The Danger of the Diagnosis Gap: Why Undiagnosed Neurodivergent Women Need to Know
I want to share with you a scenario of a woman I know; a woman who had experienced multiple incidents of coercive control and intimate partner abuse by in previous relationships. She has provided her consent for me to share a part of her story. She described her last relationship as having been the “worst”. Over almost seven years she was subjected to verbal abuse, gaslighting, blame shifting, isolation, and threats that led to significant physical, psychological, occupational and financial harm. Her sense of self, her confidence and her capacity to function were severely eroded to the point of collapse by the time she escaped. Now this woman would likely be considered objectively intelligent and highly capable having been awarded several academic awards and had established a modicum of professional success. She had worked for years in environments that focussed on supporting victims of abuse and violence; and yet for several years, she had struggled to apply her knowledge and experience to her own relationship.
Why?
Having researched coercive control, psychological abuse and domestic abuse extensively, including having published a guide for victim-survivors and those who support them, I can explain this woman’s experience through the lens of power and control dynamics, intermittent reinforcement scheduling, and the trauma bonding that harmful relationships can engender, and all of that would be true for her. However, the protagonist in this story happens to be a neurodivergent woman, an AuDHDer in fact, and while she received her diagnosis and treatment for ADHD in the fifth year of that seven-year relationship, she wasn’t diagnosed as being autistic until a year after it had ended.
Does this woman’s neurotype, the particular ways in which her brain processes information, explain why this woman was harmed?
No, the responsibility for that definitively lays with the partner that chose to use abuse to have his own needs met.
Could earlier identification, recognition and support to understand this woman’s neurodivergent neurology have reduced the harm she was exposed to?
Potentially, yes. However, having a specific type of neurotype is in no way a failing on her behalf, but could be considered a failure of a system that continues to construct barriers to diagnosis and the acceptance of neurodiversity.
Here is why.
Higher Prevalence of Abuse and Violence toward Neurodivergent Women
Across all demographics, neurodivergent adults are estimated to be two to three times more likely than neurotypical adults to experience domestic abuse, including coercive control, from an intimate partner with up to 84% having experienced some form of domestic or relationship violence in their lifetime. [1][2] For autistic women and those diagnosed with ADHD, the risk of experiencing relational harm is a lifelong trajectory rather than only being a ‘temporary phase’ with one extensive British longitudinal study that followed 5,770 participants from age 10 until age 51 reporting that the probability of a woman experiencing intimate partner violence by mid-life was increased by 23.99-32.68% when she had exhibited ADHD traits during childhood.[3] Another large French cohort study, one of the largest studies on this population, reported that 88.4% of autistic women reported having experienced sexual violence, with 75% having been assaulted multiple times in comparison to approximately 30% of their allistic peers. This finding suggests that autistic women are targeted at nearly three times the rate of neurotypical women.[4][5] Trust me when I say there is a substantial mountain of research that clearly demonstrates that neurodivergent women are at a significantly greater risk of all subtypes of relational abuse and violence.
Broadly between 15-20% of the Australian population is estimated to be neurodivergent[6]. There are no universally reliable and valid statistics that tell us the exact size of the undiagnosed neurodivergent adult population, however researchers and statistical bodies agree that the official diagnosed rates are significantly underestimated. The Olga Tennison Autism Research Centre (OTARC) in Australia notes that the official national figure of 1.1% for autism prevalence is a substantially below actual population percentage estimates that are closer to between three to four percent6, suggesting that more than half of autistic Australian’s may currently be undiagnosed. Clinical data shows that adult ADHD remains widely under-recognised, and actual recorded diagnoses represents only a fraction of estimated clinical prevalence.3
How many neurodivergent women are dating, entering new relationships, or being harmed by coercive control relationship dynamics unaware of their heightened risk and greater vulnerability?
What Makes Neurodivergent Women Vulnerable to Coercive Control
We know that this vulnerability to risk of harm is much greater for neurodivergent women, however what happens to her when she finds herself in a relationship with someone who chooses to use coercive and psychological abuse?
