Editor’s note: Sarah Swenson, LMHC is a private practice psychotherapist in Seattle, Washington, where she specializes in working with neurodiverse couples. Her continuing education presentation for GoodTherapy, titled “When Your Partner is on the Autism Spectrum: Individual Therapy for the Neurotypical Partner,” will take place on February 21, 2020 and is eligible for two CE credits. This event is available at no additional cost to Premium and Pro GoodTherapy Members (Basic Members and mental health professionals without membership can view this event live for $29.95). Learn more and register here.

Author’s note: Sometimes, of course, the neurotypical partner in a neurodiverse relationship is a man. I also work with gay and lesbian couples, and couples who are polyamorous. This article describes the client I encounter most frequently, a neurotypical woman married to an autistic man. Also, please bear in mind this guiding principle: If you’ve met one autistic person, you’ve met one autistic person. Nothing in this article will apply to everyone.

In my clinical practice as a therapist and in my international work as a coach, my clients are neurodiverse couples in which one partner is autistic and the other is not. As a result, I have come to know well one of the most misdiagnosed clients you will likely encounter. I’m speaking of a woman married to an autistic man who may or may not be formally diagnosed with autism (ASD).

When this woman comes in for individual counseling, she may have a flat affect. Her presenting concerns might sound vague, including hints of depression or anxiety. She may be self-effacing and ready to blame herself. She may stop and start, not seeming to know how to explain herself. She may appear embarrassed to be taking up your time.

Or she may seem full of rage. Her language might sound pressured, disorganized. She may be close to tears. She is the victim here, and she is furious.

Or she may simply present as hopeless.

I am not describing three separate women. You are likely to see all of this in the same woman in one session. Would you know how to understand her and offer her the support she needs?

She will not fully understand that over time, she has learned to minimize her needs and desires because conflict avoidance has become her chief survival strategy.

Meeting the Neurotypical Partner in Therapy

Most often, these clients are experiencing complex trauma (C-PTSD). They won’t be able to identify a specific traumatic injury because they are in a relationship that inadvertently creates the conditions of ongoing trauma. And since in this relationship there in no intention to harm, no intention to abuse, she is confused. She loves–or did love–her husband. She will tell you he is a good man.

She will not fully understand that over time, she has learned to minimize her needs and desires because conflict avoidance has become her chief survival strategy. She will tell you that she has changed. She will tell you she is not the woman she used to be. She feels less joy in life. She has let friendships fall away. She can’t muster interest in the things that used to give her pleasure. When asked, she is unlikely to be able to express her needs. She can’t remember what she needs. She knows this, however: she feels alone. And she may fear she’s losing her mind.

You’ve read her intake paperwork, so you will know that her husband is successful in his career, which may be in a highly competitive and well-respected field. When you talk to her, you’ll hear about his high intelligence and how well-regarded he is at work. As you get to know her better, she will tell you that everyone thinks that the two of them have the perfect marriage because that’s what it looks like from the outside. She realizes all marriages have problems. Her well-meaning friends certainly share enough of their stories that she feels a little guilty when inside she’s thinking, “Yes, but you don’t understand what it’s like for me…it’s different…I can’t explain it…”

She may sound petulant, self-involved, or impossible to please, due to the fact that she can express her pain but can’t put her finger on exactly what the problem is. She knows it has something to do with her husband and the way he treats her. Yet she has painted a picture of him that impresses you. You may think she is exhibiting narcissism as a result.

Another possibility is that he is a good man, but for some reason, he cannot seem to keep a job. He’s intelligent. He’s talented. But the financial strain of his chronic unemployment has pushed her to the brink. She is the sole earner. She manages the household. She supervises and provides for the children. She hides this internal familial dysfunction from her friends and her family. She has no one else to rely on. She is embarrassed. She is utterly exhausted. She can’t see a way out of her distress and she fears it may kill her. You may diagnose depression.

Sometimes, from session to session, you’ll see her condemn her husband and the way he cannot seem to do anything right, from loading the dishwasher (“I even made a little diagram and taped it to the counter!”) to listening to her when she’s upset (“He always wants to fix everything and doesn’t even notice I’m crying!”). Next session, she will be filled with compassion for him because he honestly seems to be doing the best he can. She’s just expecting perfection from him. He’s human. (“Why do I always have to be like this? Why can’t I just let him be himself?”) You may wonder if you’re seeing borderline personality.

And when she paints a complex picture of her experience with him that screams “Run for your life!” you may wonder why she can’t decide to leave. You consider codependency.

This is the woman married to an autistic man before she understands that he is autistic and before she understands what autism means in a relationship. I agree with you that it is difficult to identify her based on the information described above. Here are some important things to consider that may help you sort this all out.

Signs You’re Working with the Neurotypical Partner in a Neurodiverse Relationship

The primary area of conflict for many neurodiverse couples can be broken into two components: emotional connection and communication. Many of the women I work with identify the courtship phase of their relationship as short, comfortable, and consistent. More often than not, however, they can look back and identify what they call red flags: his quirky manners, his deeply focused conversations on things he’s interested in and silence when he’s not, his apparent discomfort at expressing emotion. At the time, they interpreted these things to be endearing eccentricity, intelligence and skill, and admirable reticence–the stiff upper lip.

For reasons of misinterpretation like this, they went forward to the commitment of marriage. Only with time did the veil slip away, and they realized they were habitually filling in with projections about what their partner’s behaviors and comments meant on the basis of what they would mean if they did these things themselves. In other words, they applied neurotypical standards and expectations to the behavior of an autistic individual. Slowly but surely, their sense of who their husband actually is erodes until they often become quite uncertain about who he actually is.

The primary area of conflict for many neurodiverse couples can be broken into two components: emotional connection and communication.

Over the course of the marriage, this woman will feel minimized and criticized. She will express her husband’s constant negativity and say that she’s begun to feel negative about everything, too. Her descriptions of their sex life will be particularly illuminating.

Generally, by the time these women come to therapy, their sex lives are completely ruptured. They have to think when you ask them about it. They’ll tell you they don’t remember precisely when or how, but at some point, things just stopped. For some, it has been months, but for most it’s been a matter of years. And, frankly, when their sex lives were more active, it wasn’t all that rewarding: it felt mechanical, always the same, with no foreplay and no sense of intimacy.

She doesn’t miss the specifics of sexual encounters with her husband, but she craves sexual intimacy. She craves intimacy, period. She wonders whether she should have an affair, though she doesn’t really want to go outside her marriage to have her needs met. She’ll just stifle them for a while, hoping they subside. Instead, she worries that they will continue to grow. She may not be able to look you in the eye at this point. She is desperate not to be viewed as promiscuous, and she fears you will judge her.

There are exceptions. Sometimes, a woman will tell you she feels like a sex doll to her husband’s routine and frequent sexual demands. She continues to participate. She hates herself for her inability to stand up for herself, but she has tried, and it just seems pointless. She continues to acquiesce. She is becoming numb to her own sexuality, to any physical sensations at all. She cannot afford to feel aroused because she knows she will be disappointed once again.

As you know, diminished sexual intimacy in a relationship is usually a sign of severed communication. In the neurodiverse relationship, this is most often the case. The woman needs emotional connection before she can feel sexually vulnerable. She is unlikely to feel this with her autistic husband. I often hear from these women that they don’t feel safe enough emotionally to present themselves sexually to their husbands. She does not feel seen or heard or known by her husband, whose sexual needs are often more physiological than emotional. He doesn’t understand her withdrawal any more than she understands the way he treats her.

Work with Neurodiverse Couples: Moving Forward

If you see enough of these signs in your client, I suggest asking whether she has considered that her husband might be autistic. In order to do this well, you’ll have to be certain she understands what you mean and why you’re asking. If she has not thought of this possibility herself, you’ll need to explain to her that autism is a result of neurological variance and not mental illness or personality disorder. You don’t want her to reject your suggestion on the basis of having misunderstood you.

Many times, though, women come in for counseling after having read articles of mine or other material on the internet and already suspect autism (some still call it Asperger’s) in their husbands. They want to know what to do. In this case, we discuss all the points mentioned above in terms of what it would mean if their husband were in fact autistic. I do not ever volunteer a diagnosis of autism without having met someone, but we do reality testing to rule it in or out as a differential. Then I suggest couple work. I help her with language for bringing this up to her husband, which is a sensitive task in itself.

Sometimes, after several sessions, we schedule a couple session, if the husband is willing to explore the possibility. It is often a watershed moment in a couple’s life to learn that there are reasons that explain their problems and that we can work together on psychoeducation and on communication strategies and skills that offer a path toward improved intimacy. The relationship will never be neurotypical or autistic, but it can become more rewarding for both partners.

