Autism and Paranoia: Is There a Connection?

When we look at persons with autism, we tend to focus on the social challenges they bravely face daily.  What is less looked upon is that many of those with ASD tend to have significant and unusual fears that can impact their daily functioning. But is there a connection between autism and paranoia? 

In studies, it is noted that up to 64% of youth with ASD experience what can be described as intense fears. At times, irrational fears can cross boundaries to that of paranoia, in which a person develops false beliefs that others are planning to harm or conspire against them.

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Understanding paranoia

It is important to distinguish paranoia from common fears and anxiety. Anxiety tends to be generalized and is a typical response that most of us have to daily worries and fears.  

Paranoia, on the other hand, tends to be a more deep-seated misconception that the world is actively conspiring against you.

Symptoms that indicate paranoia can include:

  • a lack of trust in others, 
  • difficulty in relationship formation, 
  • seeing others’ actions as deliberate attacks against you, 
  • being extremely sensitive to criticism. 

In these cases, an inherent belief that those around you are to persecute or punish you intentionally occurs with little or no evidence. 

What’s the connection between autism and paranoia?

Studies suggest a connection between paranoia and autism spectrum disorder. It is theorized that this may be, in part, due to persons with ASD having difficulties with understanding social and emotional interactions, which can create the increased possibility of negative social relationships.

Research indicates a connection of as much as 34.8% for those with ASD having some form of delusional thinking. Those with ASD face challenges of feeling the need to be cautious of their surroundings, attempting to determine patterns in those around them, and a high degree of sensitivity to environmental events, which may make paranoia a perceived way of self-preservation for some with ASD.

What often causes paranoia in autism?

Though an actual cause of paranoia in those with ASD has not been established, several theories of what may create an environment for paranoia have been noted by researchers.  

One of the primary considerations is that those with ASD have difficulty reading others’ nonverbal cues and, therefore, make negative assumptions within their relationships. 

A scared young boy covering his eyes with his hands

Additionally, it is theorized that up to 84% of those with ASD have intense fears that could create the belief that they need to be extremely skeptical of others around them as a process of self-preservation and safety.

Paranoia’s impact on daily life

Individuals with ASD who exhibit paranoia often find significant impacts on their daily life and functioning.  As trust is a key to any strong and lasting relationship, paranoia can make developing relationships a great challenge and lead to isolation.

At the far extreme, those with ASD may further pull away from any type of relationships or opportunities for fear of potential unwarranted danger.

Managing the challenges

Individuals with ASD have difficulty in social and emotional interactions that can often exacerbate potential paranoia because of not understanding the motives, nonverbal cues, and communication of others around them.

Therefore, being educated on social-emotional learning curricula can be a very useful means of decreasing paranoia and misinterpretation of others. Cognitive behavioral therapies (CBT) can also help challenge some of the irrational belief systems that support paranoia.

Psychodynamic therapies may work to help those with paranoia to try to find concrete evidence of the true motives of others before jumping to conclusions and recognizing what is within one’s control and what is not.

A call for empathy and acceptance

When we look at paranoia and ASD, we must look at it from the perspective of a self-preservation skill to address a world that is often difficult to interpret and can seem threatening and unpredictable.

The world is made less fearful and, in turn, less a place of paranoia when we begin to understand others’ motivations and recognize the positive aspects of human nature in ourselves and others. It is when we walk alongside those with ASD and show them the world is a place to tread cautiously but bravely that we can begin to help teach life skills of independence.

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Q: Is paranoia a symptom of Asperger’s?

A: Though those with ASD tend to score higher on scales of paranoia, it is not necessarily a symptom of Asperger’s. Rather, it would seem that social-emotional skill defects and difficulty reading nonverbal as well as other social cues may make those with ASD more susceptible to paranoid thought processes.

Q: What is the difference between autism and paranoid schizophrenia?

A: Though sometimes there may be some similarities between paranoid persons with ASD and paranoid schizophrenia, these are very different diagnoses. Those who have paranoid schizophrenia tend to be diagnosed after symptoms appear in the teenage years, and they may have hallucinations and difficulty distinguishing fantasy from reality. Commonalities between both can include social isolation, difficulty making eye contact, social challenges, and flat affect.  

Q: What mental illness is often confused with autism?

A: ASD shares signs and symptoms with various mental conditions, making diagnosis challenging. These include avoidant personality disorder (those who are extremely socially inhibited and fear criticism),  sensory or processing disorders, reactive attachment disorder (infants or children who have difficulty making bonds with others due to early childhood neglect), communication disorders, and schizophrenia. Experienced practitioners must carefully distinguish between these conditions when treating individuals.

Q: Can autism have psychotic symptoms?

A: Individuals with ASD generally do not exhibit psychotic symptoms. That being said, research has indicated that those with ASD have a prevalence of psychosis of more than 3 in 100 persons. This makes those with ASD have an incidence of psychosis slightly more than three times that of the general population.


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