Let's Get PHYSICAL: The Physiological Effects of Autism
Autism isn’t just in your head (unfortunately)
I spent most of my teens and 20s navigating physical health issues that were truly debilitating at times. I was diagnosed with IBS at 13, PMDD at 21 (back when it was called Late Luteal Phase Dysphoric Disorder (LLPDD), and POTS at 23. I underwent a hysterectomy with unilateral oophorectomy and bilateral salpingectomy due to adenomyosis and hemorrhagic ovarian cysts in my mid 30s. Around that time I also developed recurring migrainous vertigo. These ailments cost me jobs, friendships, and even my independence. I spent two years in my early 20s completely unable to drive or even ride in a car because of the nonstop dizziness and motion sickness I lived with.
As you might imagine, these issues added a great deal of anxiety to my already anxiety-fueled nervous system and I fell into a deep spiral of anxiety, panic attacks, and isolation for years. Never once did it occur to me that all my physical health issues could be connected by my neurotype. Like most people, I’ve lived most of my life thinking autism was “just” about social quirks, intense interests, and sensory sensitivities. I was wrong. Turns out, being autistic can also mean living in a body that behaves differently; sometimes quietly, sometimes in loud, obvious ways that make everyday life more complicated than it needs to be.
When people talk about autism, they’re typically referencing its neurological or behavioral traits. But, there is a growing awareness that autistic bodies often carry their own unique patterns, susceptibilities, and challenges. For me, understanding the physiological side of autism has been just as eye-opening and validating as exploring its social and mental health implications.
Here is a look at some of the physical conditions more commonly experienced by autistic people, along with what that might mean for late-diagnosed folks navigating life and healthcare.
POTS & Dysautonomia
For some autistic people, the autonomic nervous system (that’s the one that handles all your “automatic” functions like heart rate, blood pressure, breathing, and digestion) does not always play by the usual rules. Dysautonomia (dysfunction of the autonomic nervous system) is quite common, particularly in the form of Postural Orthostatic Tachycardia Syndrome (POTS).
In POTS, the body struggles to regulate heart rate and blood pressure, especially when standing from a sitting or lying position. This can mean dizziness, fainting, brain fog, and rapid heartbeat after even mild exertion. For someone who is already navigating constant sensory overload, social demands, and executive function challenges, the unpredictability of POTS can feel like an invisible weight dragging on top of an already precariously full plate.
It is more than just feeling tired or lightheaded. It is a nervous system that is constantly demanding accommodations, whether anyone else notices or not, and failure to provide those accommodations can mean neurocardiogenic symptoms that cannot be ignored. Recognizing this overlap between autism and dysautonomia has helped me approach my body with curiosity rather than frustration; it is just another byproduct of an extraordinarily sensitive nervous system.
EDS & Connective Tissue Disorders
Many autistic people also experience differences in joint mobility, connective tissue strength, and proprioception. Ehlers-Danlos syndrome (EDS) is one condition often discussed in neurodivergent communities.
EDS can present as hypermobile joints, chronic pain, and frequent injuries, and it many times coincides in autistic individuals with other conditions like POTS. For me, this connection made sense in hindsight. While I haven’t been diagnosed with EDS, it seems unlikely that my lifelong inability to sit in a “normal” position and the way I nailed every flexibility test but failed at literally everything else in P.E. class aren’t related to my autism diagnosis. They’re just another part of a broader physiological pattern.
These differences are not just medical trivia. They shape how we move, how we exercise, how we sit at a desk, and how much sensory input our bodies can comfortably handle. Understanding this has allowed me to prioritize physical accommodations and listen to my body rather than pushing through pain. If old school step aerobics is the only exercise my body doesn’t despise, then bring on the leotard and sweat bands (I guess)!
PCOS, Endometriosis/Adenomyosis & PMDD
Hormonal patterns can be pretty massively affected by neurodivergence. Autistic AFAB individuals experience conditions like PCOS, Endometriosis, and Premenstrual Dysphoric Disorder (PMDD) much more frequently than the general uterus-bearing population. In fact, in one 2008 study, 92% of autistic individuals met the criteria for Late Luteal Phase Dysphoric Disorder (LLPDD) in comparison to just 11% of the control group. LLPDD (now known as PMDD) is primarily associated with mood instability, but it causes a whole host of physical symptoms as well, including monthly “flu-like” illness for some.