Sometimes, the husband is unwilling to consider autism and will not come in for a couple session. He fears being judged. Labeled. Vilified. She cannot get through to him that this is a supportive process. He locks into his fears and there is nothing more to be done. In this case, I continue to work with the woman alone to help her understand her choices. They are not always binary. There are more options than staying married or getting divorced. We explore them all.

It is important never to minimize the experience and challenges faced by the autistic partner.

It is important never to minimize the experience and challenges faced by the autistic partner. This work is about identifying differences and creating more successful ways to communicate. There are good reasons why the autistic partner behaves the way he does and says the things he says. I have never met an autistic person who sets out intentionally to hurt his wife, and seldom have I encountered an autistic person who lies. Misrepresenting something has its own rational pathway for an autistic person, and I distinguish this from intentional lying. This is an example of the kind of subject we explore in couple sessions. Sometimes, the intense anger of the neurotypical partner can be diffused with education and compassion. Sometimes, the weight of this anger and feeling responsible for the relationship is too much for her.

If you have any suspicion about autism in a client’s partner, please tread carefully to explore the possibility. But do take the chance: otherwise, you could be missing the core challenge your neurotypical client is facing, which is the hub from which all her other apparently confusing behaviors emanate. The challenges to communication in the neurodiverse relationship are not insurmountable, but to ameliorate them requires sensitive counseling support. Educating yourself on the nature of autism, how it creates the lens through which a person experiences and interacts with reality, and how to help a couple bring implicit expectations to explicit and comprehensible statements are essential in this work. For initial solid grounding in the field of autism, I refer therapists to the work of Tony Atwood, PhD, and Simon Baron-Cohen, PhD.

Loneliness can be one of the most painful experiences in a relationship—especially when the relationship is neurodiverse. If you love your partner but still feel unseen, unheard, or emotionally distant, you are not alone. Many couples face this challenge, and understanding its roots can be the first step toward healing.

While loneliness can occur in any partnership, the dynamics in neurodiverse relationships bring unique emotional and communication challenges that deserve special attention.

Understanding Loneliness in Neurodiverse Partnerships

Many people experience occasional loneliness in relationships, but the loneliness in a neurodiverse partnership often has unique characteristics. Friends may reassure you by saying “that’s life” or “marriage is hard,” but these responses can dismiss what makes your situation different.

A person in this situation may feel guilty or wonder if they are making too much of the problem. They might try to convince themselves that things are fine—until the longing for emotional connection grows too strong to ignore.

How Autism Can Impact Emotional Connection

For some in neurodiverse relationships, deep loneliness becomes a constant presence, not just an occasional feeling. It may wax and wane, but it’s always there—woven into daily life, much like a wedding ring on your hand.

Autistic and neurotypical partners can both feel lonely, but for different reasons. A neurotypical partner may crave affective empathy—emotional attunement and validation—while an autistic partner may respond with cognitive empathy, offering solutions rather than emotional comfort. Neither is wrong, but the mismatch can create feelings of being unseen or unsupported.

Over time, these differences can lead to frustration, hurt, or even withdrawal from the relationship. In some cases, both partners feel equally isolated. 

Common Causes of Loneliness for Both Partners

• Communication gaps: Different ways of interpreting emotions and intentions

• Mismatched needs: One partner seeks emotional reassurance while the other prioritizes practical solutions

• Chronic stress or fatigue: Emotional distance can worsen when mental and physical resources are low (fatigue)

• Self-blame: Both partners may feel they are failing the other

• Depression and low self-worth: Persistent loneliness can lead to depression and negative self-talk

Strategies for Bridging the Understanding Gap

One of the most effective tools for working with neurodiverse couples is psychoeducation (learn more). This involves exploring both the autistic and neurotypical experiences—not to label one as “better” but to understand similarities and differences.

From there, couples can:

• Learn each partner’s communication style and needs

• Make the implicit explicit—clearly stating expectations and emotional experiences

• Develop strategies for expressing affection and empathy in ways the other partner understands

• Practice nonverbal communication (read more)

• Build trust through small, consistent actions

When to Seek Professional Support

If loneliness is leading to ongoing resentment, emotional withdrawal, or repeated conflict, it may be time to seek outside help. A therapist experienced in neurodiverse relationships can help partners:

• Translate and interpret each other’s communication styles

• Rebuild emotional connection

• Develop realistic expectations for the relationship’s dynamics

You can find a qualified therapist who understands both autism and relationship challenges.

Questions to Ask Your Therapist

• How do you help couples navigate neurodiverse relationship challenges?

• What strategies can increase emotional connection when communication styles differ?

• How can we each better understand and meet the other’s needs?

The Path Forward

Every relationship faces challenges, but in a neurodiverse partnership, understanding and acceptance are the keys to a deeper connection. A neurodiverse relationship will never be entirely neurotypical or autistic—it will always be uniquely yours. By learning to navigate your differences, you can deepen your connection and create a partnership that honors both individuals.

You don’t have to navigate this alone—working with a therapist experienced in neurodiverse relationships can help you and your partner build mutual understanding and emotional closeness. Find a qualified therapist on GoodTherapy today and take the next step toward a stronger, more connected partnership.

Author’s note: It is always a challenge to choose genders when writing about neurodiverse couples. Here I use the example of an autistic man and a neurotypical woman. I don’t mean to imply there are no cases in which this is reversed. It’s just that at this time, men are diagnosed at a 4:1 ratio to women, and in my practice, it is the majority of men who are the autistic partners. This could reflect the higher frequency of autism among men, or it could mean more couples like this present for counseling than couples in which the autistic partner is female. It is also important to note that individuals on the spectrum can be susceptible to gaslighting from others, and I will address this in a separate article.

In my work with neurodiverse couples in which one partner is autistic, one of the words I hear most often is “gaslighting.” Here’s an example:

“It would be one thing if we just fought like other couples who eventually make up. But that’s not how it is with us. Instead, we argue about something, and he tells me I’m being irrational. Or childish. Or critical. Then he shuts down. Often, he storms out of the room. If I try to bring it up later, he tells me I’m imagining things, that he didn’t say that, or if he did say it, he didn’t mean it the way I took it. He says I’m being too sensitive. And he shuts down again. I’m left feeling as if I’ll explode with frustration. I’m furious. And I have nowhere to go with it. I start to wonder if he’s right about me. I don’t know what to believe anymore. Is this gaslighting?”

Gaslighting Defined

In brief, gaslighting is a term that derives from the 1944 movie called Gaslight in which a husband successfully manipulates his wife into doubting her own reality. The husband in the story has a dark secret which is at the root of everything he says and does to his wife. To him, she is not a person with her own interior life. She is a pawn in his selfish game, which until the end he plays shrewdly enough to cause her to doubt her own version of reality.

“Instead, we argue about something, and he tells me I’m being irrational. Or childish. Or critical. Then he shuts down. Often, he storms out of the room. If I try to bring it up later, he tells me I’m imagining things, that he didn’t say that, or if he did say it, he didn’t mean it the way I took it.”

In reference to the flickering gaslights in the story, this effect has become known as gaslighting: intentionally treating a person in such a way as to cause confusion and cognitive dissonance, which eventually lead to collapse into self-doubt.

Of note is that at the heart of the husband’s motivation is a desire for riches, symbolized by jewels. This part of the story is often overlooked, but it is worth consideration when we are talking about autistic behavior.

Questioning Reality in Neurodiverse Relationships

First, let’s return to the comments of the neurotypical partner I quoted above. One way to view her statement is in terms of gaslighting, just as it is laid out in the movie.

In this model, time after time, incident after incident, she is cajoled into questioning what her own eyes, ears, and heart are telling her. Finally, she gives up. She begins to believe the mirror her partner holds up to her reflects an accurate representation of who she is. In order to believe that, she has been forced to discount any impulse of her own that contradicts such an image. She collapses into self-doubt. His manipulation has succeeded. Does this make him right? His smugness suggests that he believes so. He feels clever. He has won.

What would motivate someone to treat another person this way? Such manipulation may be observable in certain personality disorders, such as narcissistic personality disorder (NPD), antisocial personality disorder, and borderline personality disorder (BPD). In short, it is not healthy to intentionally set out to dominate someone else by negating that person’s reality. Such individuals leave a trail of emotional wreckage in the lives of others. Shelves full of books and countless hours of therapy are devoted to helping those victimized by such manipulators.

