Autism and psychosis are important to understand together. On average, psychotic experiences appear more common in autistic people or people with more autistic traits than in the general population. However, most autistic people will not experience psychosis. 
 

Autism and psychosis: key messages

• Most autistic people do not develop a psychotic disorder.
• Trauma and chronic social stress are major contributing factors to whether someone might experience psychosis. These are preventable and treatable.
• Many autistic people have had traumatic experiences, which can help explain why autistic people might be more likely to have psychotic experiences compared to non-autistic people.
• Although experiencing psychosis can be distressing, there are several treatments available. With the right support, many people make a full recovery.

What is psychosis?

Psychosis isn’t a diagnosis; it is an umbrella term for a set of symptoms that someone may experience. If someone experiences psychosis, it does not automatically mean that someone has a psychotic disorder. Many people have these experiences without becoming unwell.

Someone could experience psychosis and have a diagnosis of another condition, such as schizophrenia, bipolar disorder, postpartum psychosis, depression or delusional disorder.  

The most well-known psychosis symptoms are:
 

• Positive symptoms: These include hallucinations, delusions, and disorganised thinking and speech. These are called ‘positive symptoms’ because they refer to additional experiences someone has when they become unwell.
• Negative symptoms: These include reduced interest in activities, lack of energy, poor motivation, diminished self-care, less emotional expressiveness, and reduced communication. These are called ‘negative symptoms’ because they relate to behaviours or experiences that reduce when a person is unwell. 
  
  
  Psychosis exists on a spectrum. What psychotic symptoms a person experiences, and how distressing they are, vary from person to person and can change over time. People also experience psychotic symptoms for different lengths of time and at varying intensities. Some people may have one episode of psychosis or experience mildly distressing symptoms, while others may have repeated episodes of psychosis. 
  
  
  There is a lot of misinformation about psychosis. Some people associate psychosis with someone being dangerous, angry or out of control. This is a harmful misunderstanding that worsens stigma and often stops people from seeking and receiving help. People experiencing psychosis are far more likely to be the victim of a crime than to commit one.³

Autism and psychosis

Jump to: Prevalence of psychosis in autistic people Communication differences, autism and psychosis Possible connections between autistic traits and psychosis

Prevalence of psychosis in autistic people

A large systematic review and meta-analysis found that around 24% of autistic people reported some kind of psychotic experience, compared with about 5–12% in the general population.¹ The link between autistic traits and psychotic experiences was small to moderate*, meaning autistic traits don’t cause psychosis, but can co-occur with these experiences more often than expected by chance.¹

Some types of psychotic experiences are more likely to be reported in autistic people than non autistic people. Hallucinations were relatively uncommon (around 6%). Delusional-like beliefs were more common (around 45%). This number varied a lot between studies. This may be because clinicians may misinterpret autistic ways of thinking or communicating as delusional.¹

Communication differences, autism and psychosis

Autistic people communicate their thoughts, feelings and experiences differently from non-autistic people. This can lead to some autistic people being misdiagnosed with a psychotic condition, due to differences in the way they use and understand language.

Many experiences labelled ‘psychotic-like’ may instead reflect:

• Sensory sensitivities
• Communication differences
• Intense focus
• Strong or unusual beliefs
• Differences in interpreting social situations.¹

Some autistic people may be more literal or concrete in their answers to diagnostic questions, such as, 'Do you hear voices when no one is there?'. Someone who thinks literally may answer, 'Yes', because they hear people talk when a radio or TV program is playing, even if physical people are not in the room, not because they are experiencing hallucinations.

Communication differences can make it harder for clinicians to spot signs of psychosis in autistic individuals. For example, an autistic person might experience a lot of distress, but this may not be reflected in their facial expressions or tone of voice. This can be especially likely if someone communicates without speaking. 

Possible connections between autistic traits and psychosis

There is no single cause to explain the co-occurrence of psychosis in autistic people. The research suggests a mix of social, developmental, and sensory factors.

Childhood trauma is a major factor that increases the chance of psychotic experiences, especially for people with higher autistic traits.² In the Avon Longitudinal Study of Parents and Children (ALSPAC) study, childhood trauma explained 28–45% of the link between early autistic traits and later psychotic experiences, including experiences of bullying, emotional abuse, or neglect.⁴ Trauma did not fully explain the link, but it was a significant factor. Autistic people often face more bullying, misunderstanding, exclusion, or unmet needs. These stressful experiences can have long-term mental health impacts.

Social communication differences. Difficulties being understood, loneliness, or chronic social stress may make unusual thoughts or perceptions feel more threatening or confusing, increasing distress around them.⁴

Sensory differences. Some autistic sensory experiences can be mistaken for psychotic symptoms. For example, hearing faint sounds others miss, or strong visual pattern recognition. This can lead to overdiagnosis or misinterpretation of autistic traits as psychosis.¹

Genetic factors. Research has consistently shown that shared genetics between autism and psychosis exist in general. However, genetic risk for schizophrenia did not explain the link between autistic traits and psychotic experiences.¹,⁴ This means the overlap is not only genetic and may be much more about environment, experience, and how society treats autistic people.

References

[1] Kyono et al. (2020) The prevalence of psychotic experiences in ASD and autistic traits: a systematic review and meta-analysis

[2]  Dogan et al. (2025) The moderating role of genetic and environmental risk factors for schizophrenia on the relationship between autistic traits and psychosis expression in the general population

[3] De Vries et al. (2019) Prevalence rate and risk factors of victimisation in adult patients with a psychotic disorder: a systematic review and meta-analysis

[4] Dardani et al. (2023) Childhood trauma as a mediator of the association between autistic traits and psychotic experiences: evidence from the Avon Longitudinal Study of Parents and Children cohort

[5] Linden et al. (2022) Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials