Autism-pedia / Co-occurring conditions / Co-occurring conditionsbrianspringer.com
Co-occurring conditions

Co-occurring conditions

An overview of the conditions that often occur alongside autism: trauma and PTSD, personality-disorder diagnoses and misdiagnosis, chronic pain and hypermobility, alcohol, drugs and eating disorders, psychosis and bipolar disorder, catatonia, and movement, coordination and tics, and OCD. Anchored by an umbrella review of 134 reviews of outcomes for autistic people. Each section links to a full entry.

Some other conditions often come along with autism, like trauma and PTSD, personality-disorder labels, pain and bendy joints, problems with alcohol, drugs and eating, psychosis and bipolar disorder, catatonia, and differences in movement and coordination, and OCD. Each part links to a longer page.

Last reviewed 13 October 2026 · one person's reading of the research · 38 sources

Trauma, PTSD and dissociation Established

Autistic people are exposed to violence, abuse and other traumatic events at high rates. A meta-analysis of 34 studies pooled victimization at about 44% across autistic samples, with bullying at 47%, child abuse at 16% and sexual victimization at 40% in separate pooled subsets.4 Diagnosed PTSD is not common in absolute terms: the estimate from 13 studies covering 142,081 autistic adults is a lifetime prevalence of 2.72%, close to general-population figures and far below what questionnaires record.2 The relative risk is higher: a Swedish register followed 49,049 autistic people and found a hazard ratio of 4.27 for a new PTSD diagnosis, and four further samples point the same way at smaller magnitudes.3 An umbrella review of 134 reviews of adverse outcomes lists victimization and bullying among the findings most consistently reported across independent reviews.1

Full entryTrauma, PTSD and dissociation How often autistic adults are exposed to trauma and diagnosed with PTSD, why both are missed, what dissociation adds, how thin the treatment evidence is, and the reported overlap with functional neurological disorder.

Trauma means something very bad or frightening happening to you. Autistic people go through trauma more often than other people. One review looked at 34 studies. It found that about 44 in 100 autistic people had been hurt or treated badly by someone. About 47 in 100 had been bullied.4 PTSD means lasting problems after trauma. Not many autistic adults have a PTSD diagnosis. One review looked at 13 studies. Together they covered 142,081 autistic adults. It found that about 2.7 in 100 had a diagnosis at some point. That is about the same as other people.2 Even so, autistic people are more likely to be given that diagnosis. In a Swedish study of 49,049 autistic people, the chance was about four times higher. Four more studies point the same way.3 A big review looked at 134 other reviews. It also lists being hurt by someone, and being bullied, as two of the things found most often.1

Full entryTrauma, PTSD and dissociation How often autistic people go through frightening events and get PTSD, why both are often missed, what is still not known about treatment, and a condition with real symptoms but no damage to the nerves.
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Established

Summarizes Trauma, PTSD and dissociation. Meta-analyses give the exposure and prevalence figures, and five independent samples in five countries agree on the raised relative risk of a PTSD diagnosis. The symptom and treatment findings in the full entry are weaker.

Established

Many studies from different countries agree that autistic people face more trauma and are more often diagnosed with PTSD. How best to help is much less certain.

Personality-disorder diagnoses and misdiagnosis Established

Personality-disorder diagnoses appear in autistic people's records several times as often as in other adults'. In UK primary-care records covering 22,112 autistic adults, autistic men without an intellectual disability were given a new personality-disorder diagnosis 4.8 times as often as comparison men, and autistic women 4.6 times as often as comparison women; among autistic people who also had an intellectual disability the rate was 8.3 times as high for women.9 Many autistic people say the label came first: in a Dutch register of 1,211 autistic adults, 24.6% reported at least one earlier psychiatric diagnosis they considered a misdiagnosis, personality disorders the most frequent.10 A chart review of emergency-department visits by autistic adults found a borderline-personality diagnosis recorded in 33.5% of visits, which its authors read as possible diagnostic overshadowing.11

Full entryPersonality-disorder diagnoses and misdiagnosis Autistic adults are given personality-disorder diagnoses several times as often as other adults, and borderline personality disorder is the one most often discussed in connection with autism. Many autistic people say such a label came before anyone assessed them for autism. This entry covers the record-based rates, how the two kinds of diagnosis overlap, why autism is missed first, and what would change it.

