Identifying the Partner of Someone Who May Be Autistic: They’re Usually Misdiagnosed

Therapist working with neurotypical partner in therapyEditor’s note: Sarah Swenson, LMHC is a private practice psychotherapist in Seattle, Washington, where she specializes in working with neurodiverse couples. Her continuing education presentation for GoodTherapy, titled “When Your Partner is on the Autism Spectrum: Individual Therapy for the Neurotypical Partner,” will take place on February 21, 2020 and is eligible for two CE credits. This event is available at no additional cost to Premium and Pro GoodTherapy Members (Basic Members and mental health professionals without membership can view this event live for $29.95). Learn more and register here.

Author’s note: Sometimes, of course, the neurotypical partner in a neurodiverse relationship is a man. I also work with gay and lesbian couples, and couples who are polyamorous. This article describes the client I encounter most frequently, a neurotypical woman married to an autistic man. Also, please bear in mind this guiding principle: If you’ve met one autistic person, you’ve met one autistic person. Nothing in this article will apply to everyone.

In my clinical practice as a therapist and in my international work as a coach, my clients are neurodiverse couples in which one partner is autistic and the other is not. As a result, I have come to know well one of the most misdiagnosed clients you will likely encounter. I’m speaking of a woman married to an autistic man who may or may not be formally diagnosed with autism (ASD).

When this woman comes in for individual counseling, she may have a flat affect. Her presenting concerns might sound vague, including hints of depression or anxiety. She may be self-effacing and ready to blame herself. She may stop and start, not seeming to know how to explain herself. She may appear embarrassed to be taking up your time.

Or she may seem full of rage. Her language might sound pressured, disorganized. She may be close to tears. She is the victim here, and she is furious.

Or she may simply present as hopeless.

I am not describing three separate women. You are likely to see all of this in the same woman in one session. Would you know how to understand her and offer her the support she needs?

She will not fully understand that over time, she has learned to minimize her needs and desires because conflict avoidance has become her chief survival strategy.

Meeting the Neurotypical Partner in Therapy

Most often, these clients are experiencing complex trauma (C-PTSD). They won’t be able to identify a specific traumatic injury because they are in a relationship that inadvertently creates the conditions of ongoing trauma. And since in this relationship there in no intention to harm, no intention to abuse, she is confused. She loves–or did love–her husband. She will tell you he is a good man.

She will not fully understand that over time, she has learned to minimize her needs and desires because conflict avoidance has become her chief survival strategy. She will tell you that she has changed. She will tell you she is not the woman she used to be. She feels less joy in life. She has let friendships fall away. She can’t muster interest in the things that used to give her pleasure. When asked, she is unlikely to be able to express her needs. She can’t remember what she needs. She knows this, however: she feels alone. And she may fear she’s losing her mind.

You’ve read her intake paperwork, so you will know that her husband is successful in his career, which may be in a highly competitive and well-respected field. When you talk to her, you’ll hear about his high intelligence and how well-regarded he is at work. As you get to know her better, she will tell you that everyone thinks that the two of them have the perfect marriage because that’s what it looks like from the outside. She realizes all marriages have problems. Her well-meaning friends certainly share enough of their stories that she feels a little guilty when inside she’s thinking, “Yes, but you don’t understand what it’s like for me…it’s different…I can’t explain it…”

She may sound petulant, self-involved, or impossible to please, due to the fact that she can express her pain but can’t put her finger on exactly what the problem is. She knows it has something to do with her husband and the way he treats her. Yet she has painted a picture of him that impresses you. You may think she is exhibiting narcissism as a result.

Another possibility is that he is a good man, but for some reason, he cannot seem to keep a job. He’s intelligent. He’s talented. But the financial strain of his chronic unemployment has pushed her to the brink. She is the sole earner. She manages the household. She supervises and provides for the children. She hides this internal familial dysfunction from her friends and her family. She has no one else to rely on. She is embarrassed. She is utterly exhausted. She can’t see a way out of her distress and she fears it may kill her. You may diagnose depression.

