Anxiety and Depression in Asperger's Syndrome
Anxiety and depression are extremely common in people with Asperger's syndrome — far more so than in the general population. Understanding the relationship between Asperger's and mental health is important both for people with Asperger's themselves and for those who support them.
Anxiety
Anxiety affects the majority of people with Asperger's at some point in their lives. In many cases it is significant enough to be a diagnosable anxiety disorder in its own right. The social world is inherently unpredictable, and for someone who relies heavily on rules and patterns to navigate it, unpredictability is genuinely threatening.
Sources of anxiety in Asperger's often include:
- Social situations — uncertainty about how to act, fear of saying the wrong thing, anticipating misunderstanding
- Change and unpredictability — transitions, new environments, schedule disruptions
- Sensory overload — anticipating or being in overwhelmingly stimulating environments
- Perfectionism — fear of making mistakes or not meeting self-imposed standards
- The effort of masking — constant vigilance about behavior is inherently anxiety-provoking
- Social exclusion and bullying, particularly in childhood and adolescence
Depression
Depression is also significantly more common in people with Asperger's than in the general population. It can develop as a direct result of:
- Chronic social isolation and loneliness
- Years of feeling misunderstood or fundamentally different
- Repeated social failures and rejection
- Autistic burnout
- The sustained effort of masking
- Inability to access or maintain employment or relationships
Complications of Co-Occurring Conditions
Having anxiety or depression alongside Asperger's can complicate both diagnosis and treatment. Some of the typical symptoms of anxiety and depression may manifest differently in people with Asperger's. Difficulty identifying and describing emotional states (alexithymia) means that a person may not be aware that what they are experiencing is anxiety or depression — they may describe physical symptoms, or report "not wanting to be around people," without recognizing the emotional component.
Treatment Considerations
Anxiety and depression in people with Asperger's can be treated, but treatment needs to be adapted to the individual's needs:
- Cognitive-Behavioral Therapy (CBT): Can be effective but works best when adapted for the Asperger's profile — more concrete, structured, and explicit than standard CBT. See the article on therapy and treatment.
- Medication: Anti-anxiety medications and antidepressants may be appropriate in some cases. People with Asperger's sometimes respond differently to medications, so close monitoring is important. See the article on medication.
- Addressing the root causes: Reducing sources of overload, improving social supports, finding meaningful employment and community all address the underlying conditions that fuel anxiety and depression.
- Reducing masking: When it is safe to do so, reducing the demands of social performance can significantly reduce anxiety.