with Complex PTSD , they think of it as an adult thing. So to think someone could have both conditions is like saying someone is both a child and an adult.

A one or the other mentality

Another problem is sometimes the Asperger’s syndrome is not recognized until adulthood much later in life. So then the Asperger’s aspect gets totally ignored, and all the focus is on the trauma history. Or, if they already knew you’re an Aspie, and you didn’t have exposure to actual death, threatened death, serious injury, or sexual violence, then you cannot possibly have PTSD, let alone complex PTSD.

But the Aspies a lot more sensitive to social incidents such as being bullied, isolated, and teasing. This means that even if they exhibit PTSD symptoms, they may not be diagnosed with it, because technically they have not experience the kind of traumas that is defined in the DSM-5 diagnostic guidelines.

Lack of guidance for recognizing Complex PTSD in Aspies

To date, there are no psychological or mental health diagnosis guidance that specify how things might be different for those on the spectrum. It is only in the last few years that clinicians realized that Aspies can be so sensitive to social contention that it can be described as clinically traumatic. These includs: experiencing or witnessing bullying, teasing, arguments at home, and even domestic violence or sexual abuse.

Also, when an Aspie develops a strong sense of emotional attachment and relationship with a certain family member, a family pet or even a favorite toy, losing such a relationship can have catastrophic and traumatic impact on them. That’s why some clinicians feel that definition of trauma in the traditional PTSD or complex PTSD diagnostic criteria would simply miss them and they don’t get the diagnosis.

For example, it could be that a traumatized Aspie sometimes show an extreme form of hypervigilance, more easily startled, having more nightmares and sleepless nights, or having great difficulties in emotional regulation, or difficulties in concentration and focus.

These clinicians believe it is often too easy to dismiss these trauma symptoms as autistic traits. This means even when they are showing clear signs of trauma, the relevant help and assistance not be available.

Lack of training understanding of similarities and differences between Complex PTSD and Asperger’s

When we look at the case studies mentioned above, we can see that it is not always easy to distinguish between complex PTSD and Asperger’s. For similarities, whether male or female young or old, they all struggle with some aspect of normal daily living. Sometimes it’s destructive behaviors, sometimes it’s a reluctance to engage and interact with others, and some other times there may be observable signs of anxiety. For differences between complex PTSD and Asperger’s, the professionals look at the symptoms separately, and they do not appear to believe that you can only have one or the other.

For complex PTSD, as well as looking at the social side of things, they also look for evidence of trauma history, changes in behavior before and after the trauma, as well as evidence of flashbacks, nightmares or reenactment of the traumatic event. For Asperger’s, as well as the social side of things, they also look for absence in creativity and imagination, inability to maintain eye contacts, difficulties in adapting to change to routines and reluctance to engage or interact with others at all times.

How does Asperger’s complicate trauma recovery?

Here is a list of challenges that traumatized aspies face in a traditional trauma therapy setting.

Communication difficulties

Social interaction and communication difficulties make it more difficult to communicate with the therapist who doesn’t understand the tendencies to have a very literal interpretation of words. Psychologists my also make a lot of assumptions from what they think their autistic clients are saying based on what they know about the general population.

Level of pre-existing anxieties

Aspies already have a high level of anxiety just from dealing with everyday life alone. So discussing traumatic memories could be even more difficult for Aspies. If the aspies become non-verbal out of stress, the psychologists may dismiss them from the clinic and refuse treatment.

Difficulties in adjusting to new routines

Aspies spend a lot of time to establish a workable routine for themselves to keep their sensory overload under control. Following major traumatic events, there is usually a need to establish and adjust to new routines, which could be very overwhelming. This may leave little head space for thinking about how to address the past events or learning how to establish a routine to keep intrusive thoughts under control.

Different sensory processing system

Aspies tend to experience the world very differently from the general population. For example, the may be hypersensitive to noise, but more insensitive to physical pain. This means Aspies are likely to experience traumatice events that is unique to them. What may bother a lot of people may not bother them at all, and vice versa.

With a therapist who is not aware of this, there can be many wrong assumptions made. For example, some may conclude that if the client couldn’t recall pain even though it obviously must have hurt, then the client must have suffered some kind of memory loss. Sometimes Aspies can also be accused of lying if their description of what happened doesn’t fit the norm.