Looking Beyond the Behavior: Self-Protection

Behind the behavior of the personality disordered, there is an unconscious drive to protect that which feels threatened, which is usually the person’s self-worth. In twisted logic, anything that might compromise such fragile emotional integrity must be extinguished at all costs before it can extinguish the very life of the manipulator. This may be felt as desperation.

As a result, manipulation can be rationalized. It may not be viewed as a choice but rather as a necessity for survival. Incidentally, there is no respect for someone who can be manipulated, which makes further mistreatment easier and may even be viewed as what the person deserves.

But this is not the motivation of someone with autism.

The Tragic Dance of the Neurodiverse Couple

The jewels an autistic person guards could best be described as personal integration and a sense of security in who he is. Threats may come from feeling overwhelmed emotionally in the face of what seems like unmanageable ambiguity and uncertainty, which often lead to untenably high anxiety. Reducing that anxiety, consciously or not, is the most likely driver for behavior that appears to be gaslighting in someone with Asperger’s.

Reducing that anxiety, consciously or not, is the most likely driver for behavior that appears to be gaslighting in someone with Asperger’s.

Often, this person is oblivious to the harmful effects of his behavior and doubts the validity of someone’s observation that it might be gaslighting. The fact is that I have never met an autistic person whose conscious intent is to manipulate his partner.

But the key phrase is “conscious intent.” Because even though a person with Asperger’s may not mean to manipulate (gaslight) his partner, her actual experience is the same as it would be if intent were there.

In short, we have a couple in which one partner feels as if he is fighting for survival and another partner who feels as if she is fighting for survival, and in a two-way charge, one person’s means of doing so obliterates the reality of the other. It is what I call the tragic dance of the neurodiverse couple.

Addressing the Tragic Dance in Couples Counseling

The autistic person can learn in counseling that his behavior has the effect of invalidating his partner’s emotional life. He can come to understand that even though he does not intend to inflict such pain, the effect is real. Her dismayed and perhaps argumentative behavior is how a neurotypical person might justifiably respond to what feels like manipulative behavior from someone else. She is not trying to criticize him. She is trying to express her pain.

More often than not, this realization is met with deep remorse and often guilt. In time, he can learn to understand his own way of being in the world without judging himself harshly as being wrong or defective, because that is not the correct metric. Emotional support for him is key to his growth in this area.

The neurotypical partner can learn, first and foremost, that her response to feeling manipulated is normal. Her pain and confusion are normal. They are valid. She must be allowed to acknowledge and heal her wounds, because it doesn’t matter whether she was stabbed intentionally or inadvertently: she is still bleeding.

The second step, though, is to begin to understand that her autistic partner is not trying to hurt her; instead, what she experiences as manipulation is his way of trying to reduce omnipresent anxiety, which usually derives from a lifelong experience of not quite getting things right when it comes to understanding someone else’s emotions. She needs emotional support in order to move forward. At the same time, she also has to come to terms with the fact that her partner’s way of offering this support may not align with her idea of what that support must look like.

The way to view communication in a neurodiverse couple, or any couple, is in terms of its effectiveness. This is the only metric that matters. It’s not a matter of who is right or who is wrong. The goal of communication is mutual understanding. In order to improve communication skills and strategies, recognizing differences with an effort to respect them without judgment becomes the foundation for growth in the relationship.

When I work with couples, we concentrate on slowing down conversational speed, considering linguistics and the formal logic of argument, and identifying the emotional subtext and context inherent in communication. It takes time. It takes practice. It is not always successful. When it is, it can be described as a process of two steps forward and one step back as two parallel lives learn to build bridges between two lines that will never completely merge.

Learning to trust deeply after years of being hurt, having the faith that being vulnerable one more time might be worth the risk, accepting that one’s interpretation of another’s behavior may not be the same as that person’s intent: these are the challenges.

It can’t be gaslighting without the intent to manipulate. Regardless, it can feel like gaslighting. Education about neurodiversity, skilled counseling, and communication in renewed mutual respect create the tools for interrupting this revolving door.

Reference:

Gaslight (1944). (n.d.). Retrieved from https://www.imdb.com/title/tt0036855

Head-banging, face-slapping, scratching, and other self-injurious behaviors (SIB) are common among children who become frustrated. According to United Cerebral Palsy, up to 20% of all young children bang their heads in frustration. The behavior is common and considered developmentally typical until a child is about four years old. Among autistic people, self-injury is even more common, and it may persist later into childhood and even adulthood. A 2016 analysis found 27.7% of autistic eight-year-olds engaged in head-banging or similar actions.

Self-injurious behavior can be alarming to parents and caregivers. It can also lead to frustrating and painful judgment from bystanders. In most cases, self-harm does not cause severe damage such as concussions or life-threatening wounds, though some autistic people do seriously injure themselves.

SIB is a symptom of an underlying problem. Parents, spouses, friends, and others invested in the well-being of autistic people must look to the underlying motivation. Understanding the emotions and frustrations that trigger self-harm is the fastest route to ending it.

Common Causes of Self-Injurious Behavior in Autism

People on the autism spectrum process information, emotions, and sensory input differently from neurotypical individuals. While the experience of every autistic person is slightly different, some characteristics of autism that increase the risk of self-injury include:

Sensory overload

Autism can make a person highly sensitive to sensory input. They may feel overwhelmed by loud noises, find certain textures intolerable, or be unable to concentrate in certain environments. A small change in an autistic person’s sensory environment can feel like torture. Some autistic people engage in self-injury out of frustration when sensory stimuli become overwhelming. Others self-injure as a physical counterweight to painful sensory input.

Lack of control

Both autistic and neurotypical children may self-harm in frustration when they have little control over their environments. For instance, a child forced to play with the toys their parents choose instead of the toys they desire might bang their head. Outdated notions about how to support children with autism sometimes advocate restraint or punishment. This may trigger self-harm in some kids.

Reinforcement

Parents and bystanders may inadvertently reinforce SIB by giving the child more attention while trying to stop the behavior. They might also reward a child immediately after they stop self-injuring. This tactic can backfire and reinforce the action itself rather than the act of stopping.

Pain

Autism is linked to a number of other conditions and symptoms. For example, autistic children are more likely to have gastrointestinal problems. For some children, self-injury is a way of coping with or distracting from pain. A 2017 study argues that some physical symptoms of autism, such as stomach discomfort, are likely due to stress instead of an underlying medical condition. This suggests stressful experiences and chronic stress may play a role in SIB.

Chemical changes

Research suggests SIB and other forms of self-harm may cause the body to release feel-good chemicals called endogenous opioids. This means self-injury can be a source of pleasure. For a person experiencing stress or pain, the pleasurable chemical rush associated with self-injury can be appealing. (This theory applies to both autistic and neurotypical people.)

Environmental changes

Autism often causes a person to crave routine, order, and control. So when their environment changes, their schedule is chaotic, or they can’t go about their usual routine, they may self-harm to cope.

How to Help an Autistic Person Who Self-Injures

A generation ago, much advice about managing autism-related challenges focused on rewards and punishments. Now, with the advent of autism self-advocacy communities, autistic individuals are able to weigh in on various strategies. The overwhelming majority of autistic people and autism advocates strongly oppose punishments. Many also have expressed concerns about rewards, especially when the person giving the reward does nothing to address the underlying cause of the behavior.

Parents and others who care for an autistic person should view SIB as communication. Some strategies that may help include:

• A change in parenting strategy. Autistic individuals often thrive on order and routine. Parenting strategies that support this need can minimize SIB. A 2006 study found that a mindfulness-based parenting intervention improved parenting skills, helped parents feel more competent, and reduced aggression and self-harm.
• Offering more control over the environment. A number of studies have shown that giving autistic people more choices and more agency can reduce self-injury. For example, rather than telling a child what they will eat for dinner, offer them two or three options.
• Addressing underlying sensory issues. Sensory overload can be intense and painful. Parents and other caregivers should work to identify and understand their child’s sensory triggers. Advocates recommend removing or reducing these triggers as soon as possible. Many autistic people cannot function or concentrate until their triggers are gone. Something as simple as buying seamless socks could make a meaningful difference.
• Avoiding inadvertently reinforcing the behavior. Don’t yell, punish, or immediately divert your attention to an autistic child engaged in self-harm. Some autistic children feel chronically unheard and have learned that self-harm is the only way to get a caregiver’s attention. Reverse this cycle by listening attentively when an autistic child attempts to communicate but minimizing attention during moments of self-harm.

Self-Help for Autistic People Who Engage in Self-Injurious Behavior

Some autistic people feel an overwhelming impulse to self-harm, even when doing so causes them difficulties at home, work, school, and in friendships or romantic relationships.

