You have a headache. Stomach pain. Back pain. Chest pain. Your test results are normal, the doctor says “everything’s fine”—but the pain is real, exhausting, and won’t go away.
If you’re on the autism spectrum or are just discovering what that means for you, this description may sound familiar. Psychogenic pain—also known as functional or somatic pain—is one of the most commonly overlooked and least understood phenomena among neurodiverse individuals. In this article, we explain where the pain comes from, why it occurs so frequently on the autism spectrum, and what actually helps.
What exactly is psychogenic pain?
Psychogenic (functional, somatic) pain is real pain that arises or intensifies under the influence of psychological factors — such as unprocessed emotions, chronic stress, nervous system tension, and difficulty interpreting the body’s signals — rather than as a result of tangible tissue damage. It is neither “imagined” nor feigned.
For years, the prevailing belief was that pain “counts” only if it is visible in imaging or laboratory tests. Today we know that the nervous system can generate fully real pain signals without a tangible tissue-based cause—especially when it is overloaded, when emotions have no other outlet, or when the brain is unable to properly interpret what is happening in the body.
The most common forms of psychogenic pain include chronic headaches and migraines; abdominal pain, bloating, and digestive disorders (often diagnosed as irritable bowel syndrome); muscle and joint pain without an orthopedic cause (sometimes described as fibromyalgia); chest, back, and neck pain; and, finally, chronic fatigue and “whole-body” pain.
Before we go any further: psychogenic pain is a diagnosis of exclusion
One thing must be made clear right at the beginning, not just at the end of the article. Diagnosing a psychogenic cause is always the last step, never the first. Before anyone—you, your loved ones, or a therapist—considers the pain to be psychogenic, organic causes must be thoroughly ruled out by a doctor.
There is a specific reason for this that applies particularly to people on the spectrum. In medicine, there is a phenomenon called“diagnostic overshadowing”: when a patient has a diagnosis of autism, their physical symptoms are often automatically attributed to“autism,” “hypersensitivity,” or “psychological issues”—and the actual somatic illness remains undetected. This also works the other way around: an atypical way of communicating pain causes doctors to underestimate its severity. As a result, neurodiverse individuals are doubly at risk—both of having an organic disease overlooked and of spending years living with untreated functional pain.
When you must see a doctor (not a psychotherapist): new, sudden, or very severe pain; pain that wakes you from sleep; pain accompanied by fever, unintentional weight loss, muscle weakness, sensory or visual disturbances; a change in the nature of pain you’ve known for years. These signs always require medical evaluation—regardless of how much the picture “fits” with stress.
The Myth of Pain Tolerance
For decades, it was widely believed that people on the autism spectrum feel pain less intensely. This misconception stems from one thing: people on the spectrum often express pain differently. They don’t scream, seek contact, or ask for help—but they do feel pain, often more intensely.
Research described by the Autism Research Institute (2023) showed that people with ASD have a similar threshold for detecting pain stimuli as neurotypical people, but their brains are more active during phases of pain amplification and less active during pain inhibition. Researchers have termed this pattern the “pronociceptive pain modulation profile”: the autistic nervous system is predisposed to sustain and intensify the experience of pain, especially chronic pain. A large population-based study from 2025 added another statistic to this: children with autism are 1.76 times more likely to experience chronic pain than their neurotypical peers (Xie et al., 2025).
Interoception: The Broken Line of Communication Between Body and Mind
Interoception is the ability to interpret signals from within the body: heartbeat, breathing, hunger, muscle tension, and pain. It’s like an internal GPS.
For many people on the spectrum, this GPS operates irregularly. The signals can be too loud—the body screams where others hear a whisper. They can be too quiet or unclear—the pain is there, but it’s hard to pinpoint or name. Sometimes they’re delayed—tension builds up throughout the day, and the body doesn’t “report a malfunction” until the evening or the next day. A systematic review from *Frontiers in Psychiatry* (2025) shows, in fact, that the picture of interoception in autism is heterogeneous: various studies report both reduced and increased sensitivity, depending on age and co-occurring difficulties.