Aspies have a unique way of thinking and interpretation of events

Aspies have a unique and complex representation of social reality is often difficult to explain to others. In the meantime, psychologists are trained to use all kinds of theories to second guess what’s going in the mind. The trouble is, what’s considered to be normal to them are sometimes just not the way Aspies function.

Some psychologists may see the high functioning aspects and totally ignore the autistic needs. If the psychologists push their theories on the Aspies, many Aspies are likely to react and then there’s a break down of trust and working relationship.

Difference in capabilities

Some psychologists do not always understand that Aspies could be very clever and smart in one thing, but not the other. For example, Aspies may have abilities to remember things in details, but the thought of having to change routines can bring a lot of stress.

This can be problematic because therapy often involves learning new routines and doing things differently. But psychologists can get frustrated if they interpret the autistic traits as unwillingness to cooperate. In some cases, it could mean termination of support.

How can Aspies get help with their complex PTSD?

The objectives of complex PTSD recovery

First, you need to know how you define recovery. Here’s a list that may help.

• ability to cope with the emotional and physiological responses when those traumatic memories come to mind?
• able to keep those memories under control
• rebuilding and maintaining healthy self-esteem
• learn new skills to develop and maintain interpersonal relationships
• develop skills to identify who can be trusted and who cannot
• being able to remember and make sense of the traumatic events in a coherent way

How can complex PTSD clinics help?

PTSD specialists are trained to help you process one piece of traumatic history, but Complex PTSD specialists are trained professionals who can help you to rebuild life despite long-history of multiple traumas.

They do this by:

• raising safety awareness
• helping you to develop a reasonable sense of responsibility for the safety of self and others (not too much and not too little)
• helping you to analyze your own life and identify the kind of avoidance behaviors that are problematic for you
• understanding your own thinking that is driving the avoidance, and exploring ways to challenge those thinking
• discussing with you about your goals and wishes in life, and identifying what complex PTSD symptoms could be hindering those.
• sharing experiences to demonstrate different ways people have tried to overcome similar challenges.
• carefully listening to your feedback so that they can help you to adapt coping methods to your personal situation
• encouraging you by helping you to see your own progress
• mentoring and coaching you how to maintain physical and emotional stability when things go wrong
• helping you to master the skills you have learned and to develop a habit of applying those skills in everyday life
• before discharging you, providing you with safety-net sessions on an as-required basis, so that you know if some unexpectedly bad situation happens, you can still get help
• offering you booster sessions to remind you of all the skills you’ve learned and this will help reduce the chances of relapsing into illness.

What clinical adjustments do Aspies need?

In addition to checking that your therapist is truly experienced in treating complex PTSD, you also need to make sure your therapist knows what to do with your autism. Here are some of the things you may like to consider:

• provide an autism-friendly waiting area to avoid sensory overload before and after the session
• keep appointments regular and in the same place with a standardized format.
• assistance to develop emotional, physical and social stability including those caused by their autism
• progressive understanding of social norms that can help to distinguish trustworthy individuals from those who are not
• Guidance and support to develop the social skills required to build healthy relationships and support networks
• social support to develop living skills if required

How to test if the therapist is suitable for you?

• does the therapist actively listens to you and show empathy?
• is he curious about in the way you think or see things?
• does he double checks his understanding with you by trying to rephrase what you said and confirm with you that he has understood you correctly?
• does he take the time to hear what you have to say, or is he time conscious and prefers to stick to a certain pace or an agenda?
• does he have any experience in dealing with volatile relationships that can change from one minute to the next? If so, ask how he handled it
• is he knowledgeable about Aspie’s way of life and challenges in social setting? if so, ask how he plans to help you with it during your sessions.
• is he prepared to explore and brainstorm potential solutions to your problems that would also fit in with your artistic way of life?
• does he prefer to tell and dictate, or does he prefer to guide you through steps of self-discovery?
• Is he prepared to cater for times when you are unable to speak? Would he be prepared to read your notes and communicate with you in other ways?
• Does he view your relationship as professionals telling you what to do, or does he view himself as a knowledgeable friend who can help you find solutions that truly work for you?

Let’s face it, we all have experienced situations where personality differences get in the way of success. And when you are already a traumatized aspie, the last thing you want is a clash with your therapist. So, how can you tell if the therapist you are meeting the first time is right for you? Here’s a checklist that may help.

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