What is Autistic Burnout?
Firstly it is important to say that it is not only Autistic people who experience burnout, many different neurodivergent people experience burnout and I do look at AuDHD and PDA burnout later in the book.
Autistic Burnout can be a profoundly serious experience that is mostly the result of an Autistic person (of any age), spending what are often prolonged periods of time in ‘survival mode’ within environments that are not in sync with their different needs and therefore not safe for them. There is too often a systemic and harmful mismatch between so many social environments and the different needs of Autistic people; what are mostly neuronormative demands and expectations too often exceed the capacity of Autistic individuals.
Most Autistic people can relate to what we call ‘social hangovers’, finding themselves feeling wiped out mentally, emotionally and physically by too much time spent in many social environments, especially those where there are neuronormative demands and expectations. This might happen regularly or even daily. Without sufficient time spent away from social environments with their neurotypical demands in what we call monotropic flow states where they can rest and reset, then the inevitable toxic stress builds up and can lead to burnout. When an Autistic person is experiencing burnout, they will feel drained, exhausted, spent and that they have "no resources left to cope with or manage daily life" (Raymaker et al, 2020).
Many if not most Autistic people experience regular periods of burnout that last for weeks or months, sometimes burnout can be very acute, significantly impacting education and employment. For some Autistic people their experience is chronic and enduring, lasting sometimes for many years. It can be devastating for too many Autistic people, leading to significant physical and mental health related issues, even leading to suicide in too many cases.
Autistic Burnout is not as many might think a mental health condition or a problem to be solved. It is a whole body experience and is in fact a reasonable response of the nervous system, which is always seeking to keep us safe and can eventually reach the point of complete shutdown when an Autistic person is constantly living in survival mode. Survival mode is often just not sustainable for so many.
It is important to note here that autistic people are too often defined by crisis, only discovering they are autistic once they hit burnout. Many have spent years struggling and surviving in social environments by masking and didn’t even understand that this is what was happening.
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Judy Endow, an Autistic advocate, describes Autistic Burnout as ‘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’.
Research by Dr S. Arnold and Julianne Higgins et al, found that the most common characteristics experienced by Autistic people in burnout 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%
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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, 2022.).’
From the groundbreaking research led by Dr Dora Raymaker in 2020 they found that ‘Autistic adults described the primary characteristics of Autistic Burnout as chronic exhaustion, loss of skills, and reduced tolerance to stimulus. They described burnout as happening because of life stressors that added to the cumulative load they experienced, and barriers to support that created an inability to obtain relief from the load. These pressures caused expectations to outweigh abilities resulting in Autistic Burnout. Autistic adults described negative impacts on their health, capacity for independent living, and quality of life, including suicidal behaviour. They also discussed a lack of empathy from neurotypical people and described acceptance and
social support, time off/reduced expectations, and doing things in an autistic way/unmasking as associated in their experiences with recovery from autistic burnout’. Their conclusion was that ‘Autistic burnout appears to be a phenomenon distinct from occupational burnout or clinical depression. Better understanding autistic burnout could lead to ways to recognise, relieve, or prevent it, including highlighting the potential dangers of teaching autistic people to mask or camouflage their autistic traits, and including burnout education in suicide prevention programs. These findings highlight the need to reduce discrimination and stigma related to Autism and disability’.
Recent peer reviewed research papers
Clarissa Osbourne, Joseph Barker, Amber Cole
Measuring and validating autistic burnout (2024)
Jane Mantzalas , Amanda L Richdale , Xia Li , Cheryl Dissanayake, et al
Confirming the nature of autistic burnout (2023)
Samuel RC Arnold, Julianne M Higgins, Julian N Trollor, et al
Defining autistic burnout through experts by lived experience (2021)
Samuel RC Arnold, Julianne M Higgins, et al
Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew: Defining Autistic Burnout (2020) Dora M Raymaker , Alan R Teo, Nicole A Steckler, et al
Crossovers with depression
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​Autistic individuals do seem to be disproportionately more likely to experience depression and there are many crossovers between depression and Autistic Burnout. Of course an Autistic person can be experiencing both burnout and depression, but it is important to understand the distinct differences and what might actually help the person. Many Autistic people I have spoken with say they know for sure that when they have been burnt out they did not feel depressed and certainly not in the way depression is described in the DSM-5. So, two things:
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Maybe we need to consider the idea that Autistic people experience depression differently and certainly not as described in the DSM-5
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Consider that what might be diagnosed by clinicians or described by Autistic individuals as depression, is better actually described as Autistic Burnout.