The right therapist can help an autistic person advocate for themself, building an environment that feels safe and healthy.Correcting SIB begins with understanding what causes it. Try asking yourself which triggers are most likely to bring about SIB? Then explore how you feel while self-injuring. Does it cause feelings of relief? Pleasure? Distraction? Identifying what you get out of SIB can help you begin cultivating healthy alternatives. For example, meditation might help with feeling calm in response to stress, while exercise might help with feeling jittery or frustrated.

Autistic people often find support and help from autistic self-help and advocacy groups. These groups view autism as an identity rather than a disability or illness. They say autism is a unique lens through which to view the world. Participation in such a group can help an autistic person cultivate new strengths and find healthy alternatives for managing challenging feelings.

Medication for Autistic Self-Injury

No specific medication is approved by the U.S. Food and Drug Administration (FDA) to prevent SIB. A number of drugs, however, may help treat the underlying causes of SIB:

• Antipsychotics: The FDA has approved antipsychotics such as risperidone to treat autism-related irritability. Lowering anger may reduce one’s need to use SIB as an outlet. However, antipsychotics often make anxiety worse. Because many autistic people already struggle with anxiety, it’s often better to try other drugs first.
• Antidepressants: Some antidepressants can help with anxiety, depression, irritability, and aggression.
• Opioid agonists: Medications such as naltrexone counter the effects of opioids in the brain. Research suggests naltrexone can reduce the pleasure an autistic person experiences when self-injuring, potentially stopping the behavior.

Therapy for Self-Injury in People on the Spectrum

Therapy can help autistic people who self-injure, as well as their spouses, parents, and other loved ones. A therapist may work with an individual to identify triggers for SIB and cultivate healthier alternatives. The right therapist can help an autistic person advocate for themself, building an environment that feels safe and healthy.

Family counseling helps families better understand autism while dispelling myths about the spectrum. This can help parents better support their children, foster communication between autistic and neurotypical siblings, and offer a safe space for every family member to strategize and share concerns.

Couples counseling can help autistic people and their partners understand one another’s emotions. This fosters better communication, reduces frustration, and offers greater intimacy.

If you or a loved one would like support, you can find a therapist here.

References:

1. About autism. (n.d.). Retrieved from http://autisticadvocacy.org/about-asan/about-autism
2. ASAN Letter to FDA on banning electric shock devices. (2018, April 23). Retrieved from http://autisticadvocacy.org/2018/04/asan-letter-to-fda-on-banning-electric-shock-devices
3. Humenik, A. L., Curran, J., Luiselli, J. K., & Child, S. N. (2008). Intervention for self-injury in a child with autism: Effects of choice and continuous access to preferred stimuli. Behavioral Development Bulletin, 14(1), 17-22. doi:10.1037/h0100503
4. Living with children: Head-banging [PDF]. (n.d.). United Cerebral Palsy. Retrieved from http://ucphuntsville.org/wp-content/uploads/2015/06/Head-Banging.pdf
5. LeClerc, S., & Easley, D. (2015). Pharmacological therapies for autism spectrum disorder: A review. Pharmacy and Therapeutics, 40(6), 389-397. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450669
6. Minshawi, N., Hurwitz, S., Fodstad, J., Biebl, S., Morriss, D., & McDougle, C. (2014). The association between self-injurious behaviors and autism spectrum disorders. Psychology Research and Behavior Management, 7(1), 125-136. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990505
7. Singh, N. N., Lancioni, G. E., Winton, A. S., Fisher, B. C., Wahler, R. G., Mcaleavey, K., . . . Sabaawi, M. (2006). Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism. Journal of Emotional and Behavioral Disorders, 14(3), 169-177. Retrieved from http://journals.sagepub.com/doi/abs/10.1177/10634266060140030401
8. Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Robinson, C., Carpenter, L., . . . DiGuiseppi, C. (2016). Brief report: Prevalence of self-injurious behaviors among children with autism spectrum disorder—A population-based study. Journal of Autism and Developmental Disorders, 46(11), 3607-3614. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392775
9. Stress, not diet, likely source of GI problems in children with autism. (2017, July 14). Retrieved from https://www.healio.com/gastroenterology/stomach-duodenum/news/online/%7B6c9e6171-0a63-4f1e-9dcb-c7f0dd8e0b59%7D/stress-not-diet-likely-source-of-gi-problems-in-children-with-autism
10. Walters, A. S., Barrett, R. P., Feinstein, C., Mercurio, A., & Hole, W. T. (1990). A case report of naltrexone treatment of self-injury and social withdrawal in autism. Journal of Autism and Developmental Disorders, 20(2), 169-176. Retrieved from https://link.springer.com/article/10.1007/BF02284716

As a therapist working with people affected by someone else’s personality condition, I’m often asked the question, “How do I know if my partner is a narcissist or if they have Asperger’s?” This is an interesting question. I did some research in order to give justice to this topic.

For one thing, both are on a spectrum. Narcissism is a personality condition that ranges from mild to severe. In the most severe instances, the person demonstrates sociopathic tendencies or antisocial personality.

Autism also resides on a spectrum. It is a neurologically caused developmental condition. Prior to 2012, people with mild symptoms, considered “high functioning,” were identified as having Asperger’s syndrome. With the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this label disappeared, replaced by autism spectrum.

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Since mirror neurons are part of the brain’s social interaction system—involved with social cues, imitation, empathy, and the ability to decode intentions of others—some scientists have found that people on the autism spectrum have a dysfunctional mirror neuron system (University of California, San Diego, 2005). It appears mirror neurons also play a role in personality condition-related issues.

An emotionally neglectful childhood, involving parents who did not empathize, may result in narcissistic traits in adulthood. It has been suggested that this occurs because of under-utilized mirror neurons in childhood, which leads to dysfunctional mirror neurons in adulthood (Kellevision, 2015).

Here is a table depicting some of the similarities and differences between the two conditions. Can you see your loved one’s symptoms in either column? Could it be your loved one displays symptoms of both?

If Someone You Care About Is on the Autism Spectrum

If you are in a relationship with a person on the autism spectrum, it is helpful to know how to take care of yourself. Here are some tips:

• Be in the right “head space.”
• Take charge of your own life. It is helpful to be flexible and adaptable.
• Understand you have to do things on your own. Your partner will probably not be able to do the things that are important to you—at least not in a satisfying manner. Rather than getting upset by this, I recommend practicing acceptance. It is liberating to understand the situation and adjust yourself accordingly rather than expecting the situation to adjust to you.
• Realize you can teach a person on the autism spectrum how to be different. This will require patience and perseverance. Do not be satisfied with the status quo; instead, get in there and help your loved one learn how to relate to you in a healthy way.
• Recognize that if your partner hurts you, it is not intentional. Don’t take it personally and don’t be surprised. They do not do this to be controlling, feed their ego, or fulfill a personal need for superiority.
• Research and study autism and learn what you can to have compassion for your partner.

If Someone You Care About Has a Personality Condition

If you are with a person with a personality condition such as narcissism, then you may have similar unfulfilled relationship issues, as well as the added bonus of emotional abuse. Following are some suggestions for coping with this type of relationship:

• Observe the person’s behavior, don’t absorb it.
• Understand that people with narcissism do not cooperate or collaborate well; you will have to learn to be independent in this type of relationship.
• Do not expect the person to ever have empathy or compassion for you.
• Develop healthy, happy connections within other relationships. Don’t expect them in your relationship with the person with narcissism.
• Recognize that your partner may derive pleasure from hurting you. Why may be difficult to understand. Study the concept of “narcissistic supply” and you will discover that people with narcissism are “fed” by the reactions they get. It may help the person feel in control, superior, or powerful.
• Realize you may not be able to teach a person with narcissism how to be different. No matter how much patience and perseverance you have, you may discover nothing works to change the other person. You can only change yourself.
• Research and study personality conditions and learn to have compassion for yourself.

References:

1. Goulston, M. (2011, November 17). Just listen – Don’t confuse a narcissist with Asperger’s syndrome. Retrieved from https://www.huffingtonpost.com/mark-goulston-md/just-listen—dont-confus_b_316169.html
2. Kellevision, (2015, August 6). Psychopaths, autism, empathy, and mirror neurons. Retrieved from http://www.kellevision.com/kellevision/2015/08/psychopaths-empathy-and-mirror-neurons.html
3. Oberman, K., & Ramachandan, V. (2007, June 1). Broken mirrors: A theory of autism. Scientific American. Retrieved from https://www.scientificamerican.com/article/broken-mirrors-a-theory-of-autism-2007-06
4. University of California, San Diego. (2005, April 18). Autism linked to mirror neuron dysfunction. Retrieved from https://www.sciencedaily.com/releases/2005/04/050411204511.htm

Parents of autistic children often participate in cognitive behavioral therapy (CBT) to address emotional and behavioral concerns in their children. According to a study published in the Journal of Autism and Developmental Disorders, parents who attended CBT with their children experienced improvements in their own mental health.

