Abstract
IntroductionThere is a recognized increase in vulnerability to psychosis in autistic people (AP). However, the construct of psychosis (particularly schizophrenia) contains several distinct factors, making understanding the relationship between autism and psychosis complex. Previous research has suggested that affective lability may be particularly related to psychotic experiences for AP who have experienced psychosis (AP-P). There is also a suggestion that psychosis might be a state of extreme (over)empathizing, perhaps related to emotional processes.MethodWe recruited three groups: AP-P (N = 23), a group of AP who had not experienced psychosis (AP-NP; N = 59) and a neurotypical control group (NC, N = 41). Participants completed measures of autistic traits, schizotypal traits (as a proxy for psychosis-proneness), emotional processes, and perspective taking (as a proxy for the type of empathizing most theoretically likely to be linked to psychosis). As well as comparisons between groups, regression analyses were used to understand the influence of dependent variables on schizotypal traits.ResultsWe found that AP-P had significantly higher rates of schizotypy (positive and disorganized), as well as higher rates of emotional difficulties. Across all groups, affective lability had a positive and significant association with positive and disorganized schizotypal traits. Differences in perspective taking between groups were small and generally non-significant, particularly in adjusted comparisons; additionally, its impact on schizotypy was small and non-significant.DiscussionOur findings suggest that positive and disorganized schizotypy, in particular, have a relationship with affective lability. This, in turn, supports the idea of emotional processes as related to the development of schizotypal traits and psychosis across all individuals, regardless of autism diagnostic status. We found no evidence of empathy relating to any subscale of schizotypy, or the total schizotypy score. We contend that emotional processes should be considered in exploration of the relationship between autism and schizotypy in future. This may help to explain some of the findings of overlap between these constructs in previous research. Factors known to affect neurodevelopment of emotion systems such as history of early trauma, challenges during pregnancy and birth, and early childhood experiences of adversity during critical windows of development need further consideration in future research.
Highlights
There is a recognized increase in vulnerability to psychosis in autistic people (AP)
Gender split was similar between AP who have no history of psychosis (AP-NP) and Neurotypical Controls (NC) groups; there were significantly fewer women in AP who have experienced psychosis (AP-P) compared to AP-NP
A large and significant difference in Autism Spectrum Quotient (AQ) scores was found between AP-NP and AP-P
Summary
There is a recognized increase in vulnerability to psychosis in autistic people (AP). Since the first definition of autism, and Bleuler’s description of what we would label ‘negative symptoms’ of psychotic mental illness [6], there has been persistent debate about the relationship between experiences of autistic people (AP; individuals who meet diagnostic criteria for ASD1) and experiences of mental illness, psychosis. Chisholm and colleagues [7] reviewed eight possible models of relationship between ASD and schizophrenia spectrums disorders (SSDs), and concluded that the evidence was strongest for four models: the increased vulnerability model (AP are more at risk of psychosis due to their ASD, but the conditions are separate); the diametrical model (ASD and psychosis are opposite ends of a continuum of overlapping constructs); associated liabilities model (factors that increase risk of one condition increase risk of the other, but they remain separate); and the multiple overlapping etiologies model (some factors that lead to developing ASD lead to developing psychosis, but others do not, leading to distinct but often similar or overlapping presentations). Any research into an overlap between ASD and psychosis will be informed by, and influence, discussion of an explanatory model of that overlap
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