Sex on the Brain: Sex and Autism, Mental Illness, and Other Cognitive Diversity

Sex and sexuality can be tough to navigate no matter what, but it can be more challenging when your brain's wiring is different from that of your partners. It's important to establish from the outset that there's nothing "wrong" with you if you have mental illness, autism, or any number of other developmental, intellectual, or cognitive disabilities. You are who you are, and who you are is great! But it can make things a little snarly sometimes if you miss cues, get overwhelmed by your anxiety, or encounter people who think you're vulnerable and want to take advantage of you.

Be aware that when things are going great, nondisabled people may not think directly about your disability very much, or they may say it's not super important. You need to remind them that your disability-related boundaries and needs are always present, always important, all part of your "Big Sexy Three," and you want to put in the work with them to have a positive, healthy relationship.

Conversely, when things are going badly, suddenly it's all about your disability — and that's not correct. While your disability obviously plays a role in how you interact with people, and the world, it's not to blame for your relationship problems.

Sexuality and autism or cognitive impairments

We hear from a lot of autistic users who have some anxieties around sex and relationships, many of which revolve around feeling like they're missing cues or doing things "wrong." Sometimes that comes from within, sometimes it's the result of pressures from media and society, and sometimes it's the result of feedback from partners. Autistic brains are incredibly diverse and there's no one-size-fits-all answer to these kinds of questions, but we can take on a few of them — starting with the myth that autistic people aren't perceptive or sensitive, and therefore miss glaringly obvious things. You already know that's wrong, but I'll say it again: It's wrong.

In the early stages of relationships, or flirtation, or asking someone out, the layers of communication going on can feel fraught and stressful for neurotypical people, let alone you!

Some things to think about:

Nervousness is common for everyone when interacting with a new sweetie, and so is feeling awkward, like you're not sure how to behave, because you don't know each other well yet. Don't be afraid to be clear and direct, and to ask the same of your partner. Conversations about communication are critical for everyone, not just autistic people. If you dislike or have trouble reading sarcasm, snark, teasing, flirtation, and other sometimes confusing tones and ways of communication, say so. If someone wants to make that about your autism, think again: Plenty of neurotypical people don't like or have trouble picking up on things like that, even if they're too shy to talk about it.

If you're worried about being perceived as pushy or blundering, ask clear, direct questions and accept the answers: "Do you want to get a cup of coffee?" "No." "Okay, maybe some other time — let me know!" If talking in person makes you feel anxious, it's also totally fine to send someone an email or a text instead.

Not into small talk? Here's a little secret: Some neurotypical people aren't either. It's fine to plunge into interesting conversations about things that are meaningful to you. You might want to avoid politics, religion, and hot-button topics at first, or not — sometimes it's better for people to get to know each other as they are. If you're particularly fixated or obsessed on something at the moment — my big thing right now is quilting and yes I can go on for hours! — keep in mind that other people might not be as interested as you are, just like you would in regular conversation.

The bottom line is that if someone doesn't like you as you are, they don't deserve to date you. Compatibility doesn't hinge on your autism status, either. Sometimes people just don't click, and that's okay.

So what about intimacy and sexuality? Some autistic people have sensory sensitivities and may need to lay down some boundaries about how and where they are touched, and it's okay to say you're not comfortable holding hands, or don't want to be hugged without warning. You have the right to bodily autonomy! I'm not super into physical affection, especially in public spaces, myself, and my partners know that. Sensory sensitivities around food, the texture of clothing, scents, and other issues are also things you can bring up, because you deserve to be comfortable. You don't have to stress out through a meal of things with horrible textures or nod and smile when someone gives you a reeking perfumed candle!

When it comes to sex, clear, steady, constant communication is important for everyone — not just autistic people. Your partners should get that, and if they don't, that's not a super great sign. Sex can be silly and fun and dorky and it may include some joking around, but communicating about what you do and don't like is no game. Tell your partner you want clear guidance from them, and provide the same. Some things to consider might include: Where you do and don't like being touched, the level of pressure you like, how fast or slow you want things to go, what kinds of sensations you enjoy, the light levels you prefer, and whether you have a "stop everything right now" word (a safeword), even if it's just "stop" or "red." (Safewords aren't just for kinksters.)

Sometimes I feel out of step with the emotions and communications of the people around me — and that's when I'm fine with calling a time out to talk about things. Are you feeling jealous? Bring it up with your partner and work through it. Feeling like you're not getting enough attention? Ask your partner if you can set aside some dedicated private time. Feeling suffocated or overwhelmed? Ask if you can have some alone time.

If any of this advice sounds...familiar, it should, because it's exactly the same as the advice we give to neurotypical people, too. Your needs aren't "special," they're just needs, and you have the right to assert them in your relationship and make it clear that this is a partnership and you want to work together.

