Screening for autism in psychiatric inpatients with severe self-harm - results from the Extreme Challenges research project.

Purpose: Living with undiagnosed autism may have negative consequences for mental health, including increased risk of self-harm and suicidal behaviours. Autism is currently underdiagnosed in adult females. While severe self-harm is associated with complex psychopathologies, it is often assumed to signify the presence of borderline personality disorder, and underlying autism may not be recognised. The purpose of the current study was to explore the prevalence of diagnosed autism, as well as the prevalence of being screen positive for autism and its clinical correlates, in a clinical sample of inpatients with severe self-harm.

Materials and methods: In a national multisite project comprising 12 hospitals, 42 patients (40 female, 2 male; age >18) with frequent (≥ 5) or long (≥ 4 weeks) inpatient admissions due to self-harm during the last year were recruited for a cross-sectional study. The Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-R) was used to screen for autism.

Results: Four participants, all female, were diagnosed with autism. When applying different cut-off criteria for the RAADS-R, even the strictest cut-off resulted in a considerably higher proportion of the sample being screen positive for autism. Participants with higher scores on the RAADS-R reported more anxiety, depressive, and trauma-related symptoms, as well as poorer functioning across measures of personality, close relationships, emotion regulation and alexithymia.

Conclusions: These findings highlight the importance of actively screening for and assessing autism in patients with severe self-harm. Undiagnosed autism may involve a risk that unhelpful interactions with the mental health care system exacerbate these patients' difficulties over time.