Contemporary research emphasises that the vulnerability of neurodivergent women to become involved in relationships with abusive others is not an inherent defect of neurodivergence itself but rather, is driven by how distinct neurodevelopmental communication and cognitive traits are actively targeted and exploited by partners seeking to control.3 [7] Several factors that explain why being neurodivergent increases the likelihood of relationship abuse include:
Chronic Self-Doubt and Diagnostic Gaslighting: Neurodivergent women grow up being constantly corrected and pathologised by society, and are likely to receive up to 20,000[8] more ‘corrections’ to atypical behaviour than their allistic friends by the age of 10. They’re repeatedly told that they’re emotions are “too much”, that they’re “oversensitive”, or that the way they are behaving is, in some way, “wrong”. These messages become deeply internalised leading to the development of a baseline of self-doubt that abusers exploit, reinforcing the sense that this “wrongness” is somehow leading to them being responsible for the abuse or conflict Perpetrators may weaponise their ‘symptoms’ as being evidence to justify their abuse. Her partner may claim that she deserved to be told she was “useless” because she was so disorganised, hide or move her keys repeatedly and then tell her she must just be forgetting where she put them, or may isolate her from others for her own protection because she’d mentioned she struggled with crowds.
Masking and Boundary Erosion: The effort to fit into a ‘neurotypical’ world requires significant effort with girls learning early to ‘mask’ their differences in a bid for peer acceptance. In doing so, this well-documented social survival strategy accustoms neurodivergent girls and women to suppressing their own needs and comfort to satisfy external neurotypical expectations; and the cost in doing so is that they condition their nervous systems to ignore internal distress signals. Layer the possibility for many autistic women to have difficulties with interoception (that illusive ‘sixth sense’ that helps to notice, receive, and understand signals coming from inside our bodies), this repeated conditioning erodes the ability to discern genuine relational safety from a coercive partner’s manipulative behaviour.1 [9] Subsequently she may not question the late night texts her partner is receiving because she’s trying hard to be the very definition of a trusting partner or she may not confront him when he ridicules her in front of others.
Cognitive and Communication Differences: Two of the key differences between a neurodivergent brain and a neurotypical one can be found in the domain of social communication and in social inference of other’s behaviours. Autistic people often communicate with a high degree of honesty and directness, assuming a corresponding literalness in others[10]. Often they place a high value of justice and fairness. The danger of this assumption is in making it extremely difficult to identify passive-aggressive behaviours, hidden malice, or insincere motives. To a neurotypical mind, the intent behind the behaviour simply doesn’t make logical sense. Neurodivergent women have reported that they knew something had made them uncomfortable but had struggled to identify the behaviour that was objectively wrong or abusive.1 One very bright neurotypical woman explained that three of her previous partners had each had long term affairs that had lasted years without her knowing and she’d not an inkling. She’d missed any sign of the deception simply because she had attributed her own strong sense of values to each of her partners, had believed every lie and had simply missed, upon review, clear indications.
Rejection Sensitivity Dysphoria: This extremely painful emotional reaction to perceived rejection or criticism, whilst not specific only to neurodivergence, is particularly prevalent amongst autistic and ADHD adults. Unfortunately, it’s often misunderstood as being a deficit, a negative attribute of the neurodivergent person themselves; in reality, it’s an understandable trauma response to repeated childhood social exclusion. To avoid re-experiencing these distressing and painful emotional echoes, neurodivergent women may default to trying to please, fawn or placate others; giving abusers an easy tool to enforce control and submission. Her partner feigns disappointment, she increases her efforts to please. Another partner threatens to leave, she pleads and submits.
Executive Functioning Challenges and Survival Dependency: The neurology of a neurodivergent brain, whether autistic, ADHD or the neuro-spicy combo of AuDHD; impacts executive function, the brain function that make it possible to notice gaslighting through attention, to manage daily life independently through organising, or to plan the necessary steps to exit an abusive relationship. When the cognitive bandwidth of a neurodivergent brain becomes overwhelmed by chronic unpredictability characteristic of living inside a coercively abusive relationship, survivors have reported they didn’t have the “brain space” to notice subtle coercive behaviours or to organise an escape plan. This chronic overwhelm may lead to an exacerbation of comorbid health and pain conditions often experienced by neurodivergent women, to shutdown and withdrawal, or to autistic burnout or catatonia making it impossible to leave without support. Abusers routinely exploit this dependency to isolate and entrap.[11]
Sensory Overload and Meltdown Triggering: Abusers, whether they or their victim are aware of her neurotype, quickly learn that to manipulate the sensory and structured environment of a neurodivergent partner will trigger her to become emotional dysregulated. They will routinely disrupt routines, introduce distressing sensory input, or deny her access to safe and quiet spaces that she requires to regulate her overwhelmed nervous system. Once she becomes dysregulated or a meltdown has successfully been triggered, the abuser reverses the narrative of harm; claiming that her crying and shouting were evidence of instability and that, in fact, she is the problem. Through intentionally shifting the blame to her sensory overwhelm, she is effectively labelled as being the manipulator and abuser when she was, in fact, experiencing a natural physiological reaction that a neurodivergent nervous system may have to sensory and environmental overwhelm.10
These are just some of the factors that explain why neurodivergent women are at greater risk of coercive control and intimate partner abuse. These vulnerabilities exist, regardless of whether she is aware of her neurodivergence, or not. However, contemporary clinical and sociological research shows that, where there hasn’t been one, obtaining a formal diagnosis of autism and/or ADHD can be a critical, protective intervention for women.
