Emotion Regulation Difficulties in Autism-PTSD Co-Occurrence

Autistic individuals face an increased risk of experiencing traumatic events and of being significantly affected by them, whether these events are life-threatening or social in nature. Emotion regulation (ER) difficulties are central to both conditions, yet their role in this neuropsychiatric co-occurrence remains under-researched. This study examined ER's mediating role in the association between autism and posttraumatic stress symptoms (PTSS). Participants included 68 autistic and 101 nonautistic adults who completed the PCL-5 regarding life-threatening and social triggers, alongside the Difficulties in Emotion Regulation Scale (DERS) and a sociodemographic questionnaire. Autistic adults reported significantly higher PTSS following both event types and greater ER difficulties compared to controls. ER difficulties fully mediated the association between autism and PTSS for both life-threatening and social triggers. Specifically, the lack of emotional clarity subscale emerged as a distinct, significant mediator for both trauma types. These findings identify ER difficulties, particularly challenges understanding one's emotions, as a core mechanism linking autism and trauma-related distress. Trauma-focused interventions for autistic individuals should integrate modules enhancing emotional clarity to improve resilience and treatment outcomes.