In the standard model of therapy for autistic children, parents are usually not active participants. They are often in a separate room. For this study, researchers asked parents to act as co-therapists, directly involving them in the process.

CBT is a type of therapy that aims to alleviate distress by correcting and redirecting automatic thoughts and behaviors. Therapists work with people in therapy to help them better manage emotional distress and to change problematic behavioral habits.

CBT: Benefits for Parents and Children

For the study, researchers recruited 57 autistic children between ages 8 and 12. None of the children had co-occurring intellectual disabilities.

[fat_widget_right]Some parents were randomly assigned to serve as co-therapists during their children’s CBT sessions. Another group was placed on a waitlist. As co-therapists, parents practiced emotional and behavioral regulation strategies alongside their children. They also wrote down their children’s thoughts during therapy activities.

Compared to waitlisted parents, the parents who acted as co-therapists experienced improvements on a wide range of mental health measures. They had fewer symptoms of depression, were more adept at regulating their own emotions, and were more mindful parents with better perceptions of their children. Because CBT often cultivates mindfulness and supports emotional regulation, these improvements are likely a direct result of the parents’ involvement in their children’s therapy.

CBT as a Tool for Understanding Autistic Children

Parents who participated in their children’s therapy felt the experience improved their understanding of their children. Writing down their children’s feelings and participating in therapy sessions with their children may have helped some parents better understand their children’s challenges.

“It created a very safe, predictable approach for my son,” said Jessica Jannarone, a parent who participated in the program, in an interview posted to YouTube. “I could hear firsthand from his own perspective and his words what it felt like to be him sometimes and to work on coping skills together. The difference it’s made in the last year is more than has happened in the past 10 for us.”

References:

1. Effects of cognitive behavior therapy on parents of children with autism. (2017, August 1). Retrieved from https://www.sciencedaily.com/releases/2017/08/170801131221.htm
2. Maughan, A. L., & Weiss, J. A. (2017). Parental outcomes following participation in cognitive behavior therapy for children with autism spectrum disorder. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-017-3224-z

Autistic adults make more consistent choices, suggesting autism might make people less likely to be swayed by cognitive biases that affect their peers, according to a study published in the journal Psychological Science.

Some autistic people argue that autism should not be treated as a disease or disability. Instead, they point to some of the benefits of autism and believe it should be treated as a form of neurodiversity. This study suggests autistic people may easily manage tasks with which other people struggle.

Do Autistic People Make More ‘Rational’ Choices?

The study compared 90 autistic adults to 212 neurotypical adults in an online decision-making study. Participants completed questionnaires to assess cognitive skills and autistic traits before completing the study.

The study paired 20 objects into groups of two. In each pair, the objects differed in at least two ways. Each pair was accompanied by a less desirable third “decoy” item. For example, a group might include three USB drives with different memory capacities and lifespans. The decoy object in each group would be objectively worse than the other two items.

Each pair was displayed twice, but the third object changed with the second viewing. Researchers then asked participants to pick the best object.

[fat_widget_right]The most rational approach to choosing the “best” item renders the decoy object irrelevant. But cognitive biases can cause decoy objects to affect how people evaluate two similar objects. The results showed that neurotypical people were more vulnerable to these cognitive biases. They were more likely to switch their choice when the decoy object changed. Autistic people showed more consistency in their choices.

Autistic Individuals Show More Consistency

In a second trial, researchers performed a similar study. This time, they assessed only people who scored very high and very low on traits associated with autism. People with more traits of autism made more consistent decisions than those with few traits.

This suggests autistic people might be less vulnerable to the distraction of cognitive biases, enabling them to make more decisions based on rational analysis. The researchers say this finding is a clear demonstration of how autism may not always be a disability.

References:

1. Adults with autism make more consistent choices. (2017, June 27). Retrieved from http://www.psychologicalscience.org/news/releases/adults-with-autism-make-more-consistent-choices.html#.WVPzXYgrJhE
2. Farmer, G. D., Baron-Cohen, S., & Skylark, W. J. (2017). People with autism spectrum conditions make more consistent decisions. Psychological Science, 095679761769486. doi:10.1177/0956797617694867

There is a great deal of literature and support available for parents of children with the traits or diagnosis of autism spectrum (ASD). I write often about relationships in which this describes one partner, and there are books available in support of such couples. But what if you suspect one of your parents may be on the spectrum? There are meager resources available which specifically address such concerns.

Perhaps you have children of your own now and one of them seems autistic, prompting you to look at your family of origin with new perspective. It’s also possible you discovered that you are autistic yourself. Or you have read enough about autism that it suddenly dawned on you that ASD might explain the challenges you have always had with a parent—challenges that have, up until now, baffled you. For the sake of this article, let’s say it is your father you are concerned about.

It can be sobering to think these thoughts after all these years. It can be frightening. You may wonder whether you even have the right to consider such a thing with regard to your own father, who otherwise seems to have a successful life and a mature career. In fact, this is one of the things that has never squared with you: your father has always seemed to be a different person to you than to the rest of the world. All these years, you thought the root of the problem resided within you. Now you are beginning to wonder.

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You may wonder why what feels like relentless critical judgment always seems more characteristic of your father than confidence-building positive acknowledgment (“If you can get an A in every other subject, why do you consistently get a B in mathematics?”).

You may wonder why your father never seems to get jokes (yours or anyone else’s), figures of speech (he takes things literally), or social conventions (“Valentine’s Day is merely an excuse for card companies to make money”).

You may wonder why he can send you checks but seldom seems to ask about or understand the emotional state you may be in at any given time.

You may wonder why your mother seldom has her own interests or friends anymore, but rather seems to live in support of your father’s plans and interests.

You may wonder why your father never hugs you and doesn’t seem to like it when you hug him.

You may wonder whether your father is depressed, because he has always been so quick to anger and so slow to recover from it.

You may feel angry about all the fruitless years you have spent trying to please your father. And you may feel guilty for feeling angry.

You may wonder why a father would set out to hurt his child over and over again without seeming to understand that he does it.

The main thing to remember is that your father came of age well before the notion of high-functioning autism (until recently called Asperger’s syndrome) was understood even within the ranks of mental health professionals. Until just recently, autism was imagined in its most dysfunctional forms, as characterized by children who seemed beyond the reach of language and behavioral communication. Milder forms of autism were generally not considered.

Since ASD is invisible, those who are now older adults and had the social manifestations of mild autism as children were likely described as being “quirky,” as being someone who “hears a different drum,” or who “likes to keep to themselves.” They may have had few friends, a chemistry lab in their bedroom, and a preference for the company of adults, which was facilitated by advanced language skills.

When we do ASD evaluations as psychotherapists, we generally meet with the individual for several sessions to gather as much information as we can. Since there is no specific test for ASD, the process is narrative. Meetings with the spouse or children are of great importance in this process, because by definition people with ASD are not able to provide insight into what it is like to love them and to live with them.

The intense special interests of children with ASD were viewed most often as precocious (“Brian knows everything there is to know about the solar system”), perhaps interesting (“if you want to know anything about dinosaurs, Amber is the one to ask”), but also sometimes as weird (“Thomas knows everything there is to know about industrial exhaust systems”). The judgment depended on how mainstream the child’s special interest appeared to be.

For the fortunate, their special interests aligned with academic pursuits that led to successful professional careers (law, medicine, university professorships, music, engineering). Such individuals applied their extraordinary powers of concentration to their fields and may have had stellar success as a result. For their children and wives, this can be a source of great confusion, because this is where the split becomes most obvious to them: the doctor, the attorney, the engineer can be prominent and well-respected in the world outside the home, but when the doors are closed and the family is home alone, another person emerges. This is the person who prefers to eat in silence, who returns to the study each evening after supper only to emerge well past everyone else’s bedtimes, and who then leaves the house earlier than everyone else the next morning. This is the person who has never attended a ballet performance, who has never changed a diaper, and who may sometimes read bedtime stories in stylized and stilted English to the children.

I can tell you some things about the points I raised earlier that might help you to make sense of your father’s behavior from his perspective. This list is not exhaustive, but it can be a start.