Rather than pathologising individual differences, a diagnosis offers a vital tool to mitigate the severe psychological, cognitive, and systemic risk factors that leave neurodivergent women vulnerable to coercive control.
And here is why.
Countering the Narrative of Coercive Abusers
The Light-Bulb Moment: The chronic negative feedback loop that leads to undiagnosed girls internalising a baseline sense of being “dramatic”, “bad” or “lazy” is interrupted by a formal diagnosis, one that holds the potential for reframing her lifelong struggles as being normal neurological variations rather than moral or behavioural failures.1 With increased self-knowledge, survivors become armed with the cognitive defense needed to reject the abuser’s pathologising psychological manipulation that previously may have triggered those old “something must be wrong with me” stories or lead to her second-guessing her own perceptions. It offers her the opportunity to consider that her distress is a valid reaction to mistreatment, not an inherent flaw in her.
Deconstructing Compulsory Masking: Having navigated a predominantly neurotypical world, undiagnosed women learn to rely heavily on social mimicry and learned rules on what is, and isn’t, acceptable to belong. Identifying as neurodivergent allows women to actively transition away from the burden of exhausting identity-eroding masking behaviours that significantly contribute to neurodivergent burnout. Instead, she learns to understand, and to assert, her own unique sensory and social needs, and (perhaps more importantly), to differentiate between genuine relational safety and harmful boundary-eroding behaviours. Rather than internalising blame for the harm, she becomes better equipped to redirect it where it belongs.
Reducing Relational Trauma and Psychological Harms: Undiagnosed neurodivergence is strongly associated with higher rates of abuse, bullying and social isolation; all of which establish a trajectory where interpersonal harm is normalised and comorbid symptoms of psychological distress such as anxiety and depression, increase. She becomes the ‘owner’ of a multitude of pathologising labels such as borderline personality and bipolar when her neurodivergence has been misread. She may also meet the criteria for PTSD, with rates up to ten times greater than neurotypical populations[1]. Accessing a diagnosis as early as possible acts as a vital proactive intervention that improves her quality of life, prevents further relational trauma, and reduces the long-term psychological burden that makes neurodivergent women particularly vulnerable to coercion in the first place.[2]
Overcoming Executive Function Barriers to Safety Planning: Leaving an abusive relationship is an incredibly complex, multi-step process that demands high cognitive load and executive functioning skills to plan safely around the very real risk that all women experience when they leave an abusive partner. The core traits of both ADHD and autism can make the prospect of leaving feel utterly paralyzing. Without a diagnosis, neurodivergent women may internalise this inaction as personal failure while those around her, unaware that she’s experiencing difficulties that a neurotypical woman may struggle less with, may misinterpret her struggles as weakness, non-compliance, or disengagement; all of which make her more vulnerable to further isolation by an abuser. Formal assessment provides a logical roadmap for both the survivor and support professionals. Once she is aware of her executive functioning profile, she can be provided tailored self-management strategies and build a network of support to underpin her own neurodivergent needs. For practitioners, a recognised diagnosis shifts safety planning toward providing neurodivergent-affirming structured, visually mapped, and cognitively accessible escape steps.
Legal Safeguards and Neutralising Post-Separation Weaponisation: Leaving a partner who uses coercive control often doesn’t end the underlying belief system that underpins the abusers rationale for harming others; people that use control and abuse believe they are entitled to do so. That belief doesn’t simply evaporate when a woman leaves; instead her risk of harm increases along with her now ex-partner’s post-separation bids for control. That may involve recruiting child protection services and the legal, health and court systems. For neurodivergent women, abusers routinely weaponise her neurodevelopmental traits, such as sensory overload or emotional dysregulation, as being ‘evidence’ of her psychological instability and, where children are involved, devastatingly as evidence of being an unfit or neglectful mother. Formal diagnosis acts as a counter to a perpetrator’s attempts to discredit her and provides her essential legal legitimacy. She is able to steadfastly demonstrate that rather than her being “unstable” or “neglectful”, her reactions to ongoing abuse were directly related to a now diagnosed and manageable neurodevelopmental condition.
