PFA Tips: Autism and Suicide

Being autistic can be like living life on hard mode. It means navigating a world that wasn’t designed for you. It means your needs are often at odds with your environment, and you are frequently surrounded by people who have a difficult time understanding you. And living life on hard mode all the time can make someone not want to live at all.

The myth that “autistic people don’t have feelings”
One longstanding misunderstanding about autistic people is the idea that autistic people do not have feelings. This misconception was held for a long time, including by mental health professionals. However, autistic people love, hurt, and empathize in just as diverse ways as non-autistic people.

Autistic people also experience thoughts and behaviors related to suicide in just as diverse ways. In fact, autistic people may experience and express suicidality differently than non-autistic people. These thoughts and behaviors start young, even as young as 5 years old, and affect those with and without intellectual disability, those who are speaking or nonspeaking, and those of any gender.

The prevalence of autism and suicide
Autistic people experience thoughts and behaviors related to suicide at high rates, with approximately one in three autistic people experiencing thoughts of suicide and one in four reporting having made an attempt to die by suicide. Autistic people are globally almost three times more likely to die by suicide than the general population. Autistic people without intellectual disability have an even higher relative risk, estimated at five to nine times more likely to die by suicide than the general population.

Suicidality in autistic people wasn’t recognized for a long time, partly because autistic people were excluded from mental health research, and partly because some people confused such behaviors as part of autism itself.

Suicidal thoughts are not autistic traits
It is important not to think that suicidal thoughts and behaviors are a part of autism. Autism describes a constellation of social communication differences and repetitive behaviors and does not mean distress about being alive is inevitable.

What leads to this increased risk of suicidality?

The warning signs may present differently
The warning signs for the general population are well-known, but autistic people can have some unique factors and warning signs of suicidality. These distinct warning signs can include a sudden decrease in communication, unusual withdrawal combined with distress, drastic changes in sleep or anxiety, loss of interest in preferred activities without a replacement, and frequent meltdowns due to nervous system overload.

“Fitting in” isn’t easy
The research tells us that this high rate of suicidality has a lot to do with how the world treats autistic people. Autistic people are more likely to experience certain risk factors such as feeling they’re on the outside looking in, even around people who care about them (thwarted belonging) and believing they’re a burden to others (perceived burdensomeness). They may also be pressured to try to camouflage their traits to appear less autistic (also known as masking).

Autistic people experience high rates of victimization and rejection and may not feel they can be truly known and accepted. Paradoxically, it can be true that the more we want someone to blend in, so they are not rejected by their peers, the less they feel a sense of being known or truly belonging. These experiences can lead to a sense of being trapped with no way out.

Dysregulated nervous systems and autistic burnout
It is important to understand how these difficult life experiences interact with being autistic. The autistic traits of stickiness and repetition mean that distressing thoughts may be more persistent, getting stuck and repeating. Additionally, having a nervous system that tends toward a state of fight or flight means it is even more difficult to find a sense of consistent safety in one’s own body.

The constant demands of navigating these life circumstances as an autistic person can be deeply exhausting, leading to a state called autistic burnout. Being in autistic burnout means experiencing a complete depletion of internal resources. It can often mean losing the ability to do things they once could. This state is a risk factor for depression and suicidality.

How can you reduce these risk factors?

We still don’t know all of the protective factors that might keep autistic people from experiencing suicidal thoughts or behaviors, but there are many support strategies that can lower the risk.

Special interests are protective
Make sure an autistic person can access doing the things they love. Special interests are core to an autistic person’s wellbeing, not just hobbies. You can also ask if they want their passions incorporated into safety plans as a means of emotional regulation and distraction.

Meeting distinct needs
Autistic people tell us that unmet needs are a big contributor to suicidal thoughts and behaviors. Learning and meeting an individual’s distinct needs might include making sure they have sensory-friendly environments, alone time if desired, and ample processing time during conversations. If an autistic person experiences a meltdown, you can focus on staying quiet, calm, and helping the autistic person stay physically safe while it subsides naturally instead of forcing it to stop.

Accept people for who they are
The most important suicide prevention for autistic people is to accept them and support them for who they are. Validate their experiences, meet their support needs, and see them for the unique and valuable humans they are.

 

Additional Resources

PFA Tips: Supporting an Autistic Person Experiencing Suicidality

PFA Tips: Communication Tips for Supporting an Autistic Person in Crisis

Autism and Suicide Prevention Workgroup

Suicide Prevention for Autism Neuro-affirming Toolkit – for providers

Autistic Communication Suggestions

Autism Adapted Safety Plans

Rae is an autistic self-advocate leading peer support groups for adults to process and discuss what it’s like to be autistic in the world.  

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