Autism and Comorbidity

Dear Papabear,

I have noticed that over the years I have been rather emotionally dead inside. It seems I need strong stimulus to feel a little compassion towards others outside of myself. But this does not mean I am selfish per se. I seem caring on the outside. I am friendly with my friends I hang out with. I do chores for Mom as she has to go to work in the morning and I am home during the day. I hug her. I say I love her, but I never really feel it. When she would get home, she would have dinner and then sit on the couch [with] her iPad watching the news and relaxing while I was on the computer. I would occasionally spend some time with her on the couch, but I never really felt a connection with her doing that. Also, my intrusive thoughts would constantly make me feel bad and not happy. Too negative. Honestly, at night they make me want to commit suicide sometimes.

Sometimes I would just write my thoughts down on paper. Whatever thought popped into my head I would write down, and it is always very negative stuff.

Another example is the Thousand Oaks shooting. I was attending Moorpark College when it happened. However, since I only recently moved there, I never formed any real ties to the local area. Point is, after it happened one of our teachers talked to each of us individually in case we needed to talk to someone about what just happened. I personally never really felt anything towards the victims. I more or less went about [my business] as if nothing really happened. So when the teacher talked to me, I was rather nonchalant and did not seem very upset whatsoever. Later, I received an email asking me to [see] the Moorpark counselor. I did not understand why at the time, but looking back I think my teacher talked to someone about my lack of emotion. I went to see the counselor, but since I was perfectly fine that day, I was in and out in 5 minutes. Nothing wrong whatsoever. (Note, I was recently diagnosed with autism).

I do not actively go out and hurt anyone. However, I do not really go out and volunteer to help anyone. If it’s of any relevancy, part of the reason I am emotionally dead or think I am that way is because of a lot of trauma during my young adult years.

Recently, I got a lifeguard job, and [judging by] the first day alone, it seems like a good fit for me. That should help with my depression and give me encouragement as I now have a source of income. It seems really easy, a good thing for my OCD thoughts. (They are not as bad as they were many months ago, but sometimes they still bother me.)

I have to admit I am never happy. My day is boring day and day out, and sometimes I feel like I am far behind most people my age in their progress of life.

So, what are your thoughts? What do you think is going on, and how do you think I should proceed going forward?

Thank you.

Nicholas (age 26)

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Dear Nicholas,

I am sorry for the struggles you are experiencing. Thank you for writing. 

To make a full assessment of what's going on, I would ideally like to know more about your background, especially details about the trauma you mention only in passing. That said, my initial feeling is that all of this links with your autism. You don't say where you are on the autism spectrum, but be that as it may, autism is often associated with other emotional conditions. This comorbidity may involve all of the other problems you mention, including OCD, depression, and your lack of empathy for others.

You autism, combined with whatever trauma you might have suffered earlier, may have brought up or exacerbated these other emotional issues. Let's talk about each of these in turn:

1. Lack of Empathy: A common trait of those with ASD is how they struggle to emotionally connect to others. In your letter, you seem concerned that your lack of empathy somehow puts you at risk of being a danger to others. I really don't think you need to worry about that. You are not a sociopath (if you were a sociopath, none of this would bother you and you wouldn't be writing to me); you simply have ASD.
2. OCD: While people with autism often express symptoms of OCD, the two are also at times confused with each other. So, you might not have OCD per se. OCD involves repetitive and compulsive behaviors that a person cannot control and that have no real purpose other than to feed into a neurotic belief that if the action isn't performed something bad could happen. Autistic people, on the other hand, can engage in repetitive behavior because they find it soothing and reassuring. 
3. Depression: Depression can be tough to diagnose by medical professionals evaluating patients with ASD because their emotional behavior and facial expressions often differ significantly from nonautistic patients. But a number of studies show that people with ASD are, indeed, more likely to have mood disorders such as depression. In one article posted on the Autism Speaks website, it was reported: ​"The percentage of children rated by their parents as 'sometimes' to 'very often' contemplating or attempting suicide was 28 times greater for those with autism than those with typical development. It was 3 times less among those with autism than among the non-autistic children who had depression. Depression was also the strongest single predictor of suicidal thoughts or attempts among the children with autism."

In short, I suspect strongly that all these things you are experiencing, including your reaction to the Thousand Oaks shooting, are connected to your ASD. Therefore, the logical thing to ask is this: Are you being treated for your ASD? Are you seeing a professional? Have you consulted a doctor at any time? (I don't think your 5-minute consultation with a counselor counts).

I suggest you start by checking out the Autism Speaks website as a good place to find information and resources.

Don't worry that you might hurt someone (doubtful) and don't worry about competing with others your age (everyone is different and progresses at their own rate). But if you do have thoughts of suicide again and they get worse, please call the 988 hotline, or you can also chat at the website.

I hope this helps. Write again if you have more questions or concerns.

Bear Hugs,
Papabear