Kassandrah Cooke

Background: Autistic adults experience elevated interpersonal violence risk alongside mental health and functional challenges. However, how violence-related stress may accumulate over time and compare with non-autistic adults’ experiences remains unclear. Research often conceptualizes violence exposure, distress, and functioning as separate outcomes, rather than potentially interconnected processes across contexts and over time. We examined autistic and non-autistic adults’ narratives of violence-related stress, coping, challenges, and longer-term outcomes. Methods: Seventy-eight adults with interpersonal violence histories (27 diagnosed autistic, 21 self-identified autistic, 30 non-autistic; M _age = 31 years, standard deviation = 9.31) completed an online qualitative survey about violence experiences, coping, mental health, functioning, and changes in understanding these experiences. Using a critical realist approach, we conducted template analysis informed by reflexive thematic techniques, and initial coding was guided using broad domains of autism-related characteristics, environmental stressors, coping, challenges, longer-term outcomes, and perceived change over time, while remaining open to emergent insights. Results: Participants described cumulative and context-dependent stress processes rather than linear trajectories. Autistic accounts emphasized delayed harm recognition, sensory–emotional overwhelm, and self-protective strategies (e.g., camouflaging, suppression, withdrawal), particularly in ambiguous, invalidating, or unsafe environments. Across groups, participants described harassment, coercion, and perceived failures of protection in relational and institutional contexts, reportedly reducing trust in support pathways. Participants described coping strategies as initially protective but increasingly costly, contributing to restricted participation, reduced support access, and later functional difficulties. Non-autistic accounts reflected cumulative stress processes but were less consistently organized around autism-related characteristics. Participants identified turning points, including harm recognition, therapy, supportive intervention, and tangible exits from harmful contexts. Conclusions: Interpersonal violence may contribute to cumulative stress processes affecting mental health, functioning, and well-being, particularly where autism-related characteristics combine with threat, invalidation, conformity pressure, and inadequate support. Findings highlight the importance of recognizing cumulative stress processes, earlier harm recognition, and needs-led, responsive support in disrupting stress cycles. Community Brief: Why is this an important issue?: Autistic adults experience high rates of bullying, coercion, abuse, and other harmful interpersonal experiences, which may contribute to later mental health and daily functioning difficulties. We do not yet understand how these experiences build up over time or compare with those of non-autistic adults. Harm may arise not only from violence itself but also from coping and other people’s responses. What was the purpose of this study?: We explored how autistic and non-autistic adults describe stress, coping, challenges, and life after violence, including how these experiences may build up over time. What did the researchers do?: Seventy-eight adults with experience of interpersonal violence completed an open-ended online survey. Participants included diagnosed and self-identified autistic adults and non-autistic adults. They described their experiences of violence, coping, longer-term effects, and change over time. We analyzed responses to identify patterns and turning points. What were the results and conclusions of the study?: Participants rarely described a simple path to recovery. Many described stress, coping, and later difficulties as connected over time. Autistic participants described difficulty recognizing unclear or hidden harm, managing overwhelm, and trying to stay safe through camouflaging, self-silencing, withdrawal, or monitoring threat. Participants reported these strategies felt protective short term but exhausting and linked with reduced functioning, burnout, or isolation. Participants also described schools, workplaces, services, or authorities minimizing their experiences or failing to respond, reducing trust and making help-seeking harder. Described turning points included recognizing harm, therapy, supportive relationships, leaving unsafe situations, and developing greater self-trust. What is new or controversial about these findings?: Rather than viewing violence as a single event, participants described how stress can build over time through ongoing experiences, coping efforts, and responses from others. Comparing autistic and non-autistic accounts helped clarify how some processes were more closely linked to autism-related characteristics. Participants reported that strategies appearing effective in the moment, such as camouflaging or over-performing, were associated with longer-term strain, reduced participation, and exhaustion. Responses from schools, workplaces, services, or authorities could reportedly either reduce harm or worsen it when they minimized experiences, discouraged disclosure, or failed to provide protection. These findings challenge the assumption that appearing to cope or function means a person is safe or well. What are potential weaknesses in the study?: We used a one-time online survey with written responses. The study may underrepresent people from lower socioeconomic status groups, non-Western countries, racially minoritized communities, without internet access, or who prefer other communication methods. Participants described past events from memory, and we could not ask follow-up questions or track changes over time. How will these findings help autistic adults now or in the future?: Our findings suggest that services should not focus only on changing autistic people’s behavior or improving visible coping. Camouflaging, withdrawal, or burnout may indicate high strain rather than resilience. Earlier recognition of harm, consistent responses to reports of violence, and support based on individual needs rather than diagnosis alone may support longer-term mental health, participation, and well-being.

In this review and meta-analysis, we aimed to examine outcomes of interpersonal violence among autistic people. Intersectionality and minority theories suggest that negative outcomes are heightened among people with multiple marginalized identities. Thus, we also aimed to investigate gender-related outcomes of interpersonal violence among autistic people. We conducted a systematic database search with inclusion criteria including mixed methods, peer-reviewed research examining any harmful interpersonal act (e.g., physical, sexual, and psychological) experienced by autistic people. We undertook a random-effects meta-analysis with pooled data from 9 studies, comprising 3,647 autistic participants aged 1 to 80 years. Violence was associated with worsened mental health, with the strongest association for internalizing symptoms ( d = 0.66, p < .001; 95% CI [0.51, 0.80]) and suicidal thoughts and behavior ( d = 0.63, p < .001; [0.44, 0.82]). Narrative synthesis of 57 studies comprising 37,418 participants (13,127 autistic, 24,291 non-autistic) found violence was associated with numerous adverse health, development, and functional outcomes, including worsened mental health and behavioral difficulties compared to non-autistic controls from childhood. Females and gender minorities reported greater intra- and interpersonal health and development difficulties related to violence, emerging in early childhood and enduring into adulthood. Findings provide strong evidence of lifelong negative outcomes associated with interpersonal violence experienced by autistic people, providing evidence for the relevance of minority stress and intersectionality theories in understanding risk. Indeed, our results raise concerns that autistic people, and particularly non-male (female, gender diverse) individuals, have higher susceptibility for abuse from a young age, while being conditioned to respond with social desirability, superficial adaptivity, and dissociation.

Research has identified intersectional effects of autism and gender for experiences of interpersonal violence; however, findings have been mixed and vary by violence type. This systematic review and meta-analysis examined gender differences in autistic experiences of interpersonal violence prevalence. We identified 64 studies examining physical, sexual, or psychological violence, bullying, and homicide among autistic people, varying by gender, age, and support needs. We conducted a meta-analysis over 24 studies, and found increased violence experienced by autistic cis-females (d = 0.32) and gender minorities (d = 0.73) compared to cis-males. This review suggests autistic people experience disproportionate rates of violence compared to the general population, and highlights concerningly high rates of lifetime and poly-victimization, particularly among gender-marginalized groups.