Sometimes, from session to session, you’ll see her condemn her husband and the way he cannot seem to do anything right, from loading the dishwasher (“I even made a little diagram and taped it to the counter!”) to listening to her when she’s upset (“He always wants to fix everything and doesn’t even notice I’m crying!”). Next session, she will be filled with compassion for him because he honestly seems to be doing the best he can. She’s just expecting perfection from him. He’s human. (“Why do I always have to be like this? Why can’t I just let him be himself?”) You may wonder if you’re seeing borderline personality.

And when she paints a complex picture of her experience with him that screams “Run for your life!” you may wonder why she can’t decide to leave. You consider codependency.

This is the woman married to an autistic man before she understands that he is autistic and before she understands what autism means in a relationship. I agree with you that it is difficult to identify her based on the information described above. Here are some important things to consider that may help you sort this all out.

Signs You’re Working with the Neurotypical Partner in a Neurodiverse Relationship

The primary area of conflict for many neurodiverse couples can be broken into two components: emotional connection and communication. Many of the women I work with identify the courtship phase of their relationship as short, comfortable, and consistent. More often than not, however, they can look back and identify what they call red flags: his quirky manners, his deeply focused conversations on things he’s interested in and silence when he’s not, his apparent discomfort at expressing emotion. At the time, they interpreted these things to be endearing eccentricity, intelligence and skill, and admirable reticence–the stiff upper lip.

For reasons of misinterpretation like this, they went forward to the commitment of marriage. Only with time did the veil slip away, and they realized they were habitually filling in with projections about what their partner’s behaviors and comments meant on the basis of what they would mean if they did these things themselves. In other words, they applied neurotypical standards and expectations to the behavior of an autistic individual. Slowly but surely, their sense of who their husband actually is erodes until they often become quite uncertain about who he actually is.

The primary area of conflict for many neurodiverse couples can be broken into two components: emotional connection and communication.

Over the course of the marriage, this woman will feel minimized and criticized. She will express her husband’s constant negativity and say that she’s begun to feel negative about everything, too. Her descriptions of their sex life will be particularly illuminating.

Generally, by the time these women come to therapy, their sex lives are completely ruptured. They have to think when you ask them about it. They’ll tell you they don’t remember precisely when or how, but at some point, things just stopped. For some, it has been months, but for most it’s been a matter of years. And, frankly, when their sex lives were more active, it wasn’t all that rewarding: it felt mechanical, always the same, with no foreplay and no sense of intimacy.

She doesn’t miss the specifics of sexual encounters with her husband, but she craves sexual intimacy. She craves intimacy, period. She wonders whether she should have an affair, though she doesn’t really want to go outside her marriage to have her needs met. She’ll just stifle them for a while, hoping they subside. Instead, she worries that they will continue to grow. She may not be able to look you in the eye at this point. She is desperate not to be viewed as promiscuous, and she fears you will judge her.

There are exceptions. Sometimes, a woman will tell you she feels like a sex doll to her husband’s routine and frequent sexual demands. She continues to participate. She hates herself for her inability to stand up for herself, but she has tried, and it just seems pointless. She continues to acquiesce. She is becoming numb to her own sexuality, to any physical sensations at all. She cannot afford to feel aroused because she knows she will be disappointed once again.

As you know, diminished sexual intimacy in a relationship is usually a sign of severed communication. In the neurodiverse relationship, this is most often the case. The woman needs emotional connection before she can feel sexually vulnerable. She is unlikely to feel this with her autistic husband. I often hear from these women that they don’t feel safe enough emotionally to present themselves sexually to their husbands. She does not feel seen or heard or known by her husband, whose sexual needs are often more physiological than emotional. He doesn’t understand her withdrawal any more than she understands the way he treats her.

Work with Neurodiverse Couples: Moving Forward

If you see enough of these signs in your client, I suggest asking whether she has considered that her husband might be autistic. In order to do this well, you’ll have to be certain she understands what you mean and why you’re asking. If she has not thought of this possibility herself, you’ll need to explain to her that autism is a result of neurological variance and not mental illness or personality disorder. You don’t want her to reject your suggestion on the basis of having misunderstood you.

Many times, though, women come in for counseling after having read articles of mine or other material on the internet and already suspect autism (some still call it Asperger’s) in their husbands. They want to know what to do. In this case, we discuss all the points mentioned above in terms of what it would mean if their husband were in fact autistic. I do not ever volunteer a diagnosis of autism without having met someone, but we do reality testing to rule it in or out as a differential. Then I suggest couple work. I help her with language for bringing this up to her husband, which is a sensitive task in itself.

