Autism, female diagnosis and trauma

A two-storey red-brick clinic with a blue and white NHS sign saying "Welcome to Roselands Clinic" in the foreground. The building's windows are boarded up and there is a metal fence in front of it and some rubbish which has been dumped. Signs advertising two local businesses are underneath the NHS sign.
Roselands Clinic, New Malden, where my diagnosis took place.

Yesterday the feminist psychologist Jessica Taylor (of Why Women Are Blamed For Everything fame) made a series of tweets about the rise in women being diagnosed with autism and ADHD and suggested that it might be linked to attempts by professionals (particularly in the criminal justice system) trying to discredit women who have suffered trauma by medicalising it; in the recent past, women diagnosed with borderline or emotionally unstable personality disorder (BPD/EUPD) have been branded as unreliable witnesses by police and prosecutors who have dropped rape allegations when these diagnoses have come to light (this has been true with other mental illnesses, or histories thereof, even when the rape case is the ‘classic’ case of a woman raped in a public place by a stranger). The thread starts here but this is what it said:

I think everyone needs to be paying attention to the amount of women who have been subjected to abuse and trauma suddenly being told they have ADHD and autism. This is the next wave of pathologisation after BPD and EUPD, mark my words.

You may disagree, you might think that the huge increase in women being diagnosed with ADHD & autism (both currently described as psychiatric disorders) is a good thing, but I’m not so sure. I think it will lead to more women being oppressed & discriminated against. It amazes me that the same people who can see that the huge increase in women being diagnosed with personality disorders after disclosing abuse is negative and detrimental, but the same with ADHD and autism is positive and progressive. They are all from the same book.

What makes you totally trust the same system with ADHD and autism that you distrust about BPD and EUPD? These concepts all come from the same people and the same place. How can diagnosing more and more women after they disclose abuse be good for any of us?

I’ve worked with several rape centres who can’t get the police or CPS to charge rapists or abusers because the women have recent ADHD or autism diagnoses and are seen as ‘non credible witnesses’ Surely that’s a red flag to others? I cannot be alone in watching this unfold?

As you might expect, the reaction from the autism community, especially the women, was not sympathetic. She was accused of stigmatising women by discrediting their diagnoses as misdiagnosed trauma. This morning (Sunday), she added to the thread claiming that the ‘diagnoses’ were not diagnoses at all; someone was ‘suggesting’ that a woman had one of these conditions on the basis of some impression or other (essentially on the basis of stereotypes of how she was behaving during a police interview) and then using it to discredit the things she was telling them.

I have no idea about the diagnostic process for the other two conditions, although I am aware that BPD/EUPD is a condition notorious for “diagnostic overshadowing”, i.e. that anyone diagnosed with it will have any subsequent symptoms put down to it, and that it often results in adverse treatment from the mental health professions. I have actually been through the diagnostic process for autism, however; it takes a course of interviews with a qualified psychologist (after a wait of several months or years following approaching a GP; my referral request sat on a GP’s desk for months until I called again to remind him) and it is impossible to produce a valid diagnosis of autism on the basis of impressions, such as from how someone behaves in a police interview when disclosing recent or past traumatic events such as rape or sexual abuse. These could only be based on stereotypes, much like a lot of the other prejudices that get in the way of prosecuting rape.

The reason there has been a large increase in the number of women and girls being diagnosed with autism is because the understanding of autism has changed; in the past it has been heavily skewed in favour of boys and men, with the criteria being heavily based on how the condition manifests in them along with theories about the autistic brain being an “extreme male brain”. Even in boys, the condition often went undiagnosed until adulthood, but the tell-tale signs, such as obvious unusual interests and repetitive behaviours, manifest in girls differently, and girls might appear more sociable and more eager to fit in. The important thing is that autism diagnoses are being sought by women themselves, not being imposed on them following disclosure of abuse or inflicted on them while receiving or seeking mental health treatment, and the diagnosis may open up support even if it makes other things difficult (not all women seeking diagnosis of autism are rape victims, so that situation will not affect them); this is why the increase in autism diagnoses is welcomed while BPD diagnoses are regarded with suspicion.

A lot of autistic people do suffer trauma; many were bullied at school, or shunted into ‘special’ schools where the bullying was compounded with adult abuse. Others were institutionalised and had to deal with a closed environment ruled by staff who made no attempt to understand their condition, who made capricious decisions, who obstructed their relations with their families. Some might actually doubt that the difficulties they are experiencing in adult life are actually the result of being autistic but rather are the product of institutional trauma. The autistic author Holly Smale posted a thread that explained that autistic girls and women were more vulnerable to rape and sexual abuse because of the effects of autism (thread begins here), but that diagnosis is empowering and means that someone can stop blaming herself.

Taylor accuses everyone of misunderstanding her, but her own words suggest that she regards autism as being in the same category of diagnosis as BPD or ADHD, as a dubious psychiatric diagnosis. As for ADHD, she claims “it’s another psychiatric diagnosis which has no real tests or evidence, so anyone can be diagnosed with it”. She lumps them together, saying “they’re all from the same book” and “these concepts all come from the same people and the same place” as if the same bunch of people made them all up, which actually is not true. The fact that people discriminate against autistic people, like other disabled people, does not cast any doubt over the diagnosis itself; the fact that autistic women are disbelieved when bringing accusations of rape stems from the fact that the defence is allowed to appeal to jurors’ prejudice or ignorance and also does not mean the diagnosis is just a means of discrediting women.

The rise in women being diagnosed with autism in adulthood has nothing to do, then, with anyone’s need to discredit them; it has to do with their need for answers to the difficulties they experience in life and to those they experienced in childhood. The fact that, in a completely different set of circumstances, women are stereotyped as ‘autistic’ without actually being diagnosed, does not make the diagnosis any less valid or a bad thing. There is a saying that a man with a hammer might treat everything sticking up like a nail, but a nail is a nail all the same.

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