Are autistic individuals with high insistence on sameness more likely to have internalizing symptoms?

PostedDecember 10, 2025

UpdatedDecember 10, 2025

ByMy Patient Advice

Author: Beatrice Holloway, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Yes, there is growing evidence that links sameness and internalizing symptoms in autism. Individuals who display high levels of rigidity or resistance to change may also be more prone to internal struggles like anxiety, sadness, or self-withdrawal. Sameness and internalizing symptoms in autism often go together, forming a pattern that can be subtle but deeply impactful.

In many cases, routines and predictability serve as coping mechanisms. When those are disrupted, the individual may not react outwardly with tantrums or meltdowns but instead turn those emotions inward. This inward focus can lead to autism, anxiety and depression, especially when the person doesn’t have the tools or support to express emotional discomfort.

These behaviours are part of what clinicians refer to as emotional symptoms in autism: feelings that might be hard to spot because they’re internal rather than outwardly disruptive. Children or adults may appear quiet, withdrawn, or overly compliant while still experiencing distress. This overlap is why internalising behaviours in autism can sometimes go unnoticed, especially if external behaviour appears stable.

Signs to Watch For

These signs may indicate internalised distress linked to insistence on sameness:

Excessive compliance

Agreeing to things outwardly but showing distress later in private.

Low self-expression

Withdrawing rather than discussing emotions or discomfort.

Emotional flatness

Limited display of happiness or sadness, even in emotionally charged situations.

Quiet rumination

Spending long periods thinking or worrying without sharing concerns.

Recognising these signs early can help avoid prolonged emotional strain.

Visit providers like Autism Detect for personal consultations designed to support emotional wellbeing in autism.

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Insistence on Sameness.

Beatrice Holloway, MSc

Author

Beatrice Holloway is a clinical psychologist with a Master’s in Clinical Psychology and a BS in Applied Psychology. She specialises in CBT, psychological testing, and applied behaviour therapy, working with children with autism spectrum disorder (ASD), developmental delays, and learning disabilities, as well as adults with bipolar disorder, schizophrenia, anxiety, OCD, and substance use disorders. Holloway creates personalised treatment plans to support emotional regulation, social skills, and academic progress in children, and delivers evidence-based therapy to improve mental health and well-being across all ages.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.