Sometimes, after several sessions, we schedule a couple session, if the husband is willing to explore the possibility. It is often a watershed moment in a couple’s life to learn that there are reasons that explain their problems and that we can work together on psychoeducation and on communication strategies and skills that offer a path toward improved intimacy. The relationship will never be neurotypical or autistic, but it can become more rewarding for both partners.

Sometimes, the husband is unwilling to consider autism and will not come in for a couple session. He fears being judged. Labeled. Vilified. She cannot get through to him that this is a supportive process. He locks into his fears and there is nothing more to be done. In this case, I continue to work with the woman alone to help her understand her choices. They are not always binary. There are more options than staying married or getting divorced. We explore them all.

It is important never to minimize the experience and challenges faced by the autistic partner.

It is important never to minimize the experience and challenges faced by the autistic partner. This work is about identifying differences and creating more successful ways to communicate. There are good reasons why the autistic partner behaves the way he does and says the things he says. I have never met an autistic person who sets out intentionally to hurt his wife, and seldom have I encountered an autistic person who lies. Misrepresenting something has its own rational pathway for an autistic person, and I distinguish this from intentional lying. This is an example of the kind of subject we explore in couple sessions. Sometimes, the intense anger of the neurotypical partner can be diffused with education and compassion. Sometimes, the weight of this anger and feeling responsible for the relationship is too much for her.

If you have any suspicion about autism in a client’s partner, please tread carefully to explore the possibility. But do take the chance: otherwise, you could be missing the core challenge your neurotypical client is facing, which is the hub from which all her other apparently confusing behaviors emanate. The challenges to communication in the neurodiverse relationship are not insurmountable, but to ameliorate them requires sensitive counseling support. Educating yourself on the nature of autism, how it creates the lens through which a person experiences and interacts with reality, and how to help a couple bring implicit expectations to explicit and comprehensible statements are essential in this work. For initial solid grounding in the field of autism, I refer therapists to the work of Tony Atwood, PhD, and Simon Baron-Cohen, PhD.

© Copyright 2020 All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • jannette


    February 6th, 2020 at 9:57 AM

    excellent article. I am the sibling of a brother with autism who unfortunately died suddenly at the age of 68. He was never formally diagnosed . except for possible brain injury at birth . He was successful working for the transit authority, a dream job given his love of trains. He was married for over 40 years. The struggles in their relationship as he aged were magnified by his difficulty with abstract ideas, communication challenges, and extreme rigidity and resistance to any change. Your article help illuminate and validate the struggles I observed in their marriage and also my difficulty in intervening to help alleviate in mounting frustrations that occurred. I commend you on your work in this area and hope to meet you some day if I should find myself in Seattle

  • Sarah Swenson LMHC

    Sarah Swenson LMHC

    March 11th, 2020 at 11:00 AM

    Thank you, Jannette – I’m glad to know my writing has been helpful to you and I greatly appreciate your comments about my work. Warm regards to you.

  • Jenny


    March 11th, 2020 at 8:17 AM

    This is Me. I am the NT reading this article with so much explained. Relief of understanding.

  • Sarah Swenson LMHC

    Sarah Swenson LMHC

    March 11th, 2020 at 11:01 AM

    Hello, Jenny – I’m glad to hear that my writing has offered you support in understanding your experience. Warm regards to you.

  • Abigail


    April 3rd, 2020 at 9:11 AM

    I am compelled to write to you. My heart tells me, after reading several of your articles, that you are the first and only person I know who “gets” it: who understands what my life has been for the past 21 years married to a man with autism.
    I’ve been in and out of 3 psychiatrists offices who met my husband and myself, church pastoral services, community social services etc. for 21 years describing the situations you describe in your article and no one clued in to what was going on.
    I’ve struggled with anxiety and depression our whole marriage. I’ve thought hard about leaving my husband several times. I’m incredibley lonely. I’ve felt my life is just a test of endurance….there is nothing I can think of to do anymore to improve my marriage.
    A few months ago I came across an online questionaire on the “Empathy Quotient” The Empathy Quotient: An Investigation Of Adults With Asperger Syndrome Or High Functioning Autism, And Normal Sex Differences, by S Baron-Cohen and S Wheelright. Finally I knew what was the problem: my husband was autistic and neither of us knew. So I’ve been looking into the reality of being neurotypical married to an autistic man and discovered your articles.
    Each one sheds a little more light into the darkness. But the fact remains: I am alone in this place in which I reside. No one I know “gets it”. Neither friends nor family. I hope we can meet on line one day Dr. Swenson.

