Anxiety Disorders in Autistic Adults
- Kaitlyn Boudreault
- May 14
- 12 min read
Are there times when you replay a conversation in your head for hours or even weeks afterward? You may worry that you said the wrong thing or that the other person is mad at you or ignoring you.
Do you feel overwhelmed by crowded stores, unexpected changes, or social situations to the point where you feel as if you can’t handle these situations and want to avoid them?
Have you felt like you are constantly on alert and scanning your environment to predict if something will go wrong or figure out how others expect you to act?
If these experiences resonate with you, you were likely experiencing anxiety.
Anxiety can happen to anyone and is a common experience that occurs in stressful or threatening situations.
But for some, anxiety may be constant and disproportionate to the threat.
When you experience anxiety like this, and it is impacting your ability to function daily, you may have an anxiety disorder.
There is research to suggest that autistic individuals are more prone to experiencing anxiety disorders. For many autistic adults, anxiety isn’t just the occasional nervousness that anyone can experience. It may be the result of navigating a world that often feels unpredictable, overstimulating, socially demanding, and inaccessible.
Over time, chronic anxiety can impact relationships, work, school, emotional regulation, sleep, physical health, and overall quality of life.
At the same time, anxiety in autistic adults is frequently misunderstood or overlooked. Some autistic individuals may appear calm externally while internally experiencing intense distress, shutdowns, panic, or hypervigilance. Others may have their anxiety dismissed as “just part of autism,” preventing them from accessing appropriate support.
Understanding the relationship between autism and anxiety is essential for creating affirming support systems that focus on reducing stress rather than forcing autistic people to suppress who they are.
As an autistic individual, if you or someone you know has an anxiety disorder or is experiencing high levels of anxiety, there is support available.
At Blue Sky Learning, our neurodiversity-affirming therapists in Ontario, Canada, and international autism coaches provide compassionate, strengths-based support tailored to autistic adults.
In this edition of our neurodiversity-affirming blog, we will explore anxiety disorders in autistic adults, why anxiety is so common in autistic individuals, signs and symptoms, and supportive coping strategies.
Autism is a neurodevelopmental difference and a form of neurodivergence, like ADHD and dyslexia. The “neuro” aspect means that autism impacts the nervous system, while the “developmental” aspect means that autistic brains develop and process information differently from non-autistic brains.
Autistic individuals experience the world in unique ways, including differences in communication, sensory processing, social interaction, emotional regulation, routines, and information processing. These differences can influence relationships, school, work, daily living, and mental health. Many autistic individuals may benefit from support from a neurodiversity-affirming therapist, autism coach, or other supportive professional.
Autism is a spectrum, meaning every autistic individual has different strengths, support needs, communication styles, and lived experiences. Common autistic traits may include:
Sensory sensitivities
Strong interests or hyperfocus
Differences in social communication
Emotional overwhelm or shutdowns
Difficulty with transitions or unexpected changes
Stimming (self-regulating repetitive movements or behaviours)
Literal thinking
Deep focus on interests
Masking or camouflaging autistic traits
Social exhaustion
Differences in body language or eye contact
Heightened anxiety around uncertainty
Many autistic individuals, especially those from marginalized communities such as LGBTQ+ individuals, women, racialized individuals, and late-diagnosed adults, may feel pressure to hide or suppress autistic traits to fit societal expectations. This process, often called masking or camouflaging, can contribute to anxiety, burnout, exhaustion, and identity struggles over time.
Research suggests that genetics and differences in brain development significantly contribute to the understanding of autism, even though we don't fully comprehend its exact cause. We do know that autism is not caused by poor parenting or vaccines. Rather, it reflects a natural variation in how human brains develop and experience the world.
Related: Common Autism Myths
What Are Anxiety Disorders?
Anxiety is part of the daily human experience that everyone experiences.
For example, if you have ever seen a bear in the woods, your heart starts racing and causes you to look for a path to make sure you survive.
Perhaps more commonly, you may experience anxiety before a job interview or academic exam.
Stress or anxiety can cause you to practice before the job interview or exam to ensure that things go smoothly.
In these situations, anxiety helps to keep you safe during dangerous situations or motivates you to prepare for important events.
However, an anxiety disorder is a mental health condition that involves persistent and excessive fear or worry that is difficult to control, and the response is out of proportion to the actual threat.
Unlike temporary stress, anxiety disorders tend to have long-term impacts on relationships, work, school, sleep, emotional regulation, physical health, and overall well-being. Anxiety disorders interfere with daily functioning.