Personality disorders are lasting patterns of thinking and feeling. Autistic adults get these labels more often than other adults. One UK study looked at 22,112 autistic adults. It found autistic men were about 5 times as likely to get one as other men. Autistic women were about 5 times as likely too.9 Many autistic people say the label came first. In one study, about 1 in 4 autistic adults said an earlier diagnosis was wrong. This label was named most often.10

Full entryPersonality-disorder diagnoses and misdiagnosis Autistic adults are told they have a personality disorder much more often than other adults. Many say this label came before anyone checked them for autism. This entry explains the numbers, why it happens, and what would help.
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Established

Summarizes Personality-disorder diagnoses and misdiagnosis. Four record studies in three countries agree that the diagnoses are recorded several times as often in autistic people. The findings on why autism is missed first rest on self-report surveys and one hospital's charts, and the full entry labels them emerging.

Established

Big record studies agree. The parts about why autism is missed come from what people say about themselves, and from one hospital's charts.

Chronic pain, hypermobility and dysautonomia Emerging

Joint hypermobility and the hypermobile type of Ehlers-Danlos syndrome are reported more often by autistic people. In Swedish national registers, people with a diagnosed Ehlers-Danlos syndrome were 7.4 times as likely to have an autism diagnosis (95% confidence interval 5.2 to 10.7), and a 2025 meta-analysis of 20 articles estimated joint hypermobility in 22.3% of autistic people, rising to 31% when people were examined directly.12,13 Chronic pain is reported more often too: in a national Australian cohort of 4,961 young adults, recurrent pain was reported by 38% of those who reported autism, ADHD or both, against 27% of their peers, and a US child survey found chronic pain in 9.8% of autistic children against 6.0%.14,15 No study found as of October 2026 has measured how common POTS is in adults recruited on a clinician-diagnosed autism sample; the clearest evidence is a UK referral series of 28 autistic adults, 20 of whom had a diagnosable autonomic condition.16

Full entryChronic pain, hypermobility and dysautonomia How often chronic pain, joint hypermobility and autonomic conditions such as POTS and migraine occur alongside autism, what the research can and cannot show, and how autistic writers describe living with them. A research summary, not medical advice.

Hypermobility means joints that bend further than most people's. Autistic people report it more often. In Sweden, people with a condition called Ehlers-Danlos syndrome were about 7 times as likely to be autistic.12 Autistic people also report more lasting pain. One Australian study asked 4,961 young adults about pain. Among those who said they were autistic or had ADHD, 38 in 100 had pain that kept coming back. That was 27 in 100 of their peers.14 No study has measured how common POTS is in autistic adults as of October 2026.16

Full entryChronic pain, hypermobility and dysautonomia Some autistic people have pain that keeps coming back, joints that bend too far, or problems with the body's automatic jobs, like heart rate. Here is what scientists know so far, and what autistic writers say about it.
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Emerging

Summarizes Chronic pain, hypermobility and dysautonomia. Register, survey and referral-series studies point the same way, but most samples are defined by self-report or screening rather than by a clinician's diagnosis, the pooled hypermobility figures have no comparison group, and one school study finds no link.

Emerging

The studies point the same way, but most rely on what people say about themselves. One study of children found no link.