This has direct implications for somatic symptoms. When the body cannot clearly communicate its state, the signal is sometimes “translated” into pain—the only language that cuts through the noise.
Alexithymia—When Emotions Have No Words
Alexithymia is the difficulty in recognizing, naming, and expressing one’s own emotions. It is estimated to affect as many as 50–85% of people on the spectrum, compared to about 10% of the general population.
An emotion that has no name and no outlet in words often seeks an outlet through the body. Stress from overstimulation becomes a headache. Unprocessed frustration—stomach pain. Fear of the unknown—muscle tension or tightness in the chest. A study by Larkin and colleagues (2023) showed that alexithymia and uncertainty intolerance are two key psychological predictors of the severity of somatic symptoms—significant regardless of whether someone has a diagnosis of autism or not.
If you recognize that you have difficulty tolerating uncertainty, we’ve written about it separately— Uncertainty Intolerance: How to Cope?
Chronic Stress and a Overloaded Nervous System
Living on the spectrum in a world designed for neurotypical people is a constant effort to adapt: masking, camouflaging, and processing stimuli that are transparent to others. This effort generates chronic nervous system arousal—and chronic arousal is a breeding ground for somatic pain.
There is also a clear physiological indicator of this. The autonomic nervous system of autistic individuals exhibits reduced vagal tone (measured by heart rate variability, HRV), which, according to a study published in *Pain* (2025), is associated with a weakening of the body’s natural pain-inhibiting mechanisms. The higher the vagal tone, the more effectively the body suppresses pain signals—and vice versa.
The Scale of the Problem in Numbers
In a study of 830 adults on the autism spectrum, 42.9% had a prior diagnosis of functional somatic syndromes—IBS, fibromyalgia, or migraines. Nearly half of adults on the spectrum meet the criteria for high severity of somatic symptoms, and among women, the figure exceeds 57% (Williams et al., 2022). These are not isolated cases. This is everyday reality for a large portion of this group.
It’s worth pausing to consider this gender difference, because it is not coincidental. Women on the spectrum are more likely to receive a late diagnosis—after years of intense masking, which in itself is a chronic strain on the nervous system. More often, their somatic symptoms were previously dismissed as “neurosis,” “hypersensitivity,” or “hysteria” before anyone connected the dots. If you’re a woman who learned about (or began to suspect) your neurodiversity as an adult, and your body has been “sick for no reason” for years.
How Pain Manifests Differently in Autism
The autistic way of experiencing and expressing pain often doesn’t look the way those around you—including medical professionals—expect it to.
Instead of complaining: withdrawal and turning inward, an increase in repetitive behaviors (rocking, self-stimulatory behaviors), meltdowns or shutdowns, self-injury, and changes in sleep and eating patterns. Instead of precise localization: difficulty specifying where and how it hurts, general or metaphorical descriptions, downplaying the pain outwardly while experiencing great suffering internally.
A review from *Paediatric & Neonatal Pain* (2023) highlights an important point for parents and specialists: physiological indicators of pain—such as an elevated heart rate and hormonal changes—may be present in children with autism even when their behavior does not suggest any discomfort.
What is pain trying to tell you?
This question may sound strange—after all, pain isn’t a message with a sender’s address. But from a psychotherapeutic perspective, it’s worth treating it as a message that couldn’t find another way to get through.
| A somatic symptom | Possible psychological context |
| Headache after work | Cognitive overload, masking emotions for hours on end |
| Stomachache before an important meeting | Anticipatory anxiety, intolerance of uncertainty |
| Muscle tension after being in a crowded place | Sensory overload, inability to regulate |
| Chronic fatigue | Autistic burnout, the long-term cost of adaptation |
| Joint pain with no apparent cause | Accumulated tension, lack of true rest |
What helps? Therapeutic approaches
Psychogenic pain responds well to therapy—provided that the approach takes into account the specific nature of functioning on the autism spectrum.