What Are the Signs of an Anxiety Disorder?
The symptoms of an anxiety disorder may vary from person to person, but some of the common symptoms include:
Persistent worry or fear
Difficulty concentrating
Chronic muscle tension
Changes in appetite (eating too little or too much)
Irritability
Rapid breathing
Sweating
Avoidance of social situations
Hypervigilance
Difficulty regulating your emotions
If you are autistic, anxiety disorders may also involve sensory overwhelm, shutdowns, increased engagement in repetitive behaviours (stimming), fear around uncertainty, or exhaustion from hiding neurodivergent traits.
Some autistic adults may internalize their anxiety, while others may experience visible distress through shutdowns, meltdowns, avoidance, or increased sensory sensitivity.
Alexithymia may also occur in some autistic adults who may struggle to identify or describe their emotions or experience difficulty recognizing and interpreting their internal emotional states.
Causes of Anxiety Disorders
While the exact cause remains unclear, a mix of genetic, environmental, and neurological factors contributes to the development of anxiety disorders.
This can include an emotionally sensitive personality. Several neurotransmitters and hormones also play a role in anxiety, including norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Imbalances in these chemicals can contribute to an anxiety disorder.
Studies on anxiety disorders have also shown a link between childhood traumas and an increased likelihood of anxiety disorders later in life.
Related: Is Anxiety Genetic?
Types of Anxiety Disorders Common in Autistic Adults
The Diagnostic and Statistical Manual for Mental Disorders (DSM-5) is the main manual that is used by clinicians in Canada to diagnose anxiety disorders.
The DSM-5 lists several types of anxiety disorders, which consist of distinct symptoms and causes.
Autistic adults may experience a variety of anxiety disorders with differing severity levels.
Generalized anxiety disorder involves a persistent and excessive worry about everyday situations, including work, health, finances, relationships, or household responsibilities. To be diagnosed with GAD, you would need to experience that worry on a persistent basis for at least six months. The worry also needs to be disproportionate to the situation and interfere with your daily functioning.
Social anxiety disorder is the experience of intense fear surrounding social interactions and the possibility of judgment, rejection, or embarrassment. This fear may be so overwhelming that individuals with social anxiety disorder may avoid social interactions altogether. For autistic adults, social anxiety may also overlap with sensitivity to rejection due to past experiences of bullying, rejection, misunderstanding, or pressure to mask autistic traits.
Panic disorders involve recurrent panic attacks. Panic attacks are sudden episodes of intense fear alongside physical symptoms of anxiety, such as dizziness, rapid heartbeat, sweating, chest tightness, or difficulty breathing.
Specific phobias involve an intense fear of a specific object, situation, individual, or experience that interferes with your daily functioning. The fear exceeds what would normally be experienced by the general population and is out of proportion to the actual danger posed. Some common examples of fear include heights, spiders, or clowns.
Agoraphobia is the intense fear of situations where you feel as if you can’t escape or it would be difficult to ask for help. Individuals often avoid unfamiliar locations, such as large open spaces or crowded areas, like public transportation, as well as leaving their homes.
Separation anxiety is characterized by an intense fear of being away from an attachment figure, oftentimes a caregiver. This is more common among youth, but it can also be experienced by adults.
Social Anxiety vs. Social Exhaustion in Autism
Social anxiety may look the same as social exhaustion that is experienced by autistic individuals, and they can overlap, but they are not always the same thing.
Social anxiety is often the fear of judgment, embarrassment, or rejection due to an anxiety disorder.
On the other hand, social exhaustion may occur because autistic individuals deeply value connection but become overwhelmed by the sensory, cognitive, and emotional demands of social interaction.
Social exhaustion in autistic individuals does not stem from an anxiety disorder. Instead, individuals may experience social exhaustion due to:
Becoming overwhelmed by sensory input
Needing to process multiple conversations
Masking autistic traits by maintaining eye contact
Unspoken social rules and needing to interpret social cues
Managing unpredictable interactions
An autistic individual may avoid social situations because those interactions are exhausting for their nervous system, rather than disliking people or experiencing anxiety.
How Anxiety and Autism Interact
Anxiety is not part of the diagnostic criteria for autism. However, anxiety and autism often co-occur with one another.
In fact, a recent National Autistic Society survey found that 47% of autistic people fall into the severe anxiety category based on GAD diagnostic criteria.
Anxiety and autism often influence each other, such that autism may make the symptoms of an anxiety disorder more pronounced, and anxiety may make the traits of autism worse.
