Moral distress and moral injury in the context of autism

Purpose Clinically, it is often observed that autistic people may have a heightened need for rules and may find rule violations very distressing. It is clinically plausible that autistic individuals may be prone to hyper-morality and greater reactivity and adverse experiences arising from moral threats and violations. Such adverse experiences may, in some instances, lead to moral distress (MD) or in more extreme cases moral injury. Thus, this study aims to examine how MD can operate in the context of autism. Design/methodology/approach The authors explore clinical hypotheses on how MD can intersect with different features of autism by drawing on clinical and research knowledge of autism spectrum disorder and how it contextualises experiences of morality. Findings Based on a review of the literature and theory, the authors hypothesise that autistic individuals may be more prone to MD where they have a lower threshold for MD. As a result of this lower threshold, they may have more frequent exposure to MD, experience more immediate and intense subjective reactions to moral transgressions, for more protracted periods. Also, they may find it more difficult to over-ride and neutralise moral outrage. As a result, they may be more susceptible to mental health sequelae and impaired social and occupational functioning. Practical recommendations are made for clinicians supporting people with autism with a propensity for MD or moral injury, to improve their quality of life. Practical implications Practical recommendations are made for clinicians supporting people with autism with a propensity for MD or moral injury, to improve their quality of life. Originality/value Understanding MD in an autistic context is important for detecting and treating the adverse impacts of MD on autistic individuals. Importantly, erroneous preconceptions about moral reasoning in autism need to be mitigated to fully understand the moral experiences and harness the many strengths of people with autism.