Autism Psychosis: Features
According to recent findings, the comorbidity rate of autism and psychosis is approximately 34.8%, and it can be possible for autism to involve features that can be categorized as negative symptoms of psychosis, such as social withdrawal. Researchers note that both autism spectrum disorder and psychosis tend to occur on a continuum of severity. Someone living with both autism and psychotic symptoms may need to seek an accurate diagnosis to determine the appropriate form of treatment.
Autism spectrum disorders and psychosis
Recent findings suggest that some people with autism spectrum disorder (ASD) may experience psychotic symptoms.
In addition, one systematic review and meta-analysis found that 11.6% of individuals who are classified as being at clinical high risk for psychosis are diagnosed with autism spectrum disorder.
Autism is usually categorized as a neurodevelopmental disorder and form of neurodivergence impacting social skills and involving repetitive or restricted behaviors.
Meanwhile, psychosis can be defined as a mental state involving a disconnect from reality that is often accompanied by symptoms like delusions, hallucinations, and disordered thinking and speech. It can also come with negative symptoms, which represent a lack of typical behaviors. Negative symptoms can include social withdrawal (asociality), an inability to experience pleasure (anhedonia), and a lack of motivation (avolition), among others.
Comorbid disorders like depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) can be common within the autism spectrum. One study published in The European Journal of Psychiatry suggested that a significant number of adults with ASD and ADHD may experience psychosis, potentially indicating "the existence of a shared etiology between neurodevelopmental and psychotic disorders."
The same study noted the presence of different findings indicating "high comorbidity rates of ASD and ADHD with psychotic disorders such as schizophrenia and bipolar disorder with psychotic features." In some cases, people with ASD and ADHD may experience symptoms like hallucinations and delusions without having comorbid psychotic disorders.
The overlap between ASD and schizophrenia spectrum disorders
Schizophrenia spectrum disorders generally include schizophrenia, schizoaffective disorder, and schizotypal personality disorder. Theories suggest that multiple genes may be implicated in both ASD and schizophrenia spectrum disorders (SSDs).
One study of people with ASD and schizophrenia found each group "overlapped on negative symptoms largely related to the absence of typical social and communicative behaviors." However, those with ASD usually scored higher on restricted and repetitive behaviors and stereotyped language, while those with schizophrenia tended to present more psychotic symptoms.
Distinctions between autism and schizophrenia
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) characterizes autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSDs) as distinct disorders. Whereas ASD may present "core social and communication impairments," SSDs like schizoaffective disorder usually present psychotic symptoms, such as delusions, disordered thinking, and hallucinations, as characteristic features.
However, autism spectrum disorder and schizophrenia spectrum disorders may share "clinical and genetic components" and co-occur frequently, according to findings. Research indicates that similarities in clinical features between the spectrum of these two conditions may be partly attributed to gene- and brain-related imbalances, particularly an imbalance between excitation and inhibition. These similarities may indicate that some individuals with ASD could be susceptible to developing psychosis.
Childhood-onset schizophrenia and autism spectrum disorder
Childhood-onset schizophrenia (COS) is a rare and severe subtype of schizophrenia in which psychotic symptoms present before the age of 13. A diagnosis is usually made when other neuropsychiatric disorders have been ruled out. However, clinical and genetic commonalities between COS and ASD have been noted by various researchers.
One recent case report on childhood-onset schizophrenia notes the possibility of "a single underlying pathology resulting in a unique mixed form of catatonia, autism, and psychosis."
The case report seeks to examine the mechanisms affecting overlapping diagnostic features of COS, ASD, and catatonia, and how so-called hidden features of catatonia may go undiagnosed in COS and ASD. The report also highlights the need for further investigation into whether this pattern of catatonia within these distinct disorders may constitute a single diagnosis.
Potential risk of misdiagnosis
In certain cases, autism may be misdiagnosed as a schizophrenia spectrum disorder due to some similarities in symptom presentation. One study, for example, noted a case in which atypical symptoms of ASD were misdiagnosed as schizoaffective disorder. The misdiagnosed individual in question was found to have undiagnosed ASD with brief psychosis due to stress.
While the study noted that SSDs and ASD can share some commonalities, like social and cognitive challenges, the correct diagnosis can inform appropriate treatment.
Other studies suggest that the correlation between psychotic disorders and autism may be mainly due to the negative symptoms associated with psychosis.
Autistic traits may include the following:
- Social and communication challenges
- Restrictive behavior
- Repetitive behavior
- Challenges adapting to changes
- Anxiety around social situations
- Social withdrawal
- Finding it difficult to understand what others are feeling or thinking
- Challenges expressing oneself
- Difficulty maintaining eye contact
It has also been noted that Autistic children who report auditory hallucinations, which can be a symptom of psychosis, may simply have difficulty differentiating their own voice from that of their imagination. These findings suggest that Autistic children with what seem to be auditory hallucinations may actually be experiencing “pseudo-hallucinations” that do not indicate psychosis. Findings suggest that therapeutic interventions may reduce the stress and fear associated with the imagined voices.
Therapy options for individuals with ASD and psychosis
If you’re living with signs of psychosis, it can be crucial to seek in-person care from a psychiatrist, as prescription antipsychotic medication is usually the first line of treatment for psychotic episodes. However, once psychotic symptoms like hallucinations and delusions have been managed, it can be important to regularly see a therapist to further address any mental health challenges you’re experiencing and reduce the chance of another psychotic episode occurring.
In some cases, attending in-office therapy appointments can be overwhelming, especially for Autistic individuals who may experience anxiety regarding social situations and difficulty with changes to their usual schedule. Online therapy may be an accessible and convenient alternative that allows individuals to customize the therapy experiences to their own preferences and comfort levels. Users can schedule sessions at times that work for them and choose between video conference, phone call, and online chat for each appointment.
One study evaluating individuals' experiences with a text-based online intervention suggested that "internet-based treatment constitutes an accessible and energy-saving treatment alternative for adults with autism." The same study noted that many individuals with ASD experienced stress when seeking in-person care and communicating their needs to strangers, and an online, text-based form of treatment could make care more accessible.
Takeaway
Findings suggest that autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSDs) may share clinical and genetic components. For instance, they may both involve the negative symptoms associated with psychosis, such as social withdrawal and impaired communication. These similarities may indicate that many individuals with ASD could be susceptible to developing psychosis. It can be vital to seek professional insight and an accurate diagnosis so that individuals with ASD can receive the appropriate treatment. Often, treatment involves regular therapy sessions, which may be attended in person or online.
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