Long before I was correctly diagnosed as autistic, I collected a variety of mental health diagnoses:
- Generalised Anxiety Disorder (GAD)
- Obsessive-Compulsive Disorder (OCD - ruminative type, aka 'Pure OCD', where most of it is just thoughts not actions)
- Post-Traumatic Stress Disorder (PTSD - from extremely traumatic health events in childhood, plus subsequent traumas).
- Anxiety & Panic Disorder
- Clinical Depression.
Most of these labels relates to an anxiety difficulty, which is incredibly common with autistic people. As an autistic woman I'm probably lucky I didn't get that common misdiagnosis of Borderline Personality Disorder (BPD). As it is, those labels are still on my medical notes - they are useful, albeit slightly disingenuous since almost certainly, the behaviour labelled 'anxiety disorders' is probably just ordinary autism, in the wild (and undiagnosed for 34 years). A problem is never easy to deal with when it's been misrepresented for years! So, what I experience probably isn't entirely anxiety disorders (although living with undiagnosed autism for 34 years has undoubtedly left its scars), but it is anxiety, like the vast majority of autistic people live with.
Autistic Triggers for Anxiety
1. Social anxiety. Not the mental health condition, 'Social Anxiety Disorder', but simply because social behaviour is more conscious for us on the Spectrum and we have to work harder at it, with a greater propensity for mistakes. I cannot recall the number of times I have said to people "I have a Social Communication Disorder" only for them to criticise me for some social faux pas, inappropriate joke or other misunderstanding, declaring that this had "Nothing to do with autism".
One poor woman I encountered had been told "Autism is no excuse for rudeness", which involves so many misunderstandings of her situation, I don't know where to start! (And no, it's not an excuse, but it can be an explanation).
Autism is a Social Communication Disorder. Social communication includes being able to work out in which context a joke is funny and when it is offensive; when arguing is fine or even welcomed, or when it is considered 'aggressive'; when words are OK to use with the 'in' group, but not outside. Consequently, if you want to understand what a Social Communication disorder looks like, consider how you feel when someone says something offensive to you, without any obvious motives. That's what it looks like.
2. Executive Dysfunction aka 'Being very disorganised, bad at timing, prioritising etc.' I've always found my poor executive function very disabling, but it wasn't until recently I learned that it is the number 1 cause of anxiety for a lot of autistic people. Being constantly late (or early), forgetting things, mislaying things, forgetting birthdays, people's names, important meetings... this can cause a lot of daily stress.
The other day, for example, myself and an autistic journalist were quite proud of ourselves for getting ourselves to the café at the correct time for our meeting - only to discover we'd messed up on the location! He was in one town, I was in another, at the same chain café!
3. Sensory Dysfunction & Overload. Autistic brains are unable to filter our extraneous stimuli, so we notice every sound, every image, the sunlight flickering through trees, the hiss of the coffee machine in the café, conversations across the room, just beyond our hearing, flickering florescent lights, buzzing air conditioning, traffic... My brain notices each and everything so concentration can be a nightmare.
And don't forget, as per an earlier blogpost, senses are not just sight, hearing, touch, taste, smell... our eighth sense of interoception helps us monitor our body's wellbeing. Being unaware of the need to sleep when we're tired, eat when we're hungry, drink when we're thirsty etc. can also put a strain on the mind. How many of us feel stressed and out of control simply because we haven't had enough sleep for a few nights? For many autistic people, problems like insomnia can be chronic.
4. Cognitive Overload. The inability to filter out stimuli also applies to our own internal stimuli. For years, I struggled to understand the meaning of the term "Over thinking". Apparently, it was a thing anxious people did, and non-anxious people didn't do, but it made no sense to me. In the end, I realised that it's because what a neurotypical calls 'over thinking' is actually normal to me! I cannot not "Over think", it's the only way I think. It means I am aware of every detail, every nuance of everything I think about, all the time. Seeing the relevant details in the midst of the chaos, is tricky (or as NTs would say "Seeing the wood for the trees"). There are a lot of trees!
5. Adverse Experiences. Of course, many people (including many who read this blog) have experienced adverse experiences, some horrific, but for autistic people, those adverse experiences can be persistent micro-aggressions and repeated 'Othering' (Social science term - means making you feel different in a bad way and excluded). And for autistic people of colour, autistic trans and non-binary people, and autistic people with additional needs, and all combinations of said, racism, homophobia, transphobia and ablism simply add to the pressure.