• Regarding the critical judgment you always felt: If your father has ASD, one of the most important guiding principles in his life is likely to be his sense of justice and fairness. Therefore, for him to notice that you are clearly capable of getting all As on your report cards except for the errant Bs in math most likely means he is driven to call your attention to the problem so you can remedy it. To him, it seems perfectly clear: now that you see the error in your grading pattern, you will be able to fix it and get an A in every class. It is less likely to occur to him that you may be struggling with an ineffective instructor in math, or that you just don’t like the subject and are doing your best. It is particularly unlikely he would commend you on all the As you did receive; the grades are their own rewards, and there is little he is going to believe would be necessary to add to that. He will assume you know this already, because he will assume you think the same way he thinks.
• If your dad doesn’t get jokes, tends to take things literally, and balks at social conventions such as celebrating birthdays and holidays, it is likely due to the fact individuals with ASD process the world cognitively and not intuitively (the way of the neurotypical). This means that much of what is communicated by body language, tone of voice, gesture, facial expression, and posture is likely to go unnoticed; the meaning of the words will be heard without mitigation. Jokes fall flat. And the social conventions, those unstated but generally understood reasons for celebrating birthdays and holidays, will make no sense because they do not seem practical.
• Sending you checks may be your father’s primary means of showing he cares for you. He may not ask how you are feeling, and he may not respond much if you volunteer such information, because he is not likely to be comfortable in the realm of the emotions. This doesn’t mean he has no feelings; to the contrary, he likely feels things very deeply. He is probably at a loss for how to express them, however, and at a loss for how to offer you support when you express yours. Emotions generally don’t make sense to him.
• If you look at the arc of your mother’s life and see a constriction in her self-expression now compared to how she was when she was younger, it may be because it is so very difficult to be married to someone with ASD. Years of feeling judged and criticized have left their mark. She is lonely and tired, and she has no emotional support from the man she loves. She likely has deep pain that even she doesn’t understand. She may seem resigned to growing old, even though she is not old at all. She is likely to know your father better than anyone else. She may find great relief in your courage to come to her and raise the question. This is something for you to think about carefully, however, because sometimes bringing up ASD can sound like an accusation instead of a thoughtful inquiry to those prepared to be defensive.
• Many people who have ASD do not like to be hugged, nor do they hug others freely. It may not make sense, or it may be physically uncomfortable. Regardless, it is not to be taken personally because it is not meant personally. It is tough to think your father doesn’t want to hug you, but remember: he probably doesn’t like to hug anyone at all.
• Older adults with ASD have spent their lives trying to figure out the neurotypical world, often with great fears of never quite getting things right. This may create constant anxiety, and being on the spectrum is above all exhausting. This is why preferring to be alone for long hours is so important: transitions between one state and another (from the office to home, for example) can feel almost impossible to manage. After years of anxiety, depression is not unusual in individuals with ASD. In fact, anxiety and depression are the hallmarks of adult ASD. Your father may not describe himself as anxious or depressed, but his behavior may demonstrate these qualities.
• Your anger and frustration make sense if your father has ASD. You are just now beginning to wonder about this. Memories of frustration and disillusionment may come flooding into your mind. Remember this: you did the best you could possibly do given your age and experience at any particular phase in your life. Feeling guilty now may make sense to you, but it isn’t in your best interest because when you were growing up, you didn’t do anything with the sole intent of hurting your father. You just wanted him to be your dad. You may have acted out. That’s what kids do because they are not mature enough to do anything else. Now that you are older and more mature yourself, your inquiry is also more mature. Cut yourself some slack. This is a time to be gentle with yourself.
• Above all, the most salient point regarding ASD is this: what you see and experience in your father’s words and behavior may be different from what he means by them. It is critical to understand that your father is probably not intending to hurt you, and at the same time it is imperative to acknowledge that your pain is real. This is the great tragedy of ASD.

What can you do now that you have these questions? I recommend finding a therapist who has both a keen understanding of autism spectrum issues as well as deep compassion for those on the spectrum and for those in that person’s life. Make an appointment to discuss your thoughts and your concerns. Feel welcome to ask many questions so you can gain a sound grasp of what it means to have ASD. Remember, however, that no therapist can diagnose your father in absentia; he would need to be present in order for this to be done.

When we do ASD evaluations as psychotherapists, we generally meet with the individual for several sessions to gather as much information as we can. Since there is no specific test for ASD, the process is narrative. Meetings with the spouse or children are of great importance in this process, because by definition people with ASD are not able to provide insight into what it is like to love them and to live with them.

If after a few sessions you believe your father may have ASD, you can discuss with your therapist whether bringing this question to your father might be a good idea. There are possible benefits, to be sure. There are also possible risks. You may find it is enough for you to understand ASD well enough that you can now relate differently to your father. Or you may decide you’d like to talk to him about the possibility of coming with you to therapy to share what you are learning.

There is always the possibility this will come to him like rain in the desert and that he will welcome the opportunity to explore the possibility he has ASD. I have seen many adults cry when they recognize themselves in the diagnosis, because for the first time, certain things about their experiences over a lifetime finally begin to make sense to them. ASD becomes the key that unlocks a lifetime of mysteries.

On the other hand, he may give you a blank (or even hostile) look and dismiss the subject. If so, it may not be a good idea to push it. He has built his life with an understanding of himself that has served him well enough by his definition. Perhaps the inquiry and exploration will be for you alone. It can still be helpful to you, even without his involvement.

Finally, please remember that if your father has ASD, you likely have had a difficult childhood. It will be important for you to find a therapist who understands the impact of ASD on your life. I wish you well in your inquiry, and hope a new understanding will lead to hope and forgiveness in your life from this day forward.

Partnerships between individuals who have the traits or diagnosis of autism spectrum (previously including Asperger’s syndrome) and individuals who do not (often called neurotypical) are often challenging from the outset, based on numerous reports from such couples with whom I work in my psychotherapy practice. Over time, say 15 to 20 years, these couples typically become emotionally disengaged, spar constantly, and have long since stopped having sex or any other kind of intimate touch or even conversation. Communication has become transactional. The business of daily life is all there is.

It is not satisfying to either partner. It is frustrating. It feels as if there is no way to turn things around.

The person on the spectrum (ASD) increasingly feels judged, unappreciated, and anxious. The neurotypical (NT) partner feels dismissed, undervalued, and starved for intimacy. It is more often than not the NT partner who will have the urge to bolt. And bolt it is, because at this point, it feels more like running out of a house on fire than running toward a more fulfilling life. Leaving means stopping the pain. The ASD partner is likely to acknowledge not being happy but is unlikely to suggest or initiate separation.

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When couples come in for counseling at this point, the greatest challenge is to help both partners see that each is feeling isolated and hurt; that there is a mutual experience of being judged (even condemned) without the intent to do harm; and that these very real emotions can bring on serious depression. Usually, I see a profound sense of futility in the words of the NT partner, such as, “I just can’t do this anymore because you never listen to me.” The ASD partner is likely to respond with something like, “That’s what you always say.” It is an immediate object lesson for me in what it is like for this couple when they are at home. They may as well exist on parallel—but never converging—planes. They both respond from within their guarded “under attack” position—once again, as usual, with no prospect for change.

If you see yourself in this brief sketch, there are three important things I would suggest for your consideration before you hire an attorney:

1. It Is Likely Neither of You Is Thinking Clearly at This Point

Years of living at crossed purposes has created patterns of defensiveness and hurt in both of you. This is an excellent point for remembering the wisdom in Einstein’s notion that we don’t solve a problem by using the same kind of thinking that created it. These hardened positions of isolation are unlikely to provide either of you with the ability to see your relationship in a new light.

Understanding that you are both confused and hurt, and that neither of you will immediately see a path for healing, is key. Acknowledge the pain. Feel the sorrow, the frustration, the anger. And give yourselves permission to take a hiatus, defined as a period during which you do your best to be mutually respectful. Take a break from even trying to communicate. Rest. Determine in advance how much time you both need before you come back together, renewed, to make a plan for the future.

2. Divorce Is Not the Only Option to Remaining Married

While it may make sense to want to run from pain and start over by rushing to divorce, it is important to understand the unique composition of this relationship. It is likely there is still real love between you, though it may seem deeply buried in wreckage by this time. It is likely you are aligned philosophically on many things, such as child-rearing principles. Regardless of all the pain, there have also been good times, and you are the repository of each other’s memories. You may feel that you speak different languages when it comes to intimate communication, and to getting your emotional needs met within your marriage, but there may also be a great deal about your marriage that is working well. Do you want to throw away everything before considering alternatives?

Understanding that you are both confused and hurt, and that neither of you will immediately see a path for healing, is key. Acknowledge the pain.

