Autistic burnout

I’m the expert of my experience, I guess

I’m deep in autistic burnout, something that I’ve never experienced before but have learned about in my obsessive reading about autism. I’m very likely autistic, and am currently in stage 2 of the virtual diagnostic process through Embrace Autism. Stage 1, the screening, showed that I display more traits of autism than is technically required for diagnosis, so I consider that strong evidence that I probably am autistic. Plus, several autistic people, including my current therapist, have told me that I seem likely autistic. So in this post I am working off of that assumption.

Autistic burnout happens when autistic people experience prolonged sensory, emotional, and/or social overwhelm. For autistic people who frequently camouflage their neurodivergent traits, this camouflaging can contribute to the development of burnout. General functioning decreases, and people tend to feel physically and mentally fatigued and may even experience suicidal ideation. They may experience shutdowns and meltdowns more often, which respectively are inwardly-directed and outwardly-directed reactions to intense overwhelm. Tolerance to stressful stimuli decreases, so people retreat to private spaces and into their special interests. Basically, autistic burnout is how autistic people’s nervous systems protect themselves after long-term exposure to environments not accommodating to neurodivergence.

Burnout is distinct from depression, though it can also be concurrent with it. My experience is that in depression, I feel half-dead and want to be dead, but in burnout, I feel half-dead and feel dreadfully nostalgic for life. I do have suicidal ideation sometimes, but it’s more blurry like every other feeling that I’m having. My cognition is slower than usual, which can be frustrating as I want to engage in my interest in puzzles, but I struggle to do so. I am stimming more in all sort of ways, and I’m also sleeping more. I’m staying at my parents’ house to be cared for, as even basic errands like going to the grocery store can trigger a shutdown. Sometimes despair comes over me as a reaction to everything that’s going on: why is it that when I think I’m getting better, I am plagued with something new? But mostly, I’m just trying to focus on my present needs, which my bodymind is communicating more firmly than before.

What’s frustrating about experiencing autistic burnout as an adult not yet formally diagnosed as autistic is that psychiatric providers don’t generally have sufficient training on autism. When they do, they usually are specialized in children and adolescents. One reason is that autism is considered a neurodevelopmental condition, and most behavioral interventions are designed to make autistic children as neurotypical-passing as possible. Another reason is that generally, pharmaceuticals are not used to treat autism; there are some exceptions such as the antipsychotics risperidone and aripripazole, which are approved to treat “irritability” in autistic children, and autistic people do get medicated for any concurrent conditions they experience. But unlike for ADHD, which is also considered neurodevelopmental, there are no medications marketed to control autistic traits themselves. Since medication management is core to psychiatry, providers are not necessarily trained to adequately treat conditions that can’t just be controlled with meds.

So I have ended up needing to educate myself on what I’m experiencing (something I always enjoy, by the way — I love psychology) and then explain to my psych nurse what is going on. She accepted my belief that I am autistic and listened to my explanation, but she told me that she has never seen a patient with all the symptoms that I have, and she thus probably isn’t the best provider for me. I appreciate her honesty, but this is also frustrating. Now I’m trying to find a new provider who is better trained to address autism. I’ve actually found a good candidate, but she does not take insurance, so I’m trying to find alternatives who do take my insurance.

In addition, it has been suggested that I should see a neurologist to rule out any organic causes to my shutdowns, meltdowns, or burnout. My shutdowns can be fairly extreme; sometimes, I become frozen in place in odd postures for up to half an hour, a symptom that some have suggested may be catatonia or even a seizure, but which Reddit threads confirmed does happen to some people during a shutdown. I doubt that there is an organic cause, as my symptoms are sufficiently explained by autistic shutdown/meltdown/burnout and there were clear psychological causes. Plus, neurology is expensive and insurance coverage can be iffy.

There’s nothing to do to “treat” burnout except to rest a lot and avoid overstimulating and stressful activities. It can last for days, weeks, months, even years, perhaps depending on what triggered it. As I have never experienced this before, all I can do is wait and see when the exhaustion begins to lift.