For myself, I have repeatedly been asked to leave jobs because I didn't 'fit in' - including a number of voluntary jobs. I am socially naive so get taken advantage of constantly. People lose their temper with me - but rarely do I see it coming, so it is traumatically out of the blue for me. I have had many friendships which are entirely one-sided on their part - I have unintentionally bought a friend's carpets (she used my credit as she was unable to credit herself, she said), I have written articles for people who have published them in their name, I have done research for people without pay or reward, but because they were a 'friend', only to discover they didn't even like me! Socially and emotionally, I can feel battered and unable to defend myself.
It is not just the overt bullying, but the breaches of trust which cut deep. I've had a lot of therapy - that helped - but time and time again in my sessions with my therapist, we re-discovered how often I haven't been valued by people around me. Even though I have some amazing and genuine friends these days, the adverse experiences of the past can still inform my anxiety. What if it happens again? How can I defend against it when I am unable to see the danger coming?
Help to Cope with Anxiety
It seems today I'm doing my favourite thing: making lists. So, here's another list of the things I find helps me cope with chronic anxiety. And I won't put No.1 'Make a list..."!
1. Look after your body. Seems simple, but to an autistic person with interoceptive difficulties and organisational difficulties, making sure you eat right, sleep right, avoid dehydration etc. And don't drink too much alcohol! It makes anxiety worse in the long run, even though it might appear to relax you in the short term.
2. Do something you enjoy. A lot of autism books will talk about 'Special Interests' or 'Perseverations' - autistic 'obsessions' we get really into, like Star Trek, or trains or horses. But what a lot of people don't realise is that employing our autistic focus and attention to detail can often silence all that 'noise' in our heads from sensory and cognitive overload. If you want to help an anxious autistic friend, let them talk to you about their special interest, and listen. It might be a bit boring for you, but you'd be doing them a great favour. And maybe it wouldn't be that boring at all!
My special interests include writing this blog. I started it initially because writing, even about stuff like this, takes me out of myself and silences all that 'noise'.
3. Do something creative. In the bad old days, of just 10 years ago, the autism diagnostic criteria cited "Lack of imagination" as an autism trait. The experts tried to fudge that by saying they were talking about 'social imagination' (whatever that is) but the truth is, autistic people can be just as creative as NTs, sometimes more so.
I do watercolours and crochet myself, and I enjoy DIY, but you may enjoy something less traditionally 'creative'. My son, for instance, writes software for fun. My other half is a mathematician and tells me that 'true maths is a creative process'. I've been told the same about chess, but I'm not sure I really 'get it'. Nevertheless, find creativity that speaks to you, whether its art, music, writing... or solving maths equations.
4. Meditation Is it just me or did I hear a collective groan across the Internet? Yes, anyone with anxiety is advised to meditate, and I've been studying Buddhist meditation about 10 years, since a psychologist recommended it to me. But not everyone enjoys sitting still or chanting for hours, and if you've a very active brain, it is going to take you years to perfect it even if you start now.
So don't just think of meditation as sitting in a lotus position thinking of nothing (for a start, that's not what we do, or at least it's a very advanced practice). Consider walking meditation - or just walking while thinking, which is the foundation practice anyway. Try Thai Chi. Or yoga.
If you're Christian or Muslim, there are various forms of prayer meditation - it's not just for Hindus and Buddhists! Christians might be interested in an old book called "The Practice of the Presence of God' by Brother Lawrence - a Christian monk who would mediate while peeling potatoes or attending to the monastery garden.
And meditation is fine if you're not religious at all - there are plenty of secular techniques. One friend showed me an app on her phone which involved staring at a dot!
5. Be careful of social media. The internet can be immensely helpful for people with autism, but it can also be a pond full of piranhas for the unwary. If you find yourself, like me, obsessing over things on the internet, getting into unintentional fights and worrying about what you've said, what they've said... consider taking a break. (This by the way is advice I am yet to take for myself, but I'm working on it).
I am sure there are many other ideas - people tell me they love weighted blankets, for instance, but they tend to make me feel suffocated and therefore more anxious. Others love noise reduction headphones - I hate muffled sound though. But do prioritise your mental health, especially coping with anxiety. It is OK not to cope, it is OK to withdraw into your metaphorical cave sometimes and not socially interact if you don't have to.
Lastly, you may have noticed I'm a trainee counsellor who didn't mention counselling as a way of tackling anxiety. This is because, in my experience, counselling can be great for helping you learn to live with anxiety, and I've had CBT too, which has given me some great coping strategies, but ultimately, therapy doesn't cure your anxiety, it only strengthens you to live with it. But yes, also get counselling!
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