And there are alternatives. Each couple I know works on a plan that provides for transitional phases between the marriage as it is and the future. For example, some couples move into separate bedrooms and create schedules for interacting. Some add a condominium to their housing, and create a plan for who lives where and what the terms are for sharing meals, vacations, and space. Some agree to see others during this time. Others need to know they are both being monogamous for the duration, which is defined clearly to both. At a certain point, once a new kind of equilibrium is reached, couples come together again to define the next phase. Maybe they will keep two residences permanently. Maybe they are ready to discuss divorce. Maybe they need to extend this period of transition until they feel more sure of themselves.

3. Counseling Can Help When You Acknowledge the Role of ASD in Your Communication Problems

Because an ASD/NT couple has unique challenges and characteristics, finding a counselor who understands the experience of the individual on the spectrum as well as the experience of the neurotypical partner in this marriage is a tremendous gift you can give to yourselves. You will have the opportunity to have mediated conversations about the things most important in your lives, and for the first time may begin to understand each other’s perspectives.

The NT partner can see that while the pain is great, there has never been an intention to inflict harm: what has always felt like judgment and rejection actually comes from the ASD partner’s drive to tell the truth and to see fairness. The ASD partner can learn that the NT partner’s needs for intimacy and emotional support are valid and that they are not signs of weakness or a demanding nature.

Counseling may not help any particular couple stay together. Sometimes, however, the great gift of counseling is an understanding that there is tragic loss at the heart of this often ill-fated partnership and that respecting each other and loving each other can develop and survive even if the couple eventually decides to divorce.

This can be done with love, with honor, and in good health.

Author’s note: A caveat before we get into the substance of this article: couples counseling with a skilled therapist can greatly help couples in which one partner has the symptoms or diagnosis of autism spectrum (ASD)/high-functioning autism. This article describes the path followed by many women whose husbands are not diagnosed and who did not have successful couples counseling support to help them understand their differences. I write here about heterosexual married couples because these are the couples I see most frequently in my practice, where most often it is the man who exhibits the characteristics of ASD. This is not meant to imply only heterosexual couples face these issues or only men can have problematic ASD.

When a neurotypical woman is married to a man who has the behaviors associated with autism spectrum (ASD), several things typically occur. Over the course of her marriage, she experiences herself as gradually disappearing. In the place of her former self emerges a person she barely recognizes. She is so lonely. So hurt. So … angry. She feels isolated, as her social connections have gradually diminished. She feels misunderstood by everyone who knows her, so she has learned not to talk about her “problems.” She starts to feels crazy. She also feels guilty, because her husband is a good man.

This result can be seen in the following modified example from my psychotherapy practice:

A woman in her mid-50s came in for her first appointment. She seemed unsure of herself, eyes downcast, behaving as many women do when they first arrive. I recognized the familiar look of bewilderment, explained by others before her as wondering whether they are going to make sense when they begin to speak, of whether I will view them as whiners, or whether they may be wasting my time.

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Before taking a seat, she handed me her curriculum vitae. Many pages long, it was heavy in my hand.

“This is who I used to be,” she said.

At a glance, I could see that among other things this woman had successfully argued a case in front of the U.S. Supreme Court. Sinking into the chair in my office, however, she appeared too meek to look me in the eye as her tears began to form.

“I think my husband has Asperger’s. I don’t know, though. Maybe it’s me. Maybe there’s something wrong with me,” she said. “We have been married for 20 years. I don’t mean to say anything bad about him. He’s a good man. But I need a divorce. And my children think I’m a crazy person.”

Then the tears came in earnest.

“It’s such a relief to be here. People don’t believe me. I stopped talking about this a long time ago.”

I have seen this many times. On one occasion, a woman told me, “My husband has Asperger’s.” Then she began to cry, could not stop, seemed uncomfortable for not being able to compose herself, and left the office without uttering another word.

There are women who work with me for several months and can still feel blindsided when something comes up at home that they misinterpret from a neurotypical (NT) perspective instead of considering the implications of ASD. They continue to be surprised at the gap between themselves and their husbands. The pain they feel when they recognize this gap catches them like a stab to the stomach.

What has happened to these women? It’s difficult to see the process while it is going on, just as it is difficult to see the effects of water drops on granite minute by minute. But changes that are negligible day to day are incontrovertible over the long term. With time, granite that once held the characteristics of a unique natural form is visibly reduced to a smooth, monolithic surface.

What has happened to these women? It’s difficult to see the process while it is going on, just as it is difficult to see the effects of water drops on granite minute by minute. But changes that are negligible day to day are incontrovertible over the long term. With time, granite that once held the characteristics of a unique natural form is visibly reduced to a smooth, monolithic surface.

Instead of drops of water, women married to men on the spectrum are struck by pain from unrelenting moments of being reflected inaccurately in the place they look most often for reassurance: the eyes of their husbands. And over time, they begin to interpret what is reflected to them as a reliable representation. They try to alter their own perspective, their own aspirations, their hopes and dreams, to bring them into line so they are consistent with the way their husbands treat them. The lonely process of love and guilt and shame rips them apart.

It starts like this: a man on the spectrum (most often undiagnosed) marries a woman for all the qualities he admires, but once the wedding is over, those very qualities become the things that spark the most unsettling experiences for him. She is outgoing socially, has interesting things to talk about, and is engaged in intriguing professional activities. She is well-regarded, confident, and kind.

For her part, she finds his thoughtful attention and his stability comforting. She is also drawn to what she takes to be his reticence. She admires his ability to maintain his focus so intently and to be so successful in his work.

To a man on the spectrum, however, living with a person who has these qualities may be predictably uncomfortable. Where he seeks equilibrium in order to feel he understands the world around him, she seeks—and represents—novelty, as a result of the very curiosity that made her the woman he initially admired.

His constant anxiety related to living in what feels like an alien culture is soothed by predictability. This would be facilitated by the presence of a partner who complies with his view of reality. This is not because he sets out to manipulate her. It is because his fundamental concepts are threatened by hers. His anxiety grows with his fear of doing “something wrong” because he is never quite confident about what the “right thing to do” might be.

From her perspective, his thoughtful attention may have disappeared the very day of the wedding. He quickly became self-involved and aloof. The stability she admired slowly shows itself to be profound inflexibility. The reticence does not point to the underlying wisdom she assumed was present; she now sees that it comes from his not knowing what to do or say. And his inability to focus on her has come to mean she exists outside his field of interest, where he is apparently content to relegate her.

Mommy’s Birthday Doesn’t Matter

We can look at birthdays to explore the dynamics common to interactions between partners in an ASD/NT couple. When he does not acknowledge her birthday, and she asserts that his behavior has upset her, he may respond that he did not mean to upset her; therefore, she shouldn’t be upset. Or he might tell her that because birthdays come once year and everyone has them, they are no big deal and she should stop making such a big deal about them. Or he could tell her they celebrated her birthday last year. Or that birthdays are for children. In other words, he may hold her to the same idea regarding birthdays he holds himself. He may criticize her to the degree that her feelings about birthdays differ from his. He will miss her distress.

As a result, she doesn’t have the opportunity to celebrate her birthday, something which is generally understood as a common social convention in our culture. She also feels rejected by her husband over the belief her birthday is worth noting in the first place. She asks herself why such a little thing as a birthday seems so important to her. She wonders whether she is being juvenile, as he suggested. She sees he doesn’t care one way or another about celebrating his own birthday, after all.

She decides he is more mature than she is and attempts to comply with this idea of “maturity” by trying to ignore her own birthday. It doesn’t work. All her friends and family members mark their birthdays in some way. She sometimes has to explain to them why hers was overlooked. On occasion, she makes up stories about her birthday so people won’t feel sorry for her. She feels rejected, as well as foolish for being immature.

Overall, she is sad and lonely, still wondering why she can’t seem to make a point on her own behalf that she’d enjoy at least a card acknowledging her birthday, even though birthdays may not be important to him. But over time, she has learned further discussion is hopeless on a subject like this. She won’t say anything else about her birthday. She has learned such a conversation isn’t a discussion at all. It feels more like a pedantic correction of yet another one of her stupid ideas. And it will leave her upset, possibly in tears, with nowhere to go but inside.

She continues to celebrate his birthday. She makes certain the children’s birthdays are acknowledged and celebrated. She is now operating from the notion that her own birthday is a nonevent. It does not get mentioned because she does not bring it up. Her children, even though they are young, are noticing mommy’s birthday doesn’t matter, however. Daddy’s does. Theirs do. Mommy’s doesn’t. They do not understand it is Mommy herself—and without help from Daddy—who makes all the other birthdays happen. By complying with her husband’s view of things, however, in order to avoid the pain of being criticized about it once again, she has taught her own children that Mommy’s birthday doesn’t matter.