  • Ginette


    April 18th, 2020 at 6:19 PM

    It was so refreshing to find your articles! For the last few years I’ve become more aware of some complex couples dynamics defying most growth therapy approaches, including evidence-based practices very effective with most couples. Through the work of Dr Attwood, I became familiar with the thorough work of Karen Rodman, founder and director of FAAAS (Families of Adults Affected by Asperger’s Syndrome) and a network of individuals (mostly in the UK) engaged with the Ongoing Traumatic Relationship Syndrome (OTRS). In my clinical work, I have found C-PTSD more practical and affirming for the NTs, particularly when a great deal of grief/loss management work is encouraged. The great challenge on how to promote communication, functionality, intimacy and commitment remains! Thanks again.
    Again, thank you for your contribution on this side of the pond!

  • Sandra


    April 26th, 2020 at 1:24 PM

    I have been married for 52 years. The marriage has not been good. I discovered a few years ago that he and his brother probably have Asperger’s. I am learning about it and need all the information and support I can find. Thank you!

  • Corinne


    April 27th, 2020 at 10:13 PM

    Abigail and Sandra : Perhaps join a Facebook group such as Wives of Aspies? It could help you to read others’ posts or comments. All the best x

  • Abigail B

    Abigail B

    April 30th, 2020 at 8:13 AM

    Thank you Corinne. I just discovered precisely the support group you mentioned and it is very helpful!

  • Tammy


    June 20th, 2020 at 6:25 AM

    You have described many of the ways I feel in my marriage, and I am the autistic one! My husband could be too, but he’s not very interested in exploring the possibility. Thank you for the informative article!

  • Julie


    August 3rd, 2020 at 12:47 PM

    I’ve been married and had kids to an aspergers man for 40 years. It’s been confusing, lonely, challenging. Being so alone in life has strengthened me in ways as I had to work through the “side effects” of this situation. I appreciate finding and reading these articles as they have lifted the veil of confusion. Warm thanks

  • Matt


    August 26th, 2020 at 5:34 AM

    Thank you for this text. As pointed out in the author’s note, sometimes the neurotypical partner is a man. I am such a man and identify with very much in this article. I was married to an autistic woman for ten years, and a couples therapist was the one who sent us on the right track and my ex wife was formally diagnosed in 2015. What was never discusssed was the impact the neurodiversity already had on me, including symptoms of C-PTSD. It was only during therapy last year, two years after our divorse, that I realised that e.g. anxiety and panic attacks are quite normal reactions to a prolonged exposure to what was in effect a kind of gaslighting when a loved one never seems to care, let alone validate or even accept your experiences as real.

    Maybe it would be a good idea to screen for such symptoms whenever an adult person is diagnosed with ASD?

  • Carmella


    October 4th, 2020 at 2:45 PM

    This article has hit home!!!!!
    I want to explain I WAS in a relationship for 30 years, 28 of them MARRIED to a man who I NOW realize had high functioning autism . He died by suicide a few weeks ago in our garage after an argument the night before. I found him. You can imagine all the negative effects and feelings I am going through. After all those years of compensating for him, blaming him for his behaviors and mistakes, but LOVING him so so much, I am learning he wasn’t even responsible for the way he acted. I went through so much with him. I am troubled beyond comprehension and wish to join my husband every minute of every day. How do I get over the fact that I failed him by not recognizing this . I knew all about his quirks and oddities, I helped him with his struggles, I adored him, but I thought he had control over the things he did and said, and also things he should have done and said….but didn’t.

