It’s Here, and It’s Real: Emotional Pain in the Body by Mary P. Donahue, Ph.D.

In my experience working with autism and trauma, I’ve noticed a large number of autistic people who report physical pain that’s there “for no reason.” They haven’t over-exercised, moved furniture, or otherwise knowingly taxed the physical body. So, know this: physical pain can also result from strong emotional stress. It’s a real thing.

Taking a few minutes to consider the miracle that is the body, physical pain resulting from over-taxing the brain makes sense; high stress creates high anxiety, and over time, that can cause tightened muscles, constrained blood flow, increased heart rate, and joint pain, among other things. Such pain is not “in the head.” It’s real. And it can be toxic. But there’s more.

Besides the super high stress that can occur from particular events or lifestyles, there’s another reason why pain might occur from such over-taxation; autism. Studies in a general population show that physical pain more often manifests itself when a person has high, consistent emotional stress and is limited in awareness, expression, and processing of emotions. Given that social, communication, and executive functioning differences are central in autism, many autistic people struggle with emotion regulation. They can become overwhelmed with various sorts of stimulation and be unable to recognize what’s happening. This makes it very difficult (nigh impossible) to manage the emotion or ask for help. Thus, the body is so full of stress, often for prolonged periods of time, that the emotion piling on top of already taxed systems can produce high physical pain. Sometimes it’s so high, the person can barely move.

The good news here is that scientific inquiry is finding ways to help autistic children become more successful in managing their emotions, which could lead to less physical pain overall. Unfortunately, there are large numbers of autistic adults living independently for whom emotional regulation, particularly in uncertain times or without a soothing support system, remains hyper-challenging. It is to these people that we say, “It’s real. You’re not strange. It’s more common than you think.” Consider that emotional experiences produce energy; since ASD folks are challenged to recognize and manage emotional responses, that energy has to go somewhere. Thus, it can manifest itself in physical pain.

The question is, how to help? Many parts of the answer lie in self-management.  Of course, you’ll want to see a doctor if the pain is debilitating or focused on one area, just to be sure there isn’t a medically physical issue. Be sure the doctor knows you’re autistic and that they recognize how pain can be experienced differently in autistic people. Then, recognize that there are things you might be able to do on your own to help reduce the pain.


Much research literature on emotion regulation seems to focus on how to manage in a social environment, which is quite important. However, something we often forget is that before attending to the social world, one must get along with themselves first.  Again, in both theory AND practice, so many autistic adults seem to struggle against themselves. It’s easy to see why. It’s hard to fit into the mainstream social world. Perhaps constantly coming up against those challenges makes one judge themselves as ‘not right.’ Thus, they reject themselves in favor of trying to be or act in a manner that isn’t them. This can lead to mental and emotional overload, and more pain.

Acceptance of Pain

The first step in trying to manage physical pain resulting from emotional difficulty is to allow that the pain is logical. Accept that you’re in pain. Take care of your body that way. No judgement, no retribution. Eat, hydrate, and attend to your body appropriately. Some days, just that is challenging enough.

Voluntary Solitude

If you don’t feel like being around other people, that’s okay! You can take time for yourself, without the need to achieve if necessary. Or, maybe you can sit on a bench and people watch – be with people without the pressure of engaging. Try to restrict the “have-to’s” of life for a little while. Lower the lights, get a favorite blanket. Stim. Do what you gotta do. For you.

Safe People

Only you know who you feel are safe people. Just because someone wants to help, doesn’t mean they know how. And well-meaning people can inadvertently make things worse. Thus, before the situation gets really debilitating, review who in your circle is safe enough to be able to listen without judgement or mandated direction. If possible, plan ahead with that person what you might need when you reach out. And when you need to, reach out.


Many people have found that distracting themselves from the pain is useful. The autistic mind tends to perseverate on various forms of stimulation, and being in physical pain is certainly a valid, intense stimulation. In addition to mindfulness, explained below, other forms of distraction might include using the body’s big muscles as a means of helping your brain to release helpful neurotransmitters. Exercise is a good way to treat the body as it both distracts from the focus on pain and produces endorphins. It doesn’t have to be hard exercise, just enough to raise the heart rate. A brisk walk or bike ride, skipping rocks in the water, throwing darts (safely) or playing individual yard games can help. Remember to breathe, slow and deep.


Over the past few years, the practice of mindfulness has been gaining in popularity. This is a practice that helps to quiet the mind. It involves learning to pay attention to the present moment, without judging it or yourself. Just noticing. It takes motivation and practice to learn it, but once you do, it can be a valuable tool in your self-care toolbox.

Mental Health Therapy

If your pain is at such a level that you can barely move, you may be able to benefit from mental health therapy such as Emotion-focused or Cognitive-behavioral. A well-trained professional who is skilled in working with autistic people can help to uncover what’s causing the emotional upheaval that can be causing the physical pain. They can work with you and your environment to help you recognize problems outside your awareness.

Some of these interventions may or may not work: they all take practice and guidance. You know yourself best, though, so engage your personal and professional support system to learn things that can bring relief. But for now, recognize that the pain is here, it’s real, and do what you have to do to take care of you.

About Mary Donahue

Dr. Donahue earned her doctoral degree in Counseling Psychology from the University at Albany, State University of New York. She maintains a clinical practice specializing in grief and trauma. As well, she works toward helping adults later in life who may fall on the autism spectrum, particularly as it relates to development of major mental health issues such as post traumatic stress disorder and suicidal ideation. Though an adventurous and happy traveler, Dr. Donahue is always glad to return home to Southern Maine where she resides with her partner and extended family.