Autism and chronic ill health: an observational study of symptoms and diagnoses of central sensitivity syndromes in autistic adults

Abstract

Background Autistic adults, particularly women, are more likely to experience chronic ill health than the general population. Central sensitivity syndromes (CSS) are a group of related conditions that are thought to include an underlying sensitisation of the central nervous system; heightened sensory sensitivity is a common feature. Anecdotal evidence suggests autistic adults may be more prone to developing a CSS. This study aimed to investigate the occurrence of CSS diagnoses and symptoms in autistic adults, and to explore whether CSS symptoms were related to autistic traits, mental health, sensory sensitivity, or gender. Methods The full sample of participants included 973 autistic adults (410 men, 563 women, mean age = 44.6) registered at the Netherlands Autism Register, who completed questionnaires assessing autistic traits, sensory sensitivity, CSS, physical and mental health symptoms. The reliability and validity of the Central Sensitization Inventory (CSI) in an autistic sample was established using exploratory and confirmatory factor analyses. Chi2 analyses, independent t-tests, hierarchical regression and path analysis were used to analyse relationships between CSS symptoms, autistic traits, measures of mental health and wellbeing, sensory sensitivity, age and gender. Results 21% of participants reported one or more CSS diagnosis, and 60% scored at or above the clinical cut-off for a CSS. Autistic women were more likely to report a CSS diagnosis and experienced more CSS symptoms than men. Sensory sensitivity, anxiety, age and gender were significant predictors of CSS symptoms, with sensory sensitivity and anxiety fully mediating the relationship between autistic traits and CSS symptoms. Limitations Although this study included a large sample of autistic adults, we did not have a control group or a CSS only group. We also could not include a non-binary group due to lack of statistical power. Conclusions CSS diagnoses and symptoms appear to be very common in the autistic population. Increased awareness of an association between autism and central sensitisation should inform clinicians and guide diagnostic practice, particularly for women where CSS are common and autism under recognised.

Measuring subjective quality of life in autistic adults with the PROMIS global–10: Psychometric study and development of an autism-specific scoring method

“…Combined with the high levels of multi-system somatic complaints reported by autistic adults (Williams & Gotham, 2022), including those in our current sample, an elevated loading of pain onto the mental health factor indicates that variance in pain ratings in autistic adults may be disproportionately affected by the presence of so-called Central Sensitivity Syndromes (CSS), such as fibromyalgia and irritable bowel syndrome (Yunus, 2015), the severity of which can be greatly influenced by psychosocial stressors (Alok et al, 2014). Although infrequently assessed, CSS and associated symptoms appear highly prevalent in autistic adults (Grant et al, 2022), and it is possible that these conditions play an outsized role in predicting healthrelated QoL in this population, particularly in samples, such as ours with relatively good physical health. Notably, these claims are purely speculative at this time, and additional research is warranted to specifically assess whether somatic symptom burden in autism is primarily driven by CSS diagnoses and to determine whether biopsychosocial interventions targeting central sensitization (Adams & Turk, 2018;Gatchel et al, 2007) meaningfully increase QoL for autistic adults.…”

“…Although the current study did not seek to comprehensively investigate the predictors of QoL in autistic adults, exploratory analyses also demonstrated small yet practically significant differences in self-reported QoL according to sex assigned at birth (M > F), sexual minority status (sexual minority < heterosexual), and gender minority status (transgender/non-binary <cisgender). The mediators of these demographic effects were not explored in the current study, but we suspect that known group differences in both physical and mental health conditions (DaWalt et al, 2021;Grant et al, 2022;Kassee et al, 2020;Lai et al, 2019;Murphy et al, 2020;Simantov et al, 2022;Strauss et al, 2021;Weir, Allison, Warrier, & Baron-Cohen, 2021;Williams & Gotham, 2022) contribute substantially. Additional research is needed to further interrogate these relationships and determine whether increased rates of co-occurring mental and physical health conditions/symptoms fully explain, at least in part, the associations between female sex and SGM status and reduced QoL in autistic adults.…”

Alexithymia and intolerance of uncertainty predict somatic symptoms in autistic and non-autistic adults

“…It is likely that stress and social conditions have an impact on physical health (Kirmayer et al, 2004), and given that autistic individuals are more vulnerable to psychosocial stressors (Griffiths et al, 2019), this may go some way to explaining these heightened physical symptoms. Recent work on central sensitisation in autism may also offer some promising developments in this field (Grant et al, 2022). This area deserves further attention in research and clinical settings, in order to understand the experience of somatic symptoms among autistic people and their impact on health care needs and quality of life.…”

Indifference or hypersensitivity? Solving the riddle of the pain profile in individuals with autism

“…19,24 Moreover, the latter might increase the incidence of common pain conditions chronicity because of comorbidities and in turn increased propensity for self-injuries. 25,39,49,53 Of note, because throughout the autism spectrum there are shared neural mechanisms, we believe that these results may also apply to people with autism whose cognitive and verbal communication impairments may eliminate their ability to communicate their pain. 19,45 These findings may raise physician, parent, and caregiver awareness to the pain phenomenon in autism and thus lead to early and effective treatment to improve the well-being and quality of life for autistic individuals and their families.…”

“…Thus, we suggest that preexisting augmented responses and the inability to inhibit tonic pain, considered an experimental model for clinical pain, may lead to the establishment of a pronociceptive profile and the acquisition of pain chronification. 63,81,85 Indeed, a higher incidence of chronic pain conditions is reported in the autistic population 39,80 probably not only due to the preexisting pronociceptive state but also due to self-injurious behaviors that potentially bias other judgments of pain in autistic individuals. 1,15 Thus, pain is overlooked by caregivers and untreated by physicians.…”