A Qualitative Exploration of Self-Harm Among Autistic Women

Background: Autistic individuals, particularly females, demonstrate a higher prevalence of self-harm compared to those who are not autistic. Core cognitive, affective, and sensory differences inherent to autism are linked to the increased vulnerability within autistic populations. However, these factors are not sufficiently explored in relation to individuals’ social and environmental contexts, resulting in a gap in understanding the self-harm experiences of autistic females. Methods: Eleven autistic women participated in semi-structured interviews to explore their experiences of self-harm. Data was transcribed and analysed using reflexive thematic analysis. Results: Three key themes were identified: Regulation of Emotional States, highlighting self-harm as a coping mechanism for managing high and low energy affective states; Navigating a Neurotypical World, exploring how societal and interpersonal challenges influence these behaviours; and Changes in Self-Harm Over the Lifespan, examining the evolution of self-harm across different life stages. Conclusions: Findings reveal that self-harm in autistic women stems from both autism-related differences and unique experiences, vulnerabilities, and societal expectations. Influences of delayed diagnosis, burnout, and victimisation, required self-harm for self-punishment and regulation. Mislabelling and misdiagnosis throughout participants’ lives exacerbate risks and demonstrates an ongoing misunderstanding of distress of autistic females. Future research should focus on adapting interventions to better address the challenges unique to this population, and improving diagnosis and identification by considering the functions of these behaviours.