For example, sensory overload, executive functioning challenges, and stress around social situations and uncertainty in autistic individuals may increase anxiety. Anxiety can also intensify the emotional regulation, communication, and concentration challenges that autistic individuals experience.
The overlap of anxiety and autism can show up differently depending on the individual, but some common overlapping experiences may include:
An autistic adult experiencing anxiety may struggle more with transitions or decision-making.
Sensory overwhelm may intensify panic or emotional dysregulation.
Anxiety may increase shutdowns or withdrawal.
Fear of making mistakes may contribute to perfectionism, comparing yourself to others, or avoidance.
Chronic stress may increase the risk of autistic burnout.
Over time, this cycle can become exhausting without appropriate accommodations and support.
Why Is Anxiety So Common in Autistic Adults?
Anxiety in autistic individuals is often connected to navigating a world that is not designed for neurodivergent needs. Autistic individuals experience sensory processing differences, social challenges, and an increase in stress in environments that are sensory overwhelming.
While every autistic individual is going to experience anxiety differently, several factors may lead to an increase in anxiety or anxiety-related symptoms in an autistic adult.
Sensory Overload
Sensory overload or sensory sensitivities involve the feeling of overwhelm due to too much sensory information coming through your senses. The amount of information you are taking in is more than what you can process.
Some of the most common triggers for sensory overload include bright lights, crowded environments, loud noises, strong smells, or uncomfortable textures.
If you experience sensory overload on a repeated basis, this may send your nervous system into a state of chronic stress. You may also experience anticipatory anxiety and avoid any situations where there may be too much sensory input.
For example, an autistic adult who experiences sensory overload consistently in grocery stores or public transportation may become overwhelmed or anxious even at the thought of going to these places. This overwhelm and anxiety can cause avoidance of these situations altogether.
Masking and Camouflaging
Masking or camouflaging involves the suppression of autistic traits or mimicking behaviours that follow societal standards so that you can fit in.
Although everyone who engages in masking will do so in different ways, there are some common masking experiences, which include:
Rehearsing conversations beforehand
Forcing eye contact
Suppressing stimming
Monitoring facial expressions
Copying social behaviours
Hiding sensory distress
In the short term, masking behaviours may help autistic individuals fit in and avoid stigma and social rejection. But it often comes at a high emotional and physical cost when masking behaviours are engaged in for extended periods of time.
Long-term masking may result in increased anxiety, burnout, exhaustion, identity confusion, depression, or an increase in emotional dysregulation.
Intolerance of Uncertainty
Many autistic adults have a strong preference for routine, order, or sameness. When a situation becomes unpredictable or there is a sudden change in plans, an autistic adult may experience heightened distress.
Some common triggers for this distress or significant levels of anxiety include the following:
Unexpected schedule changes
Unclear instructions
Unfamiliar environments
Uncertainty about social expectations
To support autistic individuals in feeling regulated and safe, predictability and routine are often important. When these routines are disrupted, the nervous system of autistic individuals may respond with overactivation and anxiety.
Social Stress and Past Experiences
Bullying, exclusion, rejection, criticism, and misunderstanding are common experiences for many autistic adults.
When you navigate the world and are constantly rejected or experience negative social experiences, this can create a sense of hypervigilance or fear about future social interactions.
To try and compensate for this, autistic adults may avoid these social situations, or they may engage with the social situation but constantly monitor themselves during the conversation or experience significant anxiety. They may have a fear of saying the wrong thing or being judged by others.
The Relationship Between Anxiety and Autistic Burnout
As an autistic individual, you may experience chronic anxiety because your nervous system is on overdrive, trying to navigate this unpredictable world.
Chronic anxiety and the concurrent masking or hiding of autistic traits to fit in can contribute to autistic burnout.
Unlike regular burnout, which usually stems from the workplace, autistic burnout involves an intense physical, emotional, and cognitive exhaustion caused by ongoing stress and the pressure to function in environments that are not supportive or accessible.
The experience of autistic burnout differs based on the individual, but some signs that you may be experiencing autistic burnout include:
Increased sensory sensitivity
Emotional exhaustion
Loss of functioning
Withdrawal from responsibilities
Increased shutdowns or meltdowns
Difficulty communicating
Loss of skills, even in areas of special interest or where you consider yourself a master.
Chronic fatigue
Autistic burnout is also not something that just goes away with rest. Many autistic adults report spending years pushing themselves beyond their limits, and they eventually stay in a consistent state of burnout.
