Suppression of emotions in autism can lead to increased depression

Research and clinical experience have found that autistic adults are most likely to utilise the coping mechanisms of suppression and avoidance for anxiety and depression, rather than other coping strategies such as seeking support or using cognitive reappraisal. Suppression of painful emotions can hide the symptoms of depression so effectively that the person slips ‘under the radar’ and does not receive the help they so desperately need. Unfortunately, the painful emotions do not go away, but can intensify and elongate the depressive episode, and can also lead to “depression attacks.”

Sometimes compounding these problems, many autistic adults camouflage their social communication difficulties by using observation, imitation, intellectual analysis and use of masks and personas. We now understand that use of camouflaging, whilst effective for managing the task of day-to-day life, can increase mental health concerns, including anxiety and depression. The person feels constantly exhausted, can experience autistic burnout, and feels alienated from their authentic self.

For some autistic adults, emotions do not show, either on their face, in their body or in their tone of voice. The circuitry in the brain responsible for expression of emotion through the body and voice is working differently in autism. The results of this difference are some of the observable features of autism, including a facial expression that can be described as a “wooden mask,” less use of gesture, and a monotonic tone of voice. However, because the person does not look or sound distressed, there can be a lack of recognition of that person’s feelings and increasing feelings of alienation and depression may occur. As one autistic woman described, “People at school thought it was okay to bully and taunt me. They interpreted my lack of visible emotional expression as lack of feelings, they truly believed that I was not hurt by the taunts and severe bullying.”

Any one of, or a combination of, these factors can lead to a depressive episode, and indeed depression is far more common in autistic adults than in nonautistic adults. Fortunately, once recognised, depression is treatable.

Tony and I wrote a book, Exploring Depression: A CBT Programme for Beating the Blues (2016) based on our extensive experiences in treating autistic adolescents and adults with depression. We also offer an on-demand online course equivalent, Exploring Depression and Beating the Blues.