In research carried out by Emma Hinze, Nicole Dargue and Dawn Adams, ‘Same but different: How Autistic adults describe depressive symptoms and their alignment with the DSM-5TR criteria’ (Feb 2026) they found after asking 109 Autistic adults that their experiences of depression were as follows:
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Depressed mood often felt like anger, irritability or emotional numbness rather than sadness.
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Anhedonia (loss of pleasure) often meant losing emotional connection and joy in deep and focused interests, which are usually an important source of emotional regulation. Some people described continuing their interests, but without the same enjoyment.
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Fatigue felt like physical heaviness rather than general tiredness.
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Although broadly consistent with DSM-5-TR concentration and indecisiveness criteria, participants often described executive-function impacts (task initiation, time management) and disrupted hyperfocus.
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Depression attacks, which they described as sudden, intense suicidal thoughts with a sense of losing control.
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Depression-related variations in Autistic characteristics, such as fluctuations in sensory sensitivities, increased repetitive behaviors, and self-injurious behavior.
Some treatments for depression, particularly certain talking therapies such as CBT, often are not adjusted and may not help an Autistic person particularly when they are experiencing burnout. Talking therapy might actually exacerbate their experience of
burnout and exhaust them further. It is also very important to understand that Autistic or other neurodivergent burnout is not caused by false core beliefs, not being resilient enough or by having the wrong mindset. There can of course be trauma but any subsequent therapy that An Autistic person might decide to have when they have the capacity must be appropriately adjusted and suitable.
‘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, Clinical Psychologist.
AuDHD burnout
Most people who are AuDHD talk about experiencing the tension within themselves, an intense pushing and pulling. Being a person who on the one hand finds comfort in certainty and routine but equally also needs spontaneity, novelty and excitement can mean finding balance is far more challenging, although not impossible. Being AuDHD can mean being very driven, reward focussed (dopamine seeking) and having a mind that rarely switches off, regularly experiencing racing thoughts. Due to the differences in interoception and often experiencing alexithymia this can mean a muted awareness of their emotional state including fatigue, and so in turn can lead to pushing even harder when actually they need to slow down and rest.
AuDHDers along with Autistic people, are more likely to be monotropic and their wellbeing is very much tied up with being able to spend time lost in flow states with interests, passions and concerns. I like to call these wormholes. When environments do not support the needs of monotropic people, an AuDHDer will significantly struggle. ‘When an AuDHDer is forced to operate in a scattered, polytropic way (forced to multi-task, juggle constant interruptions, or mask), their nervous system burns through energy rapidly, frequently driving them toward burnout’ Helen Edgar, Autistic Realms, www.autisticrealms.com/monotropism.
The causes of AuDHD burnout can be the same as Autistic or even ADHD burnout, but for some who are AuDHD they may experience an acute extreme crisis, which may even include psychosis or what might present as psychosis. An individual can experience very intense, rapid changes in mood. They can feel extremely unsafe within themselves which can increase the more exhausted they become and the less capacity they have to self regulate. The individual can experience very distressing meltdowns, intrusive thoughts and hallucinations. What may be loud intrusive thoughts can be stuck on a monotropic loop; these can be very distressing and can be very hard for them to deal with and combined with increased impulsivity can lead to the individual engaging in significant risk taking which might for many include suicide attempts.