It is fair to wonder why a woman can’t decide to celebrate her own birthday on her own terms, regardless of what her husband thinks about it. In most cases, this would be a valid point. When ASD is present, though, the calculus is different. She can celebrate. She can bake a cake. She can buy herself flowers and even make reservations to go to dinner that evening. If she does, however, her husband’s attitude will be clear to her and to the children, whether he says anything with actual words or keeps his silence. It will be obvious to all concerned that he does not approve. He will comply to a minimum degree. He will participate begrudgingly. He will damn with faint praise. He will stonewall, which means he will say nothing at all, when she suggests (even mildly) that he participate. She has become accustomed to his stonewalling, which Dr. John Gottman, relationship expert, believes can kill a relationship because it denies communication and denies opportunity for the relationship to grow.

The Children Are Watching

The children are watching everything, interpreting it from their limited perspective and understanding. Mommy isn’t thinking of this at the time. She is not thinking the children learn how to treat their mother by observing the way their father treats her. She is operating on the assumption her children know her and love her and they see she is a good person. She is unaware that negative lifelong attitudes toward her are being formed in the young minds of the children she loves so dearly, and that these attitudes can come at her later to hurt her every bit as much as the behaviors she suffered from her husband, their father—the very behaviors that instilled these attitudes in the children in the first place. She is not thinking about the fact the children will likely remain unware they hold these subconscious notions regarding their mother, regarding how to treat her, regarding what she “deserves.” They watched how their father treated her. They learned. As adults, they may ignore their mother’s feelings and question her judgment, just the way Daddy does.

She is also unaware that in doing all the work and providing all the energy toward celebrating Daddy’s birthdays and the children’s birthdays, she is showing the children one more example of taking on both roles, Mommy and Daddy. She does it because it is important to her, for example, that the children’s birthdays are celebrated. She wants them to have fun. She wants them to have one special day a year that is all about them. She sees this as normal.

Daddy doesn’t agree, so he doesn’t participate.

Mommy does it all, from the planning to the present buying to the cake decorating, at home or at the bakery. She chats with all the parents who bring their own children to celebrate. She cleans up after the party. She is exhausted. She says so. Her husband may respond by saying, “Well, you’re the one who had to have this big party! You asked for it.” He may not help with the cleanup because, well, it was “her idea to have the party.”

The children are watching as Mommy cleans up and Daddy retreats to his study. If they get wild or misbehave, a distinct possibility after having the house full of friends and their tummies full of birthday cake and ice cream, it will be Mommy who has to enter the fray and settle things down. If she’s tired and feeling lonely and rejected by her husband, she is at her least resilient point, and she can snap unintentionally at the children. She looks like the bad guy, the parent who is “always angry.” This is how it may seem to small children.

The children are also susceptible to misunderstanding another basic fact they observe regularly. They see Mommy being strong. They see her as the one in charge of all the daily life of the family, and of all the extras (such as birthday parties, ballet lessons, soccer games, play dates), and they wonder where Daddy is. Because the reality of the situation is impenetrable and inaccessible to the children, they may create their own narratives. They may believe Daddy is a good man, yet Mommy seems to want to do everything. They determine this is because Mommy has pushed Daddy aside in order to control everything herself. Mommy doesn’t let Daddy help. Poor Daddy! Mommy is really mean.

Time to Make a Change

The years go by. The children go off to college, graduate, create their own lives. Mom couldn’t be more proud of the young people they have become. She decides she can no longer survive the relationship with her husband, however. It is not unusual for women to leave these marriages once the children are at least in high school, but often the marker is when they leave the house for college. This is not an easy decision for a woman. In fact, it is brutal. And it often makes no sense to anyone who is looking in at the marriage from the outside, including the couple’s children. She must give up everything in order to save her sanity. Yes, it has come to that.

This woman has lost a partner, lost a marriage. She has also lost her dreams, her hopes. She has lost her fundamental sense of who she is. She has to mourn these losses. She then has to heal. And she has to re-create herself.

The woman by this time may have few friends, few confidants. She has learned to refrain from discussing her marriage difficulties, because the friends she has have always seen her husband as such a “nice guy” and because he is undeniably a good provider. She stopped trying to talk about it because she got tired of hearing “all marriages have problems,” she is “expecting him to meet all her needs, which is impossible for any one person to do,” and she is “misinterpreting things.”

When she finally does go through a divorce, she discovers it will take her years to sort things out. She will think she is doing well immediately afterward because it feels so good to be free from the constant state of stress and criticism. This can be exhilarating. But gradually, she learns it is a phase. And it reveals a miscomprehension of how much healing she really has to do. During this time, before she reestablishes her new self, she may do things that seem rational and make decisions that seem logical. However, it is in looking back from a vantage point of several years after her divorce that she is likely to begin seeing just how separated from her true being she was during these years of healing, and of how much more healing she had to do, and still faces.

This woman has lost a partner, lost a marriage. She has also lost her dreams, her hopes. She has lost her fundamental sense of who she is. She has to mourn these losses. She then has to heal. And she has to re-create herself. It can take a decade or more to sort these things out and to become strong on her own. If she enters into a relationship with another man before she gets her bearings, she is likely to face additional confusion until the dust settles. This is not to be dismissed as the normal post-divorce phase of a woman’s life. It is an epic battle for reconstruction.

A No-Win Situation

By this time, the children see her differently. She is the woman who did not deserve to have birthday parties, remember. She is the woman who appeared to have pushed their father aside, so he was unable to be part of their daily lives. She appeared to have been the one who rejected him, and who instead of involving him in their lives, inserted her own agenda and goals. She is the one who spent all the money, because she had to manage everything and make all the decisions without her husband’s input. She is the one, most importantly, who broke up the family. Her selfishness caused the divorce, and the children were left to sort it all out.

Dad is the victim. Mom is the witch.

Mom has given her life to be both mother and father to the children because their father, on the autism spectrum but undiagnosed, was incapable of being involved emotionally and practically in the daily lives of their young family. Patterns were established. Mom continued to give. She finally left the marriage for her own sanity. She loses her marriage, her husband, her intact family. She appears to be the agent of the demise of the family, but she is not, because in running from abuse (regardless of the fact it was not necessarily intentional), she is running from a burning building in order to save her life. A fire set by intent, an accidental fire—what’s the difference to the person inside the house who must flee if she wants to live?

The woman loses again when she begins to understand her children treat her the way their father always treated her. They don’t respect her. They keep their distance. They blame her for everything they ever felt was wrong in the house when they were growing up.

The woman coming out of an ASD/NT marriage loses twice. She loses her husband and she loses when her children treat her the way their father treated her.

And to attempt to tell her story to her children is wrought with landmines invisible to her and unimaginable to the children. She feels she cannot convey the reality to them, regardless of her attempts. And even after all these years, she does not want to disparage their father, because she understands ASD is not his fault. She still treads carefully, even though he is unlikely to extend the same grace toward her. The children do not see this. Too much time has gone by. Too many patterns are set. They see only criticism of their father if she mentions she had to heal, or that she had to rediscover who she was after the divorce, or that she may have made decisions in the early years following the divorce that were not ultimately consistent with the person she now knows herself to be. She is, once again, judged and criticized—this time by the very children she exhausted herself to nurture.

If she is fortunate, she has found a good therapist along the way. She has had the opportunity to talk without feeling crazy. She has cried the bulk of her tears, though they still come when she thinks of her children, of how she loves them, of how unfair this has been to them, to her, to her former husband.

She has herself. She has friends. If she is fortunate, she has learned to re-create herself in such a way she has a career or an involvement in the community that allows her to experience herself in her competence and to be acknowledged by others as a person worthy of attention, worthy of friendship, even worthy of a birthday party.

Postscript: This article is a composite of what I have seen in my practice over the years among neurotypical women who have emerged from marriages with men who exhibit the behaviors consistent with a diagnosis of autism spectrum disorder (formerly called Asperger’s syndrome, high functioning autism). As a psychotherapist, I work with ASD/NT couples. I work with individuals affected by ASD. I work with women who are or were married to men with ASD. My role can be described as that of an ASD/NT translator, essentially, and my goal is to help both partners understand the world as seen from the other. By writing this, I do not mean to disparage or judge anyone. This article reflects my experience as a therapist, and I offer it here in this form to help women understand that their experiences are valid as well as to help their friends and family members understand what these women have been struggling with—and what they may well continue to struggle with for some time to come.

References:

1. Gottman, J. (2015). The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert. New York, NY: Harmony Books.
2. Silverman, S. (2015). NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. New York, NY: Avery Publishing.