'I feel trapped in my safe clothes': The impact of tactile hyper-sensitivity on autistic adults.

Clothing-related tactile hyper-sensitivity has been frequently reported among autistic people, but research investigating how this affects autistic adults is limited. This mixed-methods study investigated the impact of clothing-related tactile hyper-sensitivity on autistic adults' lives, focusing on appearance dissatisfaction, appearance awareness, self-esteem and self-expression through clothing. An online survey was completed by 86 autistic adults in the United Kingdom. Regression analysis revealed a significant predictive relationship between tactile hyper-sensitivity and appearance dissatisfaction. Moderation analysis revealed a significant negative relationship between tactile hyper-sensitivity and self-esteem, moderated by appearance dissatisfaction. Moderation of the relationship between appearance dissatisfaction and self-esteem by appearance awareness was not significant, but both appearance constructs were independent negative predictors of self-esteem. Three themes relating to the impacts of clothing-related tactile sensitivity were generated through thematic analysis of open-ended questions: 'Negative consequences', 'Managing clothing-related tactile sensitivity' and 'The emotional value of clothing'. Altogether, the findings indicate that clothing-related tactile sensitivity is prevalent and can impact autistic adults' appearance satisfaction, self-esteem, clothing options and choices, and self-expression through clothing. This highlights the need for a wider choice and availability of sensory-friendly clothing and further research exploring the diverse effects of tactile hyper-sensitivity on autistic people's lives, including mental health outcomes and employment opportunities.Lay abstractMany autistic people experience strong reactions to sensory information, such as certain sounds or smells. Tactile hyper-sensitivity is the strong, negative reaction to touch. Previous research suggests autistic children experience tactile hyper-sensitivity towards clothing, such as disliking labels or seams touching them. However, little is known about tactile hyper-sensitivity towards clothing in autistic adults and how this affects how they see themselves, feel about their appearance and express themselves through clothing. This study explored this by asking 86 autistic adults in the United Kingdom to complete an online survey. The results showed that autistic adults with a higher level of tactile hypersensitivity are more likely to be dissatisfied with their appearance, and that higher tactile hyper-sensitivity is also linked to lower self-esteem among autistic adults who are unhappy with how they look. Autistic adults with greater awareness and dissatisfaction with their appearance were also found to have lower self-esteem. In addition, autistic adults shared with us that sensory sensitivity towards clothing can negatively affect how they feel physically and emotionally, and their ability to take part in activities such as formal social events. Autistic adults have different ways of managing this, such as buying multiple of the same sensory-friendly clothing item, inspecting clothes in shops before buying them and only wearing clothes that feel comfortable. Being able to wear clothes they like and that reflect who they are is important for many autistic adults; but difficulties finding comfortable clothing left some autistic adults feeling frustrated, unhappy with their appearance and less confident. Together, the findings suggest that access to sensory-friendly clothing is very important for autistic adults' well-being. These findings are relevant for mental health professionals working with autistic adults, clothing brands and workplaces with a dress code or uniform.