Hallucinations which can be sensory, auditory, tactile or visual, are three times more likely to be experienced by people who are Autistic or AuDHD and can be linked to extreme sensory overload and differences in brain chemistry for example differences in dopamine and GABA levels. ‘Other abnormal perceptions include strange body sensations such as experiencing a burning sensation and strange feelings in the body, hearing one’s own thoughts or fearing those near you can hear your thoughts’ (Dr Neff, neurodivergentinsights.com) Hallucinations are also even linked to experiences of isolation and bullying. In a study of Autistic adults and personal relationships researchers found ‘high rates of interpersonal violence and victimisation within personal relationships. The trauma of victimisation led to high levels of masking within relationships which often led to exhaustion and burnout’. Kieran Rose, Dr Amy Pearson and Jon Ress (2022) ‘Professionals are the hardest to trust: Supporting autistic adults who have experienced interpersonal victimisation'.
Defined by crisis
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In many cases a person is not likely to be identified as Autistic or AuDHD until they have reached some kind of crisis, either burnout or a mental health crisis. It’s also not uncommon for girls, women and people assigned female at birth to have been missed and misdiagnosed with a personality disorder such as EUPD or BiPolar for example, when in fact they are Autistic or AuDHD. Being missed means they are highly likely to have not had their needs met for many years or have been offered support that is unsuitable for an Autistic person. This can also mean that Autistic individuals are traumatised by having been seen and labelled as mentally disordered and maybe also as aggressive, time wasting, selfish, overreacting, manipulative or controlling. These labels have a devastating impact upon individuals,. The misinterpretation, misdiagnosis and misunderstanding of Autistic individuals can have tragic consequences, not only leading to mistreatment but an individual being locked out of all support and care, even criminalised and too often leading to suicide.
Rather than considering that a person is more likely Autistic or AuDHD clinicians far too often jump to the conclusion that a person (who is usually female or AFAB) has a personality disorder because they are displaying:
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A persistent and unstable self image
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Inappropriate anger
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Rapid mood changes
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Might be self harming and experiencing suicidal thoughts (and may have also made or threatened attempts)
All of the above can be a person who is Autistic or AuDHD and is traumatised, burnt-out, highly anxious and distressed because they are feeling unsafe in their nervous system. It is not uncommon for Autistic people who are distressed, overwhelmed and experiencing sensory and emotional overload to be misinterpreted as aggressive. Autistic meltdowns might be interpreted as threatening behaviour rather than a person who is Autistic or AuDHD in distress, experiencing a fight, flight response and needing appropriate support to feel safe within themselves.
Even when there is an Autism diagnosis or a person’s medical record strongly suggests they are Autistic, this can still be ignored. Regarding this, Dr Judy Eaton says in her book ‘Autism missed and misdiagnosed’ (Jessica Kingsley Publishers, 2024) ‘this can not only lead to the individual feeling invalidated, it can also wrongly place the blame for the development of these difficulties upon close family.’
Chronic and enduring
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For some Autistic people their experience of burnout is acute and lasts for short periods of time, maybe days, weeks or months but for many their experience is severe and chronic, lasting years. There might also be co occurring physical conditions that compound their burnout experience.
When burnout persists and things don’t change for what can be years, it can lead to an unbearable sense of frustration, desperation and they can become very isolated. Many have lost friends and may not have a supportive family that understands their needs. Many can become suicidal, having lost hope of any kind of recovery, which just feels impossible.
For many Autistic people experiencing burnout medication can help with high levels of anxiety, depression or OCD for those who experience this. SSRIs and commonly Sertraline might be prescribed. It is important to understand that burnout itself does not respond to medication but it might be part of the person’s recovery journey. Some Autistic people are very hypo or hyper sensitive to medication and may not respond ‘typically’. For those who are AuDHD, as I have mentioned previously, ADHD medication can for some people trigger a significant crisis.
When burnout has persisted for long periods of time an Autistic person can be carrying extremely high levels of shame. When professionals that might be involved with them do not understand Autistic Burnout, they can inadvertently increase the person’s sense of failure and usefulness.
What the individual needs is:
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To feel heard, believed, accepted and validated
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To know that burnout is not due to any kind of personal flaws
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Help to reduce their shame in safe spaces
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Support to find ways to embrace their neurodivergence
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The person’s sense of grief and loss acknowledged and supported
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Help to find safety within themselves, often with safe people they can co-regulate with and also via interests and passions, glimmers and monotropic flow states.