Strategies to Manage Anxiety in Autistic Adults
Managing anxiety as an autistic adult looks different for everyone.
Support should focus on reducing stress, increasing sensory and emotional safety, and affirming autistic needs rather than forcing compliance or masking.
Create a Routine: Planning brings predictability and prepares your senses. For example, if your train commute is loud, listening to music can help minimize stress.
Join Support Groups: Engaging with others can provide community and new strategies for managing sensory overload.
Engage in Physical Activity: Regular exercise boosts mood and reduces stress. Aim for 30 minutes of physical activity most days to reap the benefits for both autism and anxiety.
Try Daily Self-Calming Activities: Practices like tai chi, yoga, colouring, or meditation can maintain a calm nervous system. Engage in the 5-4-3-2-1 exercise: identify five things you see, four you hear, three you smell, two you feel, and one you taste.
Use Sensory Tools: Specific sensory items can help manage overwhelming sensations. For example, noise-cancelling headphones reduce sound, while plush toys can soothe tactile input.
Ask for Accommodations: Familiarize yourself with local disability laws. Based on your neurodivergence, you can request support for quieter work environments, fewer meetings, or written communication.
Identify Your Triggers: Analyze which situations overwhelm you. Minimizing sensory stimulation or avoiding certain environments can help.
Implement the Pomodoro Technique: Breaks from overstimulating environments prevent shutdowns. Try spending 20 minutes in a stimulating space, followed by a 5-minute break in a quieter area to recharge.
Use the STOP Method: This relaxation technique helps regulate your nervous system. When feeling overwhelmed, stop what you’re doing, take a step back, observe your surroundings, and decide how to proceed mindfully.
Practice Self-Compassion: Treat yourself with kindness just as you would a friend. Living in a world unsuited for neurodivergent individuals can be challenging. Many autistic adults grow up internalizing shame about their differences. Self-compassion involves recognizing that needing accommodations or support does not make someone “lazy,” “dramatic,” or “difficult.”
Consider Neurodiversity-Affirming Therapy: A neurodiversity-affirming therapist can help autistic adults better understand anxiety, identify triggers, build coping strategies, process trauma, and reduce self-blame without encouraging masking or suppressing autistic traits.
Monitor Energy Levels: Socializing, masking, and sensory exposure can drain energy quickly. Scheduling recovery time is important. Use the spoon theory to monitor your energy levels.
Set Boundaries: Anxiety can stem from taking on too many tasks. Learn to say no to reduce your workload, minimize sensory input, and reduce the risk of anxiety and exacerbating autism.
Neurodivergent Sensory Tools for Anxiety Relief
Autistic individuals often experience heightened sensory sensitivities, which can be further intensified by anxiety disorders. This overlap may lead to increased reactivity to sensory inputs, making daily tasks more challenging and overwhelming.
An anxiety toolkit serves as a personalized resource to help autistic individuals manage their anxiety effectively.
It can provide comfort, regulate emotional responses, and assist in maintaining control over arousal levels. This kit provides comforting tools to help regulate emotions in overwhelming situations.
Visual Schedules: Creating a visual representation of daily tasks can alleviate uncertainty, reducing anxiety related to organization and planning.
Fidget Tools: Items like stress balls, fidget spinners, or textured objects can provide a calming sensation and help redirect nervous energy.
Sensory Breaks: Incorporating short breaks into one’s routine for activities such as deep breathing exercises, stretching, or engaging with calming sensory items can ground individuals and reduce anxiety.
Soothing Music or Sounds: Curating a playlist of calming music or natural sounds can offer an immediate resource for alleviating stress during overwhelming moments.
Mindfulness Apps: Guided meditations and mindfulness exercises available through various apps can foster relaxation, helping individuals access coping strategies in real-time.
By addressing sensory sensitivities and their role in autism and anxiety, individuals can mitigate triggers and create supportive environments.
This proactive approach enhances emotional regulation and makes everyday experiences less overwhelming, empowering individuals to navigate their world with greater ease and confidence.
Book a Free Consultation With Blue Sky Learning
Are you experiencing anxiety as an autistic adult? Do you need support navigating sensory overwhelm, burnout, masking, or emotional regulation?
Blue Sky Learning offers neurodiversity-affirming coaching and therapy that supports autistic adults through compassionate, strengths-based approaches.
Book a free 20-minute consultation today by emailing hello@blueskylearning.ca or following the link below to connect with one of our therapists or coaches.
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