Self-Harm Is a Common Behavior in People with Autism, But Experts Say Autism Isn’t the Cause

Self-harm in itself is a destructive and therefore undesirable behavior, but it can also be so bad as to lead to hospitalizations and even suicide attempts, making it an even more vital problem to solve. Self-harm is ostensibly far more prevalent now than it was decades ago, and it’s important to investigate the causes and associations so we can work on solutions to this major issue of our day.

But where self-harm intersects with autism, the connection gets a little murky. This complex topic deserves considerable thought and, ultimately, more research.

A 2023 study published in JAMA showed that people who are on the autism spectrum, especially females, are much more likely than the general population to struggle with self-harm behaviors, particularly those self-harm behaviors that led to hospitalizations or suicides. Specifically, females in the study had an 83 percent increased risk of such self-harm behaviors over their non-autistic counterparts, while males had a 47 percent increased risk.

The study looked at Canadian public healthcare records of 380,000 autistic and non-autistic Ontarians from between 1988 and 2018. Starting at age 10, the team compared the incidence of hospitalization for self-harm or death by suicide for the two groups and found that those who were diagnosed with autism were more likely to end up in the hospital or die because of self-harm behaviors than their peers.

This data seems to suggest that being on the autism spectrum somehow causes or encourages self-harm behaviors. But experts say it’s unlikely that it’s the autism itself that is the cause of this phenomenon, at least not directly. Rather, it seems that having autism increases the risk of mental illness, and mental illness in turn creates a higher chance of self-harm and related behaviors.

Of course, one could argue that there’s little difference between autism being a direct and an indirect cause of self-harm. But there is one substantial difference, and that is how we perceive our ability to design a solution. Let me explain.

If autism directly causes or encourages self-harm, it’s tempting to think that it’s beyond our control, that there really is no solution. Because autism is likely at least partially genetic and doesn’t have a cure (whether or not you think we should aim to find a cure for autism is irrelevant here), it stands to reason that the associated self-harm behaviors are also not “curable.”

However, if we look at mental illness as the likely cause of self-harm, our mindset changes. We’re less likely to look at mental health as something permanent or incurable. There is a large body of knowledge about mental illness and what we can do to remedy it and even prevent it. We have mental health professionals, drugs, lifestyle changes, and a variety of other options in our tool belt. Using these tools, we can combat mental illness and associated self-harm behaviors.

It is important not to downplay the struggle of those with mental illnesses, as there are certainly people who never feel they’ve reached a real “solution” to their mental health problems, even after trying every available tool in the box. But for most people, one or more of these tools will make a significant impact on their lives and health.

The results of the study suggest that more effort should be made to create custom mental health interventions for people on the autism spectrum and improve their access to treatment options. Meng-Chuan Lai, professor at the Centre for Addiction Mental Health at the University of Toronto and a lead author of the study, says that the key takeaway here is that we need to be paying more attention to the mental health needs of people with autism.

Mary Doherty, an anesthesiologist and the founder of Autistic Doctors International who was not involved in the study, says, “It is often assumed that being autistic means poor mental health, and while that is currently true for way too many of us, it is far from inevitable.”

If you or someone you know is considering suicide, please do not hesitate to seek help. To contact the 988 Suicide & Crisis Lifeline, call or text 988 or chat 988lifeline.org.