Autistic Burnout and Extreme Burnout Crisis
Autistic burnout is a common experience in the neurodivergent community and has been known and talked about for many years now. There is still however a great deal of ignorance among professionals working with autistic people and this too often leads to misdiagnosis and the wrong support being given to the individual. There are crossovers between Autism and certain personality disorders (EUPD esp) and autistic burnout can present as depression. But as the quote below from the Royal College of Psychiatrists says, it is vital professionals consider burnout before jumping to conclusions about a mental health condition/diagnosis, especially if they know or suspect the individual is autistic or if the individual self-identifies as autistic.
To find out information about Autistic Burnout, there are resources for autistic adults and parents of autistic children in my shop.​
According to Judy Endow autistic burnout “is a state of physical and mental fatigue, heightened stress and diminished capacity to manage life skills, sensory input and social interactions, which comes from years of being severely overtaxed by the strain of trying to live up to demands that are out of sync with your needs”.
The Royal College of Psychiatrists describes autistic burnout as "a state of exhaustion, associated with functional and cognitive deterioration and an increase in autism symptomatology, as a consequence of coping with social interaction (including masking) and the sensory environment. It may be a short-lived state (as at the end of a working day), relieved by a relatively brief withdrawal from the stress. However, longer and more severe stress can produce a more sustained state (which entails some form of innate change) which has to wait on its natural remission. It overlaps symptomatically with anxiety and depression, and there may be a heightened risk of suicide.
Its anecdotal basis and the lack of systematic research mean that burnout does not have the status of a formal syndrome or disorder. Nevertheless, the concept captures the need to consider the effect of adjusting somebody’s setting, support, and style of life before assuming their malaise to be a recognised psychiatric disorder." (Royal College of Psychiatrists, The psychiatric management of autism in adults).
​
​“Autistic burnout is a severely debilitating condition with onset preceded by fatigue from masking autistic traits, interpersonal interactions, an overload of cognitive input, a sensory environment unaccommodating to autistic sensitivities and/or other additional stressors or changes. Onset and episodes of autistic burnout may interact with co-occurring physical and or mental health conditions” (‘Investigating autistic burnout. Final report’, Dr S. Arnold, Julianne Higgins et al Feb 22)
Research by Dr S. Arnold and Julianne Higgins et al, found that the most common characteristics experienced were:
-
Chronic exhaustion 72%
-
Sensory overload 80%
-
Heightened anxiety 90%
-
Low mood 95%
-
Increased shutdowns 80%
-
Loss of skills 90%
-
Suicidal thoughts 64%
-
Intrusive thoughts 59%
The main causes of autistic burnout are:
-
Prolonged masking (often fawning, camouflaging, identity management) in social situations and environments (a mostly subconscious protective trauma response to feeling unsafe in social environments – not a choice an autistic person makes). Masking is mainly the result of the stigma surrounding autism.
-
Prolonged periods of time spent in social situations & environments that are not safe and drain an autistic person of energy because the environments are not in sync with the needs of the autistic individual
-
Prolonged sensory overload (autistic people can be hyper and hypo sensitive to all their different senses)
-
Too many demands and expectations (this is particularly an issue for those with a PDA profile who need more autonomy)
​
​
​
​
​
​
​
​
​
​
​For some people, especially those who are AuDHD (autistic and ADHD) and also autistic people with a PDA profile, their experience of burnout can be very extreme and may mean the individual's life spins significantly out of control. 50% of autistic people have Alexithymia, which literally means the person "has no words for emotions". This can affect their ability to appreciate how exhausted and anxious they are, which makes it much harder to self regulate (especially if you add in the executive functioning differences in an ADHD brain). Difficulties with 'stopping' to rest means they might push themselves harder. Perfectionism can also play a part in pushing through.
They might self medicate with drugs and alcohol, or relapse if they have been in recovery. This can mean, among many other things, that they can experience extreme paranoia and even mania. In this manic state of mind, the person might also have very intrusive, racing thoughts, that can get louder and louder (sensory overload can also lead to hallucinations). It can be very hard when you are AuDHD and spiralling, in a kind of dark wormhole, with stuck and looping intrusive thoughts that you cannot shift. Co-occuring things like OCD can also play a part for many in a crisis they may experience.
For those who do experience this extreme burnout crisis, there can be very serious consequences. It is vital to understand that the individual is in the midst of a crisis and needs support. If they are diagnosed with ADHD, their medication (if they are prescribed ADHD medication) may need to be looked at. Ultimately this person may need significant help and support to stay safe.
I have worked with many ND (neurodivergent) people in the criminal justice system. They too often end up in the system because their needs as an autistic, PDA, ADHD or AuDHD person have been missed and/or ignored. I have worked with individuals whose autistic meltdowns were not recognised or supported by first responders and it led to a criminal conviction. In some cases the individual's experience of extreme burnout crisis even led to a prison sentence. Too many autistic, PDA and AuDHD individuals are ending up being detained in psychiatric units and even in the criminal justice system; their needs as a vulnerable person (autistic people are considered vulnerable under the law) and their different sensory, social, communication and executive functioning needs are not understood or met.
​
The diagram below shows a cycle that some autistic, PDA (particularly AuDHD) people may experience in extreme burnout. Any false memories they experience, can be the result of trauma and it's important that the individual feels heard and believed. In a heightened state an autistic person may feel very unsafe and in a meltdown state (an involuntary fight/flight response) they may sometimes seem aggressive and may make threats. If they have a PDA (pathological demand avoidance) profile, they may be experiencing extreme distress, due to a loss of autonomy and a feeling of inequality. It's important to understand that the autistic person is often more likely to be a threat to themselves than to others; they are in extreme survival mode and will feel terrified.
​
​
​
​
​
​
​
​
​
​
​
​
If you are in crisis, if you are experiencing suicidal thoughts, there are people you can communicate with:
Papyrus HOPELINE 247
If you are having thoughts of suicide or are concerned for a young person who might be you can contact HOPELINE247 for confidential support and practical advice.
Call: 0800 068 4141
Text: 07860039967
Email: pat@papyrus-uk.org
Samaritans
Call us any time, day or night
Whatever you're going through, you can call us any time, from any phone for FREE.
Call: 116 123
Write the Samaritans an email. Sometimes writing down your thoughts and feelings can help you understand them better.
Response time: It may take several days to get a response by email
​
​
​
​
Extreme Burnout Crisis
Crossovers between depression and autistic burnout
There are many crossovers between depression and autistic burnout but it is important to understand the distinct differences. Treatment for depression does not work for an autistic person experiencing burnout and may actually exacerbate the burnout symptoms they experience and exhaust them further.
"While Autistic Burnout may co-occur with depression, it is distinct from it. Historically, Autistic Burnout may have been understood as depression. You may even have been diagnosed with depression by your GP when your symptoms might be more accurately understood as Autistic Burnout" Dr Alice Nicholls, ND Psychologist.