Psychosis and bipolar Established

Psychotic and bipolar disorders are diagnosed more often in autistic people than in other people. A meta-analysis of 53 studies restricted to adults pooled a rate of about 9% for psychosis and about 7.5% for bipolar disorder, both far above general-population rates, and an updated meta-analysis of 63 papers covering about 6.9 million people put the odds of one diagnosed condition given the other at about seven times.17,18 A meta-analysis of 96 studies counting only confirmed diagnoses, across all ages, put bipolar disorder at about 5% and a schizophrenia-spectrum disorder at about 4%.19 A whole-population register in Manitoba, Canada, where autism is identified from health and education records, found autistic people about ten times as likely to have a recorded schizophrenia diagnosis (age- and sex-adjusted relative risk 9.8).20 The pooled figures sit at the top of a range because the measures can inflate them: in the Netherlands Autism Register, 34.1% of 1,686 autistic adults scored above the cutoff on a brief psychosis screen, but only 5 of 361 people (1.4%) reported a new schizophrenia-spectrum diagnosis at follow-up.21

Full entryPsychosis and bipolar Psychotic and bipolar disorders are recorded far more often in autistic adults than in other adults. The size of the link is uncertain because the measures overlap and because autistic speech and reactions can be read as psychosis; this entry covers the rates, bipolar's distinct picture, how the two are told apart, and what happens after a diagnosis.

Psychosis and bipolar disorder are found more often in autistic people. One review pooled 53 studies of adults. It found psychosis in about 9 in 100 autistic adults. It found bipolar disorder in about 7.5 in 100.17 A second review covered about 6.9 million people. It found that one of these conditions makes the other about seven times more likely.18 A third review counted only people with a firm diagnosis. It covered all ages. It found bipolar disorder in about 5 in 100. It found a schizophrenia-spectrum disorder in about 4 in 100.19 A record study comes from Manitoba, Canada. It looked at a whole country. It found autistic people about ten times as likely to have a recorded schizophrenia diagnosis.20 Short tests can overstate the problem. In one Dutch study, about 34 in 100 autistic adults scored high on a short psychosis test. Later, only about 1.4 in 100 were given that diagnosis.21

Full entryPsychosis and bipolar Autistic adults are told they have psychosis or bipolar disorder much more often than other adults. Doctors do not always know when autism just looks like these conditions. This entry explains the numbers, how the two are told apart, and what happens after a diagnosis.
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Established

Summarizes Psychosis and bipolar. Two adult meta-analyses, an all-ages meta-analysis of diagnosed rates and a whole-population register agree that both are diagnosed several times more often in autistic people. The size of the link is uncertain: trait questionnaires flag far more people than go on to a diagnosis, and the clinical detail rests on single studies.

Established

This is a summary. Several big reviews and one whole-country record study agree that these conditions are found more often in autistic people. A short screening test flags far more people than really have them.

Alcohol, drugs and eating disorders Emerging

Studies do not agree on whether autistic people have more alcohol and drug problems than other people: in Swedish national registers, 4.0% of 26,986 autistic people had a substance-related problem, against 1.3% of matched controls.5 In US Medicaid records for 2012, 1.75% of autistic enrollees without intellectual disability had a substance use disorder, against 4.44% of enrollees with neither autism nor intellectual disability.6 In Danish national registers covering everyone born from 1981 to 2008, 2.57% of autistic people had an eating-disorder diagnosis from specialist hospital care, against 0.91% of people without autism.7 In UK interviews, none of 15 autistic women had an autism diagnosis when first seen by eating-disorder services.8

Full entryAlcohol, drugs and eating disorders How common alcohol, drug and eating-disorder diagnoses are in autistic people, why some use substances to cope, why addiction and eating-disorder services often miss autism, and what adapted treatment has been tried. A research summary, not medical advice.

Scientists are not sure if autistic people have more trouble with alcohol and drugs. In Sweden, autistic people had more of these problems than others.5 In US health records, autistic people had fewer.6 An eating disorder is an illness in how a person eats. In Denmark, autistic people had eating disorders about 3 times as often.7 In a UK study, none of 15 autistic women had an autism diagnosis when they first got help for eating.8

Full entryAlcohol, drugs and eating disorders How often autistic people have problems with alcohol, drugs or eating, why some use them to cope, and why help often misses autism. It sums up research. It is not medical advice.
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Emerging

Summarizes Alcohol, drugs and eating disorders. Large studies disagree on substance problems. Separate Danish and Finnish registers agree that eating disorders are diagnosed more often in autistic people; the account of eating-disorder services comes from small interview studies of women.