Cognitive-behavioral therapy (CBT) tailored to ASD. This is the best-documented approach for treating somatic pain, and it is also effective in addressing alexithymia and intolerance of uncertainty—two key factors that exacerbate pain in autistic individuals. In practice, this adaptation means: less abstraction, more concrete examples; working with emotions through the body (body scan, breathing); psychoeducation on the connection between emotions and physical symptoms; and gradual, safe exposure to interoceptive signals. A review in Behavioral Sciences (2024) confirmed the effectiveness of CBT interventions, including ACT, in reducing alexithymia and its accompanying somatic symptoms.
Schema therapy. Increasingly adapted for work with adults on the spectrum—and particularly effective in cases where pain has a long history. Years of masking and suppressing emotions is often described in schema therapy as the “disconnected defender” mode: a “cut yourself off from feeling to survive” strategy that once provided protection but now also cuts off access to the body’s signals. Somatization is also sometimes linked to schemas related to disconnection—including emotional deprivation and the emotionalinhibition schema, which is a deep-seated belief that feelings must not be expressed. Schema therapy addresses these patterns at their source: it helps individuals understand where this disconnection from the body and emotions originated and gradually build a safer connection with them. Early research on the application of this approach with autistic adults—a case series and scoping review by Vuijk (2023, 2024) — show that it is feasible and promising, though it requires typical adaptations: concreteness, predictability, and working at the patient’s pace. We discuss more about how unmet childhood needs shape adult patterns in our article on basic emotional needs.
Mindfulness and working with interoception
Mindfulness practices—observing the body without judgment—allow us to gradually expand our vocabulary of internal sensations. The following are particularly helpful: a daily body scan, guided breathing exercises, and an emotion and body map, which involves linking the names of emotions to their locations. Research on mindfulness-based cognitive therapy (MBCT) shows a reduction in the severity of somatic symptoms, partly through an increase in the capacity for self-observation and self-compassion.
Regulation of the nervous system. Practices based on polyvagal theory may increase tolerance for bodily signals and reduce pain reactivity: exercises that activate the vagus nerve (singing, humming, slow exhalation), regulatory movement (rocking, proprioceptive exercises), and breathing—5 seconds of inhalation, 5 seconds of exhalation.
Learning to communicate pain. For many people on the spectrum, acquiring specific words and frameworks for describing pain is of immense importance—both to communicate effectively with doctors and therapists and to better understand their own bodies. Visual pain scales, symptom journals that include emotional context, and cards for sensations and bodily states are helpful.
A tool to get you started: a body journal—3 columns, 7 days
Before (or while) you seek therapeutic support, you can start with the simplest tool for building interoception. For a week, once or twice a day, write down three things:
- Situation —what’s been happening over the past few hours (e.g., “team meeting, 2 hours, lots of people”).
- Physical sensation — what you’re feeling physically and where (e.g., “pressure in my temples, stiff neck”).
- Possible emotion —take a guess, even if you’re not sure (e.g., “tension, maybe? Or irritation?”).
It’s not about accuracy—it’s about practicing making the connection. After a week, look at your notes: do you see recurring “situation–body” pairs? This is your first map of your somatic language. A journal like this is also great material for your first consultation—your therapist will see more in it than you’ll have time to explain in 50 minutes.
A few important words to conclude
If you’re experiencing pain that has no medical explanation—you’re not “imagining” it. Your pain is real. It stems from how your nervous system processes stress, emotions, and the world.
What to do: First, ensure a thorough differential diagnosis and make sure organic causes have been ruled out—keeping in mind the phenomenon of diagnostic masking and not letting the assumption that “it’s definitely stress” close the case prematurely. Second, talk to a psychotherapist who specializes in working with ASD or somatic disorders. Third—don’t downplay the pain or assume that “this is just how it has to be.” And fourth, seek out spaces where you can be yourself without putting on a facade, because reducing chronic stress directly reduces pain.