This can mean irregular cycles, painful periods, insulin resistance, fatigue, headaches, bloating, and severe breast tenderness tied directly to hormonal fluctuations — along with excessive bleeding that can potentially lead to additional conditions like iron deficiency anemia. For those of us already managing challenges like light and sound sensitivity and the related exhaustion, these conditions can amplify physical pain and discomfort.
It is not just about having “period problems.” It is about lived our experiences being shaped by hormonal rhythms in ways that intersect with sensory processing, anxiety, and executive function in an immense manner that is felt in the body. Learning to recognize these patterns has been transformative for both self-compassion and symptom management.
IBS & Gastrointestinal Issues
For many autistic people, the gut does not behave like the “standard” digestive system. Chronic constipation, diarrhea, reflux, or general digestive sensitivity (including food intolerances) are far more common than most doctors will readily admit.
For me, this has meant lifetime navigation of unpredictable stomach pain, bloating, acid reflux, random nausea, endless cycles of diarrhea and constipation, and sudden reactions to foods that seem perfectly ordinary to everyone else. Sometimes, it feels like my body is giving me a full-blown alert every time I eat anything, reminding me that digestion is not just about food; it is about the nervous system too.
Food texture and sensory sensitivities often compound these issues. Crunchy foods might feel painfully, unbearably loud in the mouth. Smooth or slimy foods can trigger an intense and uncontrollable physical gag reflex, possibly to the point of actual vomiting. Certain smells or combinations can make a simple meal feel like a sensory minefield that culminates in a debilitating migraine. Over time, this can affect not just what you eat, but how you plan your days, socialize, or even whether or not you leave the house.
Researchers are increasingly exploring connections between autism, GI dysfunction, and the gut-brain axis, suggesting that for many of us, digestive issues are not incidental but intertwined with sensory processing, stress response, and (once again) overall nervous system regulation.
Recognizing GI struggles as part of the broader autistic experience has been quite life-changing. It has allowed me to approach meals, healthcare, and self-care with curiosity instead of frustration, and to accept that managing digestion is part of managing an autistic body, not a personal failing.
Chronic Migraine & Headaches
Finally, let’s talk about migraines. Autistic people are more likely to experience migraines than our neurotypical peers and these attacks are often chronic (Chronic Migraine disorder) and sometimes very severe.
Migraines are not just headaches. They can bring painful sensory overload, nausea, vomiting, visual disturbances, and extreme fatigue. For someone whose nervous system is already finely tuned to detect environmental stimuli, migraines can feel like a total system explosion followed by an exhausting shutdown.
Recognizing Chronic Migraine as a neurological difference rather than just more “bad luck” has changed how I approach treatment, daily routines, and self-care. It is another reminder that autistic bodies operate on their own rhythms, often requiring extra attention, rest, and accommodations.
When we talk about autism, the conversation rarely includes these physical realities, but they matter. They shape our daily experiences, our access to the world, and even how we relate to ourselves.
Acknowledging the physiological side of autism is not about pathologizing our bodies. It is about understanding them. It is about giving ourselves permission to adjust, to accommodate, and to advocate for healthcare that sees the whole person: brain, body, and nervous system.
If you have ever felt like your body “just does not work like everyone else’s,” you are not imagining it, you are not alone…and you just might have autism.
Up next: Let’s Get Physical: The Physiological Effects of Autism Part 2
Deep dive resources:
Health Status of Adults with Autism Spectrum Disorder
After a terrible migraine recently, I have started to wonder about a connection to AuDHD, and here you are prodding that into a deep dive !!! As if I didn’t have enough to read already ! 🤣🤣🤣.
But seriously, thank you 🙏 a part 2 would be much appreciated.
Connecting the dots of my illnesses to autism is what led me to getting assessed at 54.