​Why do people who are Autistic or AuDHD experience burnout ?
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Too many neuronormative demands and expectations - These demands can also be social and gender norms and these lead to Autistic and other neurodivergent people surviving by conforming and complying, often subconsciously, with neuronormative expectations in relation to things such as communication, socialising and executive functioning, etc. Other demands relate to things like sensory overload and sensory deprivation, lack of structure, uncertainty, too many changes of focus, and many other things.
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Capacity - There can be huge differences between an Autistic person's capacity compared to amount of demands and expectations, especially those that are neuronormative. An Autistic person's capacity might be extremely low at times but the deamdns and expectations remain high.
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Prolonged periods of life spent masking - This might often be fawning (people pleasing, putting other people’s needs first, etc), camouflaging, ‘adaptive morphing’ (a term coined by Wenn Lawson), suppressing stims and other aspects of self and identity management in social situations and environments. Masking is mainly the result of the stigma that exists surrounding being different and is a mostly subconscious protective trauma response, due to feeling internally unsafe in social environments. Many people are unaware that they are Autistic which can mean they might have been masking for many years prior to being identified and this can have a huge impact upon identity formation.
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Being multiply neurodivergent - It is likely that a very high number of Autistic people are AuDHD, some believe it is 50-80%. Being AuDHD can mean a person might be more at risk of experiencing burnout and also experiencing mental health challenges.
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Missed and/or misdiagnosed - Many Autistic people (particularly girls, women and people assigned female at birth) have been missed and often misdiagnosed with things such as EUPD/BPD or depression, rather than being identified as Autistic. This leads to an Autistic person often only being identified once they hit burnout or some kind of crisis. They crash because they have never understood their true authentic self and their needs. It also means they have never been understood by others. If misdiagnosed they might have received support that is unsuitable for Autistic people or found themselves unable to access any kind of help.
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Trauma - This can be due to adverse childhood events, things such as abuse or accidents, but also school trauma, systems generated trauma, sensory trauma, interpersonal trauma including abuse, domestic violence and things such as RSD (rejection sensitivity dysphoria), etc.
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Changes and transitions - Any changes or transitions can be really challenging, but especially when a person is Autistic and therefore monotropic in environments that do not honour and support their unique needs and their cognitive processing style. Sudden or unplanned changes and being pulled out of attention tunnels can extremely destabilising especially when this happens regularly. Major bio psycho-social transitions such as puberty and menopause can be extremely intense and amplified for an Autistic person and people who are AuDHD. During these transitions everything changes for the individual in their mind and body and not just hormones.
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Multiply marginalised - Being neurodivergent and multiply marginalised because of race, ethnicity, disability, gender, sexuality etc, can mean an individual is having to survive on so many more levels. This can mean they are even more prone to experiencing burnout because of racism, ableism, transphobia, homophobia, misogyny and other hate. For many there is nowhere that they are safe to be authentically themselves and are potentially constantly masking and code switching.
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Internalised ableism, shame and perfectionism - Internalised ableism can be very common, often due to absorbing all the stigma and ableism that surrounds an Autistic person. They may feel that they are not good enough, or that they are broken and that something is wrong with them, or that despite being identified or diagnosed - believe that they are not Autistic (Imposter syndrome). It can prevent an Autistic person truly understanding themselves, their mind, body and their needs; it means they might push through when they actually need to stop for example. There can also be extremely high levels, often years of carrying shame. This can be because of traumatic life experiences, including victimisation and abuse, relationship and other interpersonal struggles, education and employment based struggles and breakdown. Trying to live up to other people’s standards, other people’s demands and expectations is exhausting. Perfectionism is an unforgiving task master, that can lead to an Autistic person putting themselves in or remaining in situations and environments that are draining and using up too much of their limited capacity. An Autistic person might also strive for perfection in order to avoid rejection from others and might be using up all their capacity masking their executive functioning and other differences in order to ‘keep up’.