The body doesn’t lie. It listens and remembers everything the mind is trying to endure.
Frequently Asked Questions
Is psychogenic pain real? Yes. The nervous system is capable of generating fully real pain signals without tissue damage—“psychogenic” describes the mechanism of pain generation, not its reality. It is not feigning or “making it up.”
How can you distinguish psychogenic pain from a somatic condition? Not on your own. The first step is always a medical evaluation to rule out organic causes; only when test results are normal and the pain persists should a psychogenic cause be considered—preferably with a psychotherapist familiar with somatic disorders. It’s also important to be aware of the phenomenon of diagnostic masking: a diagnosis of autism should never replace a thorough evaluation of physical symptoms.
Is it true that people with autism feel less pain? No. This is a myth stemming from a different way of expressing pain. Research shows a similar pain detection threshold, but at the same time stronger mechanisms for amplifying pain and weaker mechanisms for suppressing it—which means that chronic pain may be experienced more intensely by people on the spectrum, even if it isn’t apparent from the outside.
What kind of therapy helps with psychogenic pain in people on the spectrum? The best-documented approach is cognitive-behavioral therapy tailored to ASD, supported by work on interoception (mindfulness, body scanning) and nervous system regulation. When pain is linked to patterns of emotional suppression established since childhood, schema therapy is also a valuable approach. Adaptation is key: less abstraction, more concreteness, and working through the body.
At Nowe Widoki, we offer online cognitive-behavioral psychotherapy and online schema therapy —if this topic applies to you, you can schedule an initial consultation.
This article is for educational purposes only and is not a substitute for medical or psychotherapeutic advice. The symptoms described may have various causes—they should be diagnosed by a doctor or psychotherapist. If you are struggling with chronic health issues or emotional difficulties, please contact a specialist.
Sources:
- Autism Research Institute (2023). Study investigates responses to pain in individuals with autism [review of a study on the pronociceptive pain modulation profile in ASD].
- Failla, M. D. et al. (2022). The Current View on the Paradox of Pain in Autism Spectrum Disorders. Frontiers in Psychiatry.
- Health anxiety and somatic symptoms in adults on the autism spectrum (2025). Psychiatry Research.
- Larkin, F., Ralston, B., Dinsdale, S. J., Kimura, S., & Hayiou-Thomas, M. E. (2023). Alexithymia and intolerance of uncertainty predict somatic symptoms in autistic and non-autistic adults. Autism, 27(3), 602–615.
- Interoception in individuals with autism spectrum disorder: a systematic review and meta-analysis (2025). Frontiers in Psychiatry.
- Autonomic modulation of pain perception in autism spectrum disorder (2025). Pain.
- “When I’m in Pain, Everything Is Overwhelming”: Implications of Pain in Adults With Autism (2022). Frontiers in Psychology.
- Pain communication in children with autism spectrum disorder (2023). Paediatric & Neonatal Pain.
- Xie, Q., Pan, N., Ou, X., et al. (2025). Chronic Physical Pain in Children With and Without Autism Spectrum Disorder in the United States: Findings from the 2016–2021 National Survey of Children’s Health. Journal of Autism and Developmental Disorders.
- Williams, Z. J. et al. (2022). The Prevalence and Correlates of Somatic Symptoms, DSM-5 Somatic Symptom Disorder, and Functional Somatic Syndromes in Autistic Adults.
- Psychological Treatments for Alexithymia: A Systematic Review (2024). Behavioral Sciences.
- Addressing Psychosomatic Symptom Distress with Mindfulness-Based Cognitive Therapy (2024). Frontiers in Psychiatry.
- Vuijk, R., Van Genderen, H., Geurts, H. M., Sizoo, B., & Arntz, A. (2023). Schema therapy for personality disorders in autistic adults: Results of a multiple case series study. Clinical Psychology & Psychotherapy.
- Vuijk, R., et al. (2024). Schema therapy in adults with autism spectrum disorder: A scoping review. Clinical Psychology & Psychotherapy.