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Autism and the “double empathy problem”

This blog is a bit of a diversion from my other pieces. I have several clients who are neurodivergent with co-morbid issues such as complex PTSD, borderline personality disorder etc. I was investigating mentalisation and I came across the theory of “double empathy” in autism. Mentalising is the ability to perceive and comprehend our own and others’ behaviour based on feelings, thoughts, beliefs, wishes and desires that explain those actions. In other words, mentalising is the human capacity to understand why we – and others – do what we do. It is an imaginative mental activity since we cannot actually “read” another person’s mind but can only infer or resonate with what they might be thinking and feeling from their current manner, speech and behaviour, and sometimes from our past experiences or knowledge of them. It is connected with the “theory of mind” which refers to the ability to understand the desires, intentions and beliefs of others, and is a skill that develops between 3 and 5 years of age in typically developing children. It was, and to an extent still is, postulated that those who are autistic do not have a theory of mind they have “mind-blindness”, an inability to understand that other people know, want, feel, or believe things. This perspective continues to frame how autistic differences are perceived today.

Mentalising thus involves a “good enough” capacity to infer relatively accurately what is going on with us and with other people most of the time; it requires curiosity about states of mind. Mental states include somatic experience as the mind is not separate from the body. Mentalising supports ongoing updating of our mental representations of ourselves and others in order to understand and respond adaptively, it facilitates empathy and the more off base we are in our mental representations, the more we misunderstand others, so a vicious cycle of mentalising failures and inaccurate mental representations may ensue. It has long been claimed that people with BPD have problems mentalising and thus have problems empathising with others. Until recently it was thought that people with autism also had problems with mentalising and this explained why they had problems with social interaction. This defining trait of the condition has informed prevailing theories of its roots as well as the design of many autism treatments.

But an emerging line of work supports a more nuanced look at the social abilities of autistic people. Proponents of an idea called the “double empathy problem” believe that communication breakdowns between autistic and non-autistic people are a two-way issue, caused by both parties’ difficulties in understanding. This “double problem” challenges long-held theories of autism that point to social shortcomings of people with autism as the reason interactions can go awry. It also echoes principles of neurodiversity in its assumption that autistic people simply have a different way of communicating rather than a deficient one. Damian Milton, a researcher in autism who is autistic himself thinks that “As a theory, it matches autistic phenomenology coming from insider accounts.”

The basis of the theory is that a mismatch between two people can lead to faulty communication. This disconnect can occur at many levels, from conversation styles to how people see the world. The greater the disconnect, the more difficulty the two people will have interacting.

In the case of autism, a communication gap between people with and without the condition may occur not only because autistic people have trouble understanding non-autistic people but also because non-autistic people have trouble understanding them. The problem, the theory posits, is mutual. For example, difficulty in reading the other person’s facial expressions may stunt conversations between autistic and non-autistic people. Milton highlights empathy as a two-way phenomenon and notes that both autistic and non-autistic individuals may have difficulty understanding and feeling for one another because of their differing outlooks and experiences with the world.

Although the misunderstanding may be bidirectional, it disproportionately stigmatises autistic people when their perspectives are not adequately represented within institutional power structures, like education, research, and medical systems. When autistic perspectives are not heard, it becomes easy for autistic behaviour to be misunderstood and pathologised. Note, for example, much of the autism literature focuses on helping autistic individuals understand non-autistic perspectives, rather than the other way around, they are encouraged to be neurotypical.

The theory also hints at possible causes of mental health problems and trauma in autistic people. Being routinely misperceived can lead to loneliness and feelings of isolation. And attempts to conform to social norms by “masking” can be exhausting. Hopefully we can help others recognise and counter the stereotype that autistic individuals lack empathy. We need to remember that communication is two way, both perspectives are equally valid, but as Damian Milton says, a problem arises when one group has power over another.

Double Empathy diagram from: Crompton, DeBrabander, Heasman, Milton and Sasson –, CC BY 4.0,