Sexuality and mental illness

Navigating the world while mentally ill can be challenging, and the first thing you need to do before delving into the world of relationships is take care of yourself. If you're mentally ill, or you're concerned about symptoms of mental illness, talk to your doctor. Make sure you're getting appropriate treatment and have a schedule for regular check-ins. Take the time to talk to your doctor about how your mental health condition works and how it affects the way you interact with other humans. Consider popping by the library: There are some excellent self-help books written by mentally ill people about their dating experiences that could help you with real-life tips and tricks.

It's a good idea to get a handle on your mental health before you start dating, which can cause all kinds of intense feelings and complicate your life — usually in a good way, we hope!

Take the time to conduct a little self assessment. Which mental illness do you have? How does it affect the way you interact with people and the world now, and what are some warning signs that things are getting a little overwhelming for you? If you have depression, maybe you tend to retreat, withdraw, and get disinterested when you're not feeling good. If you have anxiety, maybe you're second guessing everything. Maybe you have obsessive-compulsive disorder, and you get into anxiety spirals that might result in compulsive rituals from picking at your skin to endlessly rearranging your bookshelf. If you have bipolar disorder, you might get racing thoughts and feelings of euphoria — or a crash into deep depression. If you have schizophrenia, issues like paranoia might be part of your life. Keeping a mood journal can help you sort through your feelings and provide you with valuable tools to use later.

Ultimately, you are responsible for your mental illness and how you choose to treat people, but it's hard to be mentally ill without support. Don't be afraid to reach out, and also to set limits for yourself based on your experience with your own capacity. It's not okay to take out your frustrations or fears on a partner or friend, but it is okay to say "hey, can you help me with...?" That's part of the give and take of any healthy relationship.

Ready to plunge into the dating pool? One of the first questions you may have is whether to disclose your mental illness and when. Disclosure isn't an all or nothing deal, either: As you interact with someone and get a sense of who they are, you can decide how much of your story you're comfortable telling. Mayby you just want to say: "I have depression, so if I seem a little down sometimes, that's why." Or perhaps: "I have schizophrenia, which sometimes affects my ability to communicate. I don't know how much you know about it, but I'd be happy to talk about how it affects my moods and interactions with people."

You aren't required to disclose, so balance your identity, your relationship to your mental health, and any risks to you that might need to be considered. Pick a calm, neutral environment for a conversation, offer to educate or provide resources for someone to check out on their own, and be aware that if someone does get upset, that's a reflection on them, not you. Some people may be startled or upset initially, but often they change their tune when they learn more about mental health conditions and who you are as a person.

Some people have PTSD, anxiety, or other symptoms related to past trauma, and may or may not identify as disabled, but some of the experiences associated with trauma can make it hard for people to communicate, especially when they're getting intimate with someone. It can be hard to tell when something will trigger, upset, or overwhelm you, so sometimes it's helpful to talk about this with partners — and again, you can choose how much you want to disclose, and whether you want to disclose at all. You don't need to spill it all before going home with someone, but sharing your experience can keep you two on the same page and increase the chances of having a good time together.

Make a plan with partners in advance: Do you disassociate, panic, or shut down sometimes when you're retraumatized? Knowing that about yourself ahead of time can help you discuss what to do if this happens while you're getting intimate. For example, you might ask that your partner regularly check in verbally with you to see how you're doing, and to stop if you're having trouble responding. You might also say that certain things are off limits and not open to discussion right now, and that you want to have a conversation before trying anything new.

Think beyond the "stop when things aren't okay" portion of your advance plan, too: Do you want your partner to bring you a blanket, water, your medication, or something else? Is it helpful to be gently touched, or do you want your partner to back off?

If you find yourself really struggling with trauma, it may be helpful to consider counseling — or switching counselors if you're not feeling comfortable. Many different modalities for working on trauma are available, and that work can help you lead a more fulfilling life.

Mental illness can sometimes complicate emotions, especially in new relationships and those that are struggling. You may find yourself dealing with issues like anxiety ("do they like me?" "how come they haven't texted today?") and jealousy ("why are they always hanging out with them?"). If you're feeling a little giddy or euphoric, or super down in the dumps, that can also be a warning sign that you need to book a session with your therapist! Remember that sometimes an emotional response is actually a super valid and helpful one for a given situation, but that sometimes your brain is in hyperdrive. It can be hard to distinguish between the two sometimes, which is why it helps to have a therapist, or trusted friend, to offer guidance.

The bottom line when it comes to dating and mental illness is actually the same bottom line you'll see with any relationships, and that is, wait for it...communication. If you're as open as you can be about your anxieties, needs, fears, concerns, and worries, you and your partner can work through them together. Good communications can be scary sometimes, but it's how you build a healthy, lasting partnership based on trust and collaboration.