Autistic people can develop PTSD from events which are not considered to be traumatic by the DSM-V (the manual from which mental health conditions, including PTSD, are diagnosed from).

(Although in the UK we use the ICD for diagnosis, much research focuses on the DSM. There is much overlap between the DSM and the ICD).

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Full article: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/aur.2306

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Who: Rumball, Happe, Grey

Where: Autism Research

Published: 2020

Title: Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5 Traumatic Life Events
PTSD

CW: Talking about PTSD & traumatic events

The DSM-V defines specifically which events can lead to the development of PTSD. However, autists experience and perceive the world differently to neurotypical people, and autists have increased anxiety responses to situations which NTs would not consider to be stressful. Events other than just the ones listed in the DSM-V might be traumatic to autists.

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DSM-V: PTSD: CRITEREON A

Actual or threatened death, serious injury, or sexual violence, in one (or more) of the following ways:

• Directly experiencing the traumatic event(s)

• Witnessing in person the event(s) as it occurred
to others

• Learning that the traumatic event(s) occurred to close family member or close friend

• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)

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A previous study by Rumball et al found that autistic people experience higher rates of PTSD than neurotypical people.

Neurotypical with PTSD: 4.5%
Autistic with PTSD: 45%

This study wanted to answer three questions.

1) What events are interpreted as traumatic by autistic adults?
2) What are the rates of probable current and lifetime PTSD in trauma-exposed autistic adults?
3) Is the experience of trauma type or PTSD influenced by gender or autistic traits?

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DSM-V Trauma

62% of participants (72% of females and 48% of males) had experienced trauma as defined by the DSM-V. This was most commonly sexual assault and unwanted sexual experiences (86%) and physical assault (68%).

After these events, 48% of females and 40% of males developed PTSD.

Over the life, the probability of developing PTSD after a DSM-V trauma was 70% for autistic females and 40% for males.

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non-DSM-V Trauma

35% of participants (47% of females and 78% of males) had experienced a traumatic event that does not fall under
the DSM-V definition.

These events included bullying, “non-traumatic bereavement”, mental health trauma (including eating disorders and “breakdowns”), abandonment by a significant other, the diagnostic process, experiences of therapy, being disturbed by ones own aggression towards others, and unexpected police contact.
After these events, 41% of females and 44% of males developed PTSD. This is the same rate as for DSM-V trauma.

Over the life, the probability of developing PTSD after a non-DSM-V trauma was 71% for autistic females and 56% for males.
Despite these events being traumatic for the individual, they are not included in the DSM

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All Trauma

The average number of traumatic events that autistic participants experienced was 4 events. One individual had experienced 15 traumatic events, and five individuals (8.5%) had experienced no traumatic events.

PTSD traits were not related to autistic traits or to gender.

After any trauma, the probability of developing PTSD was 43%-45%, which is much higher than the rate for neurotypical people (26.3%-33%)

This study found the lifetime probability of autistic people developing PTSD is 61%-63%, in comparison to 8%-12% in veterans, and 6% in non-veteran NT populations.

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However, this study revealed that autistic people can develop PTSD from events that the DSM does not consider to be traumatic. It is important to consider the subjective interpretation of what is traumatic.

It is essential to follow up on the findings that autistic people are being traumatised by the autistic diagnosis process and by therapeutic intervention.

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This study didn’t consider sensory sensitivities, their impact, or the impact of these being negated by others on experiences of trauma.

This study found no link between sex & PTSD traits, but also did not include any transgender or non-binary participants (autistic people are more likely than neurotypical people to be transgender or non-binary).

This study excluded people with an intellectual disability (IQ<70). It is important to investigate trauma & PTSD in this population.