  • Matt


    October 28th, 2020 at 7:51 PM

    Hmm once again another author writing about the suffering from a females perspective, the worst thing is women read these stories and relate a couple of similar traits within their relationships. And before you know it, more men are getting ladled with this never ending medical terminology like narcissistic or complex trauma (C-PTSD), sociopath or boarder line personality disorders. This is really sad as its actually creating a platform of for judgment and doubt the moment any similar behavioural trait is shown. then he is under the microscope and his behaviour is analysed, misconstrued and misinterpreted amongst her support network. Ladies, this is unhealthy and toxic within its own contradicting way and does not generate any form of security within a relationship. I have experienced more female partners who have demonstrated this particular behavioural trait as a result of poor romantic choices with bad boy abusive men! But as good men we learn to accept, overcome and compromise when our partners are moody, temperamental emotional or hormonal! where is this conveyed within the female community.?

  • Carmella


    October 31st, 2020 at 7:54 PM

    I was astonished at the obnoxious, insensitive, unsympathetic and misogynistic response I got from Matt after reaching out in unimaginable anguish.
    My Covid nurse husband of 28 years hung himself in our garage after an argument about him not taking my feelings and limitations Into consideration, I am end stage lung cancer. We argued because he was overwhelmed with stress at work and became more insensitive than usual and didn’t, or couldn’t, recognize this was hurting me. That argument was the last interaction we had. He was a GEM, and I loved him dearly. A GOOD MAN, not a “bad boy”.
    I sought professional therapy to help me with this tragic loss and trauma. I have a psychiatrist, psychotherapist, group therapy and Had a session with an Aspergers expert Doctor and author who practiced Half way across the country . My sharing of his traits and reactions displayed were discussed. He was born 2.5 lbs to a mother who really didn’t want him. His Neurological development was not normal. I also had a well known forensic handwriting analyst across the country Analyze his extremely unusual handwriting. All of these experts agreed he had OCD, possible Aspergers and extreme inner conflict with lack of emotional and communication Skills. He also had a lack of self worth. I created a list of traits he displayed through the years. This made me realize I applied neurotypical standards and expectations to the behavior of my VERY LIKELY ASD husband. Had I realized he had trouble with these things I would have sought help for him, and he may still be with me today.

  • Catherine


    December 5th, 2020 at 6:03 AM


  • Jennifer


    January 12th, 2021 at 6:03 AM

    Just googled my husband may be asd. We are in process of evaluating my 12 year old son. Having my son made so many things make sense in my husband. What a great comfort it is to have found and read this. I don’t believe I will receive this understanding anywhere else. I appreciate the acknowledgement of my broken lonely heart I have gotten here. Just when I was feeling so bad.

  • Margaret


    January 30th, 2021 at 9:37 AM

    Wow, glad to have found this article! I am actually a therapist myself, but my husband has Asperger’s and you hit the nail on the head with so many pieces I haven’t connected. Thank you for doing this work and just reading this, made me feel more understood and not so alone!

  • Kendra


    February 15th, 2021 at 7:00 PM

    I’m 49 yrs old and have been married 31 years to my husband. I have more than struggled since we were married with everything talked about in this article. To make matters worse I am a type 1 diabetic. I started counseling by myself because every counseling session we had as a couple the church and the counselors thought he was a great guy and I was the one with a problem. Well I ended up having a stoke 6 months ago. They cannot find any reason for my stroke whatsoever, so they are saying it “must be due to my diabetes”. I now feel like I am dying and my body is shutting down. I am not recovering from the stroke and have been sent to so many doctors/neurologists to determine why. No one can tell me and I have no diabetic damage to my blood vessels that they can see and only minor damage to my brain from the stroke. I finally got my husband to see my counselor because he wouldn’t help with housework or help me when I couldn’t walk immediately following the stroke and has made me feel even worse because he now has to help a little around the house and I have had to cut my work hours because of my residual stroke issues. I am a Christian and have always felt that God doesn’t just want me to walk away, but I now I think I have to determine whether God is asking me to give my life up for this man or whether He is telling me I need to leave and let this man pay the consequences for his sins rather than me. I know I sound bitter, but I am not. I am only thinking a little selfishly about my well being and the anguish I have been living throughout my life navigating what I believe to be a very Asperger’s daughter and my husband. I am wondering if me always taking the punishment and saving him from his bad decisions may have been detrimental for him. I want to say thank you for the article explaining to me how I could walk into so many counselors and church pastors offices and come out feeling like I was the problem as my husband has always told me. So funny to me because I have always been a people pleaser. But I think it was because I always spoke the truth and had to agree he was always a really nice guy (if you weren’t his wife). I could never explain the subtle destructive passive aggressive ways he would keep me doing exactly what he desired and the insanity I was feeling was the pressure he placed on me to feel bad so his life would stay the same. Maybe. But that is my life above in a nutshell except it ended in stroke for me. I would love to see if there was a support group preferably for a Christian woman because we also have the added pressure from the church to learn from the situation how to be a better person and that we must not be close enough to God if we need to leave in order to survive it.