Many factors collude as barriers to women accessing diagnosis: the historical gender bias toward male-centric diagnostic criteria that remains misunderstood by a startling number of practitioners, cultural and societal influences that have (and continue to) present the ‘good-girl’ standards of behavioural expectations that lead to neurodivergent women camouflaging traits deemed outside of these preconceived concepts, generational gaps that prior to relatively recently in terms of history framed ADHD and autism as childhood disorders, and the systemic gaps in our healthcare system that provide a distinct lack of clear and public pathways for diagnostic assessment with costs frequently exceeding $2,000 prohibiting access for many women in distress. There is little doubt that many neurodivergent people remain unaware of their differences whilst continuing to try to navigate their lives and their relationships under a misconception that they should be behaving, coping, and reacting as if they’re brain and nervous system was that of a neurotypical person. In the meantime, their vulnerability to being targeted by, or remaining in, harmful coercively controlling or abusive relationships continue.
Oh, and if you’ve read this far (and recall the story I shared at the start of this article); for full transparency, the woman I introduced -- that woman was, and is, me.
Perhaps you, or a woman you know, work with, or care for may have a similar story to share.
From October 2026, Clinical Psychologist, Dee Donaldson, will be offering limited bookings for cost-effective online diagnostic autism assessment to women (17+) who are Australian residents.
Further information can be found at the wisewoman.com website.
Sources:
[1]The convergence of autism spectrum disorder and intimate partner violence: Implications for clinical practice. (2024). PubMed Central.
[2] McCarron, M., O’Dwyer, M., & The TCAID Research Team. (2020). Autism, ageing and life expectancy: A review of the literature. Trinity Centre for Ageing and Intellectual Disability (TCAID), Trinity College Dublin. tcd.ie https://www.tcd.ie/media/tcd/tcaid/pdfs-/autismageingandlifeexpectancyreport.pdf
[1] Neurodivergence and domestic abuse: The link that we can't ignore | Clinical Partners, https://www.clinical-partners.co.uk/articles/neurodivergence-and-domestic-abuse-the-link-that-we-can-t-ignore/
[2] Neurodiversity and Domestic Abuse: Implications for Practice, Policy, and Early Intervention, https://www.makeachange.uk.net/news/neurodiversity-and-domestic-abuse-implications-for-practice-policy-and-early-intervention
[3]John, A., O’Nions, E., Corrigan, L., Cotton, J., Donnellan, W. J., Shelford, H., El Baou, C., Stewart, G. R., Desai, R., Eshetu, A., Saunders, R., Suh, J. W., Mandy, W., Asherson, P. J., Kirton, J., Pavlopoulou, G., Agnew-Blais, J., & Stott, J. (2026). Childhood attention-deficit hyperactivity disorder traits and experiences of intimate partner violence up to midlife: Evidence from a longitudinal cohort over five decades. The British Journal of Psychiatry, 1–7.
[4]Autism Research Institute. (2026). Sexual victimization in autism.
[5]Cazalis, F., Reyes, E., Leduc, S., & Gourion, D. (2022). Evidence that nine autistic women out of ten have been victims of sexual violence. Frontiers in Behavioral Neuroscience, 16, Article 852203.
[6] Five Myths about Neurodiverse Employees Busted, 3 March 2026, Source: Parliamentary Workplace Support Service (PWSS) fact sheet (PDF), https://www.jobaccess.gov.au/news/five-myths, accessed 04/09/2026
[7]Haschek, A., Dwyer, P., & Hedley, D. (2024). The Olga Tennison Autism Research Centre’s response to the inquiry into the prevalence, causes and impacts of loneliness in New South Wales. La Trobe University.
[8] Neurodiversity and Intimate Partner Violence - You Don't Own Me - Domestic Abuse, https://ydom.co.uk/neurodiversity-and-intimate-partner-violence/
[9]Wallis, M. (2025, October 1). Neurodiversity and domestic abuse: Understanding the hidden risks. Somerset Domestic Abuse Support.
[10] Neurodiversity and Domestic Abuse: Implications for Practice, Policy, and Early Intervention, https://www.makeachange.uk.net/news/neurodiversity-and-domestic-abuse-implications-for-practice-policy-and-early-intervention
[11] Experiences of interpersonal victimization and abuse among autistic people - PMC - NIH, https://pmc.ncbi.nlm.nih.gov/articles/PMC11191373/