Emerging

Big studies do not agree about alcohol and drugs. They do agree that eating disorders are more common.

Catatonia Emerging

Catatonia, a syndrome of disturbed movement, speech and behavior, is reported in about 10.4% of autistic people in a meta-analysis of 12 studies (95% confidence interval 5.8 to 18.0), from samples that were mostly male and drawn from clinics, and a 2026 scoping review repeats that figure while saying the true rate is uncertain.22,23 It is concentrated among people with higher support needs: in one clinic cohort of 45 autistic patients with catatonia, 91.1% also had an intellectual disability.24 Because catatonia and autism share signs such as mutism, echolalia and posturing, a new episode can be read as autism getting worse.23 Benzodiazepines such as lorazepam and electroconvulsive therapy are the treatments the evidence supports.25 No randomized trial in autistic people with catatonia was found as of October 2026, and in a cohort of 43 autistic and 67 non-autistic patients receiving ECT, autistic patients stayed on maintenance treatment far longer (a median of 35 sessions over 342 days, against 14 over 97).26

Full entryCatatonia Catatonia is a treatable syndrome of disturbed movement, speech and behavior that occurs more often in autistic people with higher support needs. A new episode can look like autism itself getting worse. This entry covers how common it is, how it is recognized, and what the treatment evidence supports.

Catatonia is a set of problems with movement, speech and behavior. One review of 12 studies found it in about 10 in 100 autistic people. Most of the people studied were male, and all had come to a clinic.22 A newer review repeats that number. It says the true rate is still not known.23 Catatonia is found most often in people who need a lot of support. In one clinic group of 45 autistic people with catatonia, 91 in 100 also had an intellectual disability.24 Catatonia and autism share some signs. So a new episode can look like autism getting worse.23 Doctors treat it with medicines called benzodiazepines and with electroconvulsive therapy.25 No randomized trial has tested these in autistic people with catatonia as of October 2026. In one study, autistic patients stayed on maintenance ECT much longer than other patients.26

Full entryCatatonia Catatonia is a condition that changes how a person moves, speaks and acts. It happens more often in autistic people who need a lot of support. It can look like autism getting worse, but it can be treated.
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Emerging

Summarizes Catatonia. One meta-analysis pools a small, mostly clinic-based estimate and its own reviewers say the true rate is uncertain; the treatment and outcome findings come from single observational cohorts.

Emerging

This is a summary. One review puts the number at about 1 in 10. Most of the studies behind it came from clinics, and the real number is uncertain.

Movement, coordination and tics Emerging

A systematic review and meta-analysis of 42 studies, covering 3,142 children and adolescents and 1,561 of them autistic, found autistic children scored lower than typically developing children on standard tests of manual dexterity, balance, locomotor skills and object control.27 Motor delay is reported very often by parents: in a national autism dataset, 82% of 2,644 autistic children showed a motor delay on a short motor questionnaire, and only 10% to 32% had received any physical or recreational therapy.28 Tics travel with autism too: in a Taiwanese national register, people newly diagnosed with Tourette syndrome were later diagnosed with autism about twice as often (adjusted hazard ratio 2.2),29 and in one London specialist service 69.8% of 63 young people referred with the newer functional tic-like behaviors were also diagnosed autistic.30 In US Medicare data for 13,732 autistic and 25,497 matched non-autistic older adults aged 65 and over, 47.4% of the autistic group had a fall against 31.5% (odds ratio 1.99).31 Autistic adults also report barriers to physical activity that are environmental and social, such as sensory-challenging places, cost and a lack of autism-informed support, rather than a lack of interest.32

Full entryMovement, coordination and tics Motor differences and coordination difficulties are among the most common features that travel with autism, and the strongest evidence for them comes from children. This entry covers motor skills, dyspraxia, tics and the newer functional tic-like behaviors, falls in older autistic adults, and the barriers autistic adults meet when they try to be physically active.