  • Francesca


    March 19th, 2021 at 1:14 AM

    Matt are you sure you’re not autistic yourself?

  • Lynda


    March 24th, 2021 at 3:51 AM

    This is a really good snapshot of being a wife to someone who I think has aspergers……… it took me so long to work this out and I felt really stupid as I am a therapist myself……….the best thing I did for my support was to get my own therapist who specialises in autism.

  • Joy


    March 26th, 2021 at 4:38 PM

    You have described my life, married 43 years to a good man! I have emailed this article to my closest friends saying, “I found an article about ME!” Thank you so much! ♡

  • Nadia


    April 8th, 2021 at 9:33 PM

    I’ve been with my husband almost 10 years. When we first started dating he told me he thought he could be autistic, but I didn’t realize what that would look like, and assumed he couldn’t possibly—that I would know it instantly if he was. I just didn’t understand. Yes, he’s smart, incredibly talented, has an amazing capacity for memorization, and kind. But, yes, he also has not had a job in 5 years and always procrastinates or avoids any administrative duties in our household. After many instances of very strange behavior 4 years ago I remembered him telling me he could be autistic and looked it up and it all clicked. But, I was pregnant with our son at the time and still didn’t fully understand (and can’t say I do still, although I am learning more each day). Our son who is now 3 was recently diagnosed on the spectrum. My husband will admit he is too at times, but only when he feels comfortable—otherwise he won’t really talk about it and refuses to admit it has anything to do with our many relationship issues. Since I work FT and he does not, he watches the children. He gets impatient easily, yells at them, talks to them as if they understand his adult logic and yells frequently. He needs help and doesn’t know where to start. I need help and have no time or bandwidth to get it. If it weren’t for my children I may have just put up with it forever, but I really want help now for them, and to try and salvage our relationship if that is possible. I don’t know where to go or how to find someone. Any advice would be greatly appreciated.

  • Carmella


    April 9th, 2021 at 8:20 AM

    I am not qualified to give any advice, but I was married to a wonderful man for 28 years that I now realize had ASD. If I knew then what I know now, our lives could have continued happily together for years to come. I was applying neurotypical standards to a man that just wasn’t capable of meeting them, so I was exhausted with frustration and disappointment. Only during my own grief counseling did I realize his behavior wasn’t something he could change. He was wired differently. There is an expert author and relationship counselor for couples with ASD named MARK HUTTEN that I’m sure could help you both. Please don’t give up on your husband if you still love him. Things can be different, better! Please look Mark up and reach out to one of his many support groups. Check out a few videos he has made. He gets what you are going through. I only wish I would have realized all this when it mattered. Best of luck to you.

  • Nadia


    April 9th, 2021 at 8:48 PM

    Hi Carmella, Thank you so much for your comment. I will certainly look into Mark Hutton—and doing my best every day to remember he is wired differently. I don’t give up on people I love very easily, so he’s stuck with me for the foreseeable future ;) But, would love to improve the quality of our relationships to each other and with our children. Thank you again for the advice and recommendation, I do appreciate it.

  • Carmella


    April 11th, 2021 at 10:28 AM

    Wonderful! It’s not easy, but if you both are open to it and seek relationship counseling from an expert on Aspergers, your family can benefit greatly and the relationship will grow stronger. Best Wishes! Try to update us someday.

  • Maris


    April 26th, 2021 at 10:12 PM

    Please help me with this. Every single word in this Article written here, and including those words within so many of the comments.

  • Maris


    April 26th, 2021 at 10:15 PM

    Also, I apologize for not saying Please and thank you.

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