Abstract
Autism has been observed and studied for over a century. Despite early misconceptions that autistic neurodivergence predominantly occurs in males, recent research highlights a substantial underdiagnosis and misdiagnosis of autism in females due to a lack of understanding of how they present differently to their male counterparts.
Autistic women, particularly those without intellectual disabilities, often experience distinct mental health difficulties, including internalising symptomatology and a high risk of interpersonal victimisation and suicidality. However, research on the mental health issues faced by autistic adults, especially women, is relatively scarce. The lack of awareness of autism in women and resources catering to autistic women in the South African mental healthcare system likely further exacerbates their mental health struggles. This research seeks to address these gaps by exploring the mental health challenges of autistic women, contributing to more effective, gender-sensitive mental health support services.
Using a qualitative design and guided by a hermeneutic phenomenological framework, this study employed interpretative phenomenological analysis to explore and articulate the mental health challenges experienced by two late-diagnosed and two self-identifying autistic women, giving voice to their lived experiences. Semi-structured interviews were conducted to produce detailed and in-depth descriptions of the phenomenon. Data analysis identified four main themes: (1) Feeling deeply: Embodied emotions and mental contours, (2) Socio-emotional challenges and trauma histories, (3) Psychological fortitude: Self-management and personal development, and (4) Professional support.
The findings from this study shed light on the diverse and significant mental health problems faced by autistic women. The participants shared stories of their distress surrounding sensory-emotional sensitivities and dysregulation, depressive states, social anxiety, and the impact of interpersonal trauma. The participants have histories of maladaptive coping involving emotional avoidance and substance misuse.
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However, they primarily draw on a variety of constructive health-seeking coping strategies in their pursuit of emotional equilibrium.
The participants’ stories are characterised by their intrinsic strengths, continuous perseverance amidst adversities, and their striving for self-understanding, self-confidence, and self-acceptance. The participants’ experiences with mental health services were generally negative, and emphasised the need for mental health professionals to develop a deeper understanding of autism as it presents in females, recognising the diversity within the autism spectrum and vitally integrating sensitive, trauma-informed practices in therapeutic settings. A wider lens on the resultant implications and recommendations for psychotherapy training and practice is given.