Why Black Autistic People Are Often Misdiagnosed with Schizophrenia

If you’re Black, autistic, and have ever been told you were “paranoid,” “delusional,” or “out of touch with reality,” you’re not alone. Many Black autistic people, especially those who go undiagnosed until adulthood, end up misdiagnosed with schizophrenia or other serious mental health conditions.

This isn’t just a coincidence. It’s the result of medical racism, bias in psychiatry, and a lack of understanding about how autism presents in Black people.

For decades, Black people, especially Black men, have been overdiagnosed with schizophrenia at much higher rates than white people. At the same time, autism diagnoses in Black adults remain low because medical professionals aren’t looking for it in us. Instead of seeing autism, they see psychosis, aggression, or paranoia… and that misdiagnosis can change someone’s entire life.

Let’s talk about why this happens and what you need to know if you or someone you love has been misdiagnosed.

Why Are Black Autistic People More Likely to Be Misdiagnosed with Schizophrenia?

✔ Psychiatrists Are Trained to See Black People as More “Severe”

• Studies show that Black people are four times more likely than white people to be diagnosed with schizophrenia. Even when they have the same symptoms as a white patient with depression or anxiety.
• This happens because racist stereotypes paint Black people as more “dangerous,” “unpredictable,” and “unstable.”
• When doctors expect Black patients to have severe mental illness, they look for schizophrenia first instead of considering other possibilities, like autism.

✔ Autistic Traits Get Mistaken for Psychosis

• Many autistic people experience sensory overload, dissociation, and difficulty processing emotions in real time, but instead of being recognized as autistic, these traits get labeled as “hallucinations” or “delusions.”
• Common autistic behaviors that can be misinterpreted as schizophrenia include:
  • Talking to yourself (which might be scripting, stimming, or processing thoughts out loud)
  • Having strong internal worlds or rich imagination (which doctors might mistake for delusional thinking)
  • Flat or unusual facial expressions (which could be misread as “negative symptoms” of schizophrenia)
  • Avoiding eye contact or struggling with social norms (which can be mistaken for paranoia or disconnection from reality)

✔ Sensory Sensitivities Are Seen as Hallucinations

• Autistic people often experience heightened sensory perception, hearing buzzing that others don’t, feeling overwhelmed by lights or sounds, or reacting strongly to textures.
• Instead of recognizing these as sensory processing issues, doctors may label them as hallucinations, leading to a schizophrenia diagnosis instead of autism.

✔ Emotional Dysregulation Gets Framed as “Losing Touch with Reality”

• Many autistic people struggle with meltdowns, shutdowns, or emotional overload.
• If a Black autistic person gets overwhelmed and shuts down in a hospital or therapy session, they might be seen as unresponsive, psychotic, or nonverbal due to schizophrenia instead of just needing time to process.

✔ Medical Racism & Cultural Bias Make It Harder to Get the Right Diagnosis

• Black autistic people are less likely to be diagnosed early, which means they often enter the mental health system later in life, after struggling for years.
• Many Black families don’t have access to autism screenings, so instead of getting support as children, Black autistic people may first interact with doctors through crisis situations.
• When a Black adult seeks help for burnout, sensory overload, or social struggles, many doctors aren’t trained to recognize autism in us… so they assume something more extreme must be wrong.

The Consequences of a Schizophrenia Misdiagnosis

Getting the wrong diagnosis isn’t just frustrating… it can be life-changing in harmful ways.

✔ Being Put on the Wrong Medications

• Many people misdiagnosed with schizophrenia are prescribed powerful antipsychotic drugs that can cause serious side effects.
• These medications don’t “fix” autism, but they can make autistic burnout, executive dysfunction, and sensory issues even worse.

✔ Losing Autonomy & Rights

• A schizophrenia diagnosis can make it harder to advocate for yourself in medical settings.
• Some people are forced into psychiatric treatment or lose access to certain job opportunities, housing, or even disability benefits because of the stigma attached to the diagnosis.

✔ Not Getting the Right Support

• If you’re told you have schizophrenia instead of autism, you might never get the tools, community, or accommodations that could actually help you.
• Autism-friendly therapies and supports are very different from schizophrenia treatments, and being misdiagnosed can delay the help you really need.

What You Can Do If You’ve Been Misdiagnosed

If you suspect that you, or someone you know, has been misdiagnosed with schizophrenia instead of autism, here are some steps you can take:

❤Trust Your Lived Experience

• If you’ve always felt different and relate strongly to autistic traits, you don’t need a doctor’s permission to explore that identity.
• Self-diagnosis is valid, especially for Black adults who have been dismissed or ignored by the medical system.

❤Look for a Culturally Competent Provider (If Possible)

• If you are able, seek a second opinion from a doctor or therapist who understands Black neurodivergent experiences.
• Unfortunately, Black autism specialists are rare, but organizations like Therapy for Black Girls, Therapy for Black Men, and Neurodivergent Black Support Networks can help.

❤Learn About Autism & Self-Advocate

• Educate yourself about autism and how it presents in Black adults.
• If you feel comfortable, talk to your doctor about why you think autism fits better than schizophrenia.
• If medical professionals refuse to listen, know that you are still allowed to claim your identity and seek autism-friendly support elsewhere.

Black autistic people are often misdiagnosed with schizophrenia because the medical system is built on racist and ableist biases that ignore how autism presents in us.

If you’ve been given a diagnosis that doesn’t feel right, you are not alone, and you are not imagining things. You deserve answers, support, and a community that sees you for who you truly are.

As always… take what resonates, leave what doesn’t, and know that you are not alone in this journey❤