Autism, in itself, is not a disorder of mental health. Yet autistic people are disproportionately affected by depression, anxiety, and suicidality. The connection is not biological alone — it is social. Much of the psychological distress experienced by autistic individuals stems from how they are perceived, treated, and misunderstood in everyday life.
Stigma is at the heart of this. It shapes relationships, policies, clinical care, and internal beliefs. While autism presents communication and sensory differences, it is a stigma that often transforms those differences into long-term harm.
Living Under Judgment
Autistic people often grow up knowing they are viewed as “different.” This recognition isn’t neutral — it is usually accompanied by exclusion or correction.
Sometimes, it’s subtle: being talked over in meetings, laughed at for missing a joke, or treated as incapable. Other times, it’s institutional: denied services, ignored by providers, or disciplined in schools not built to accommodate them.
Three dimensions of stigma have been widely documented in the literature:
- Public Stigma: Includes the stereotypes and judgments imposed by society, such as the belief that autistic people lack empathy or are unemployable.
- Structural Stigma: Institutions create barriers by failing to adapt environments to autistic needs. Examples include rigid hiring processes, noisy classrooms, and inaccessible therapy.
- Internalized Stigma: Develops when autistic individuals absorb these messages over time. This can result in low self-worth, shame, and a reluctance to seek help.
A study by Cage and Troxell-Whitman (2019) found a direct link between internalized stigma and elevated symptoms of anxiety and depression in autistic adults (Cage & Troxell-Whitman, 2019).
A Pattern in the Numbers
Mental health data paints a consistent picture. Autistic people are more likely than their neurotypical peers to experience mood disorders, sometimes at two or three times the rate.
- Nearly 70% of autistic adults report a history of depression or anxiety (Lever & Geurts, 2016).
- Suicide risk is markedly elevated. A Swedish study found that autistic individuals without intellectual disability were more than nine times as likely to die by suicide than non-autistic peers (Hirvikoski et al., 2016).
- Late diagnosis is common, particularly among women and nonbinary people. Many live for decades without understanding why social situations feel so difficult or why they struggle in environments others tolerate. Without that understanding, distress builds in silence.
The Hidden Labor of Masking
In social and professional settings, many autistic people learn to camouflage their traits to avoid judgment. This might mean forcing eye contact, mimicking facial expressions, stifling repetitive movements, or scripting conversations in advance. Over time, these behaviors become habitual and exhausting.
This phenomenon, known as masking, has been increasingly recognized as a mental health risk in its own right. A 2022 study showed that frequent masking is associated with higher levels of depression, anxiety, and suicidal ideation, especially in individuals who feel unable to express themselves authentically (Mandy, 2022).
Masking may allow for temporary social acceptance, but it disconnects individuals from their own identities and often prevents others from seeing their needs clearly.
Reducing Harm: Shifting Structures, Not People
Improvements in mental health outcomes for autistic individuals require more than awareness — they require systemic change. The following areas have shown the greatest potential:
- Mental health care that understands autism. Clinicians often misinterpret autistic traits as symptoms of other disorders. When practitioners are trained in neurodiversity-informed care, outcomes improve.
- Flexible education and work environments. Sensory accommodations, alternative communication methods, and remote options reduce stressors that often lead to burnout.
- Policies that include autistic voices. Programs and supports are most effective when autistic individuals are involved in their design and delivery.
- Cultural reframing. Replacing deficit-based language with acceptance of neurological diversity shifts public attitudes. This reduces stigma before it starts.
Autism is not what causes mental health decline — stigma is. When society isolates, misinterprets, or silences autistic individuals, the result is often years of emotional strain, unmet needs, and preventable harm.
Reducing that harm means listening, adjusting, and restructuring the systems that currently demand conformity. With these changes, the path toward better mental health for autistic people becomes clearer, and more.
Yoni Pomerantz is the Chief Operating Officer at Bluebell ABA Therapy.
References
Crane, L., et al. (2022). The impact of a positive autism identity and autistic community connection on mental health. Autism, 27(3), 848–857. https://pmc.ncbi.nlm.nih.gov/articles/PMC10074754/
Crane, L., et al. (2023). Development of stigma-related support for autistic adults. Autism, 27(6), 1676–1689. https://pmc.ncbi.nlm.nih.gov/articles/PMC10374993/
Crane, L., et al. (2024). Post-diagnostic support for adults diagnosed with autism in adulthood in the UK. Autism, 29(2), 284–309. https://pmc.ncbi.nlm.nih.gov/articles/PMC11816465/
Edey, R., et al. (2023). Non-autistic observers both detect and demonstrate the double empathy problem when observing social interactions involving autistic people. Autism, 28(8), 2053–2065. https://pmc.ncbi.nlm.nih.gov/articles/PMC11308351/
Rivera, R. A., & Bennetto, L. (2023). Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people. Frontiers in Psychiatry.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10511883/
Turnock, A., Langley, K., & Jones, C. R. G. (2022). Understanding Stigma in Autism: A Narrative Review and Theoretical Model. Autism in Adulthood, 4(1), 76–91. https://pmc.ncbi.nlm.nih.gov/articles/PMC8992913/
Turnock, A., Langley, K., & Jones, C. R. G. (2022). Understanding Stigma in Autism: A Narrative Review and Theoretical Model. PubMed. https://pubmed.ncbi.nlm.nih.gov/36605561/
Turnock, A., Langley, K., & Jones, C. R. G. (2022). Understanding stigma in autism: a narrative review and theoretical model. Cardiff University Repository. https://orca.cardiff.ac.uk/id/eprint/146682/
