Alexithymia and Autistic Burnout: Too tired to feel it
Autistic burnout is perpetually a hot topic (pun intended) within the Autistic community. From the earliest stages of our discovery journey through to the people who are seasoned veterans of the neurodiversity movement; burnout is an issue prevalent for any Autistic person currently in existence. Unfortunately, we often use observational techniques to try and quantify burnout. This may not be as helpful as some might think due to the dynamic and wide-ranging presentations of autism that exist within our community. We have to consider that not all burnout looks the same.
What is burnout?
“Autistic burnout is a syndrome conceptualized as resulting from chronic life stress and a mismatch of expectations and abilities without adequate supports. It is characterized by pervasive, long-term (typically 3+ months) exhaustion, loss of function, and reduced tolerance to stimulus.”
The above mentioned definition is useful for a basic understanding of Autistic burnout, but there are nuances to this conversation that need to be addressed. Burnout is usually the result of being in a prolonged state of monotropic split. When such states of being happen, we are exceeding our cognitive resources and traumatising our brains. This traumatic overworking of our mind beyond what it is capable of doing is what creates a state of burnout. This state of burnout can then be understood as the brain shutting down demands around our functioning and engagement with demands in order to recover the cognitive resources it needs to carry on.
What happens when a person can’t feel themselves burning out?
Childhood trauma has been linked to body dissociation, and as such represents interoceptive issues in terms of feeling and identifying emotions (Schmitz et al, 2023). Given the very high rates of trauma throughout the Autistic lifespan, it is unsurprising that we often have issues with recognising and articulating our emotions, presenting issues for emotional regulation and the recognition that we are in burnout.
Because we often don’t recognise that we are experiencing Autistic burnout, we may not know that it is time to take our foot off the accelerator and recover those precious cognitive resources. We also have to consider at this point that half, if not more of Autistic people are ADHD (AuDHD as the community might say) (Leitner, 2014). For those of us who are ADHD, we may struggle to stop even if we know we are burnt out. The constant need for stimulus drives us to push onward and ignore any internal signals that we may receive from our body (Adkin & Gray-Hammond, 2023).
Autistic burnout for people in situations such as that described above may actually appear to be hyperactive or even manic as they struggle to regulate their emotions, and seek out a natural monotropic flow-state. Adkin (2023) refers to this as meerkat mode. This presents an issue for a society that has conceptualised burnout as looking similar to depression as the person experiencing this atypical presentation of burnout (Adkin & Gray-Hammond, 2023) will not necessarily appear depressed.
What are the risks associated with this kind of burnout?
“There is a growing under-current in various circles questioning the validity of the diagnosis of Emotionally Unstable Personality Disorder (formerly known as Borderline Personality Disorder). We know that this is commonly misdiagnosed in Autistic people (Fusar-Poli et al, 2022). We also know that there is a huge amount of sexism involved in the identification of EUPD; women out-number men 3 to 1 in the diagnosis of EUPD (Bjorkland, 2006).
When we reverse that lens, men out-number women 4 to 1 in the formal identification of autism (Rynkiewicz, 2016). Considering the high co-occurence of ADHD and EUPD (Philipsen, 2006) and the well-known co-occurrence of autism and ADHD; is it possible that we might be looking in the wrong direction? Could many of these people be experiencing a protracted, atypical, Autistic burnout?
Adkin & Gray-Hammond, 2023)
Misdiagnosis is anecdotally, a significant issue for Autistic people, in particular, Autistic people who were assigned female at birth and socialised as girls. These atypical forms of burnout often seem to be identified by mental health professionals as bipolar and personality disorders. The issue with this is that many Autistic people find these diagnoses are weaponised against them, and provide no meaningful route to recovery from the burnout that they are experiencing.
There is also a significant risk of an Autistic person being institutionalised in this state, with a significant portion of inpatients being Autistic. This is problematic for many reasons, but in particular I worry about the sheer number of abuse scandals that come out of inpatient units year on year. We also have to consider that inpatient settings are often traumatic in their own right due to the upset to routine and having a familiar space that Autistic people often appreciate.
There is no quick fix to the development of burnout in Autistic people. The driving factor behind burnout is that our world is not well designed for people with a monotropic attentions style. If we want to reduce rates of burnout, we have to decrease the likelihood of people experiencing extended periods of monotropic split. Such endeavours may sound simple on paper, but require a fundamental change to the way our world is structured.
Autistic burnout can have severe impacts that resonate throughout the person’s life for many years, and as such, we as a community need to know how to recognise and respond to our neurokin in distress.
References where link not available
Rynkiewicz, A. (2016). Autism spectrum disorders in females. Sex/gender differences in clinical manifestation and co-existing psychopathology (Doctoral dissertation, PhD Dissertation. Retrieved from Medical University of Gdansk Bibliography Database 2016).
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