Many autistic people move and coordinate their bodies differently. A review of 42 studies looked at 3,142 children and teenagers, 1,561 of them autistic. The autistic children did worse on tests of hand skills, balance, running and jumping, and catching and throwing.27 Parents often notice this early. In one national dataset, parents answered a short motor questionnaire. It found a motor delay in 82 in 100 of 2,644 autistic children. Only 10 to 32 in 100 had been offered physical or recreational therapy.28 Tics can come along too. In a Taiwan record study, people with Tourette syndrome were later found to be autistic about twice as often.29 A newer kind is called functional tic-like behaviors. It is studied separately. In one London clinic, about 70 in 100 of 63 young people with it were also autistic.30 Autistic older adults fall more. In US Medicare records, 47.4 in 100 of autistic adults aged 65 and over had a fall. That was 31.5 in 100 of other older adults.31 Autistic adults also say the main blocks to exercise are noisy places, cost and a lack of informed support. They do not say it is a lack of interest.32

Full entryMovement, coordination and tics Autistic children often find movement and coordination harder than other children. This entry explains what the research shows about movement, tics, falls in older autistic adults, and why many autistic adults are less active.
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Emerging

Summarizes Movement, coordination and tics. One 42-study meta-analysis of motor competence in children is established; the tic, falls and physical-activity findings are single studies, and most of the evidence is in children.

Emerging

This is a summary. One big review of motor skills in children is strong. The parts about tics, falls and exercise come from single studies, and most of the research is about children.

OCD Established

OCD and autism occur together often, in both directions. Pooled across 96 studies of diagnosed conditions in autistic people, about 9% meet criteria for OCD (95% confidence interval 7 to 10),33 and about 11.6% of autistic children and adolescents do.34 Read the other way, about 9.5% of children and adolescents with OCD have an autism diagnosis.34,35 A Danish national register of 3.4 million people found that an OCD diagnosis went with a 13-fold higher rate of a co-occurring autism diagnosis (6.6% against 0.5%), and that each diagnosis predicted the other later.36 Telling a compulsion from a routine is harder than the diagnostic manuals imply: a systematic review of 31 studies found considerable overlap in repetitive behaviors between the two conditions and no established measure for separating them.37 Adult treatment is the weakest part of the evidence. No randomized trial of cognitive behavioral therapy or exposure and response prevention for OCD in autistic adults was found as of October 2026.38

Full entryOCD How often obsessive-compulsive disorder and autism occur together, how to tell a compulsion from a routine, what the treatment evidence shows, why each condition is so often missed when the other is present, and what the two conditions share.

OCD and autism often come together. A review pooled 96 studies of autistic people. About 9 in 100 had OCD.33 Among autistic children and teenagers, about 12 in 100 had it.34 Going the other way, about 9.5 in 100 young people with OCD are autistic.34,35 A Danish record study followed 3.4 million people. An OCD diagnosis went with about 13 times more autism.36 Telling a compulsion from a routine is hard. A review of 31 studies found the two look very alike. There is no good test for telling them apart.37 No study found as of October 2026 has tested talking therapy for OCD in autistic adults.38

Full entryOCD Some people have both autism and OCD. This page explains how often that happens, how to tell a compulsion from a routine, what treatment research shows, why doctors often miss one of the two, and how the two conditions overlap.
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Established

Summarizes OCD. Meta-analyses and a national register agree that OCD and autism occur together far more often than chance. The sections on telling a compulsion from a routine, on what each condition is read as, and on treatment rest on single small studies and on clinic cohorts.

Established

This is a summary. Studies from many countries agree that OCD and autism often come together. The parts about telling a compulsion from a routine, and about treatment, are much less certain.

Sources

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