Autistic (and other neurodivergent burnout such as AuDHD, PDA and ADHD burnout) is a common experience in autistic people and has been understood and talked about in the neurodivergent community for many years now. 

Autistic burnout is mostly the result of prolonged periods of time ‘surviving’ as an autistic person in environments that are not in sync with their different needs and therefore not safe. It is not as many might think a mental health condition, but in fact a whole body experience, mind, body and emotions. Most autistic people can relate to what we call ‘social hangovers’, finding themselves feeling wiped out mentally and physically by too much time spent in social environments. This might happen regularly and even daily. Without sufficient time spent away from these kind of social environments, often time spent on their own to rest and reset, then the inevitable toxic stress builds up and can lead to burnout.

Many if not most autistic people experience acute periods of burnout that last for weeks or months, but for some 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 suicide in too many cases.

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.

Judy Endow, an autistic advocate, described 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’

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According to research by Dr S. Arnold, J. Higgins and others in the team  '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)

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Dr S. Arnold and Julianne Higgins et al, found that the most common characteristics of Autistic Burnout 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%

 

There is still a great deal of ignorance amongst professionals working with neurodivergent people and this too often leads to misdiagnosis and the wrong support being given to the autistic individual (who may not have been identified as autistic). There are crossovers between being autistic and certain personality disorders (EUPD/BPD for example) and autistic burnout can also 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.

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').

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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.

Autistic burnout is too commonly misdiagnosed as depression or even personality disorders, such as EUPD (Emotionally Unstable Personality Disorder, also known as Borderline Personality Disorder). This can be a devastating misdiagnosis and can lead to support that causes more harm to the autistic individual. Many autistic people are also missed and misdiagnosed with things like EUPD or BiPolar before they eventually get an autism diagnosis (too often identified once they reach crisis), which can be many years later. Dr Judy Eaton talks about this and has published her book  'Autism missed and misdiagnosed' https://www.hachette.co.uk/titles/judy-eaton/autism-missed-and-misdiagnosed/9781839974601/ 

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For some people, especially those who are AuDHD, their experience of burnout can be very extreme and may mean the individual's life spins significantly out of control. At least 50% of autistic people experience Alexithymia, which literally means the person "has no words for emotions".  This along with other differences in their interoception, can affect their ability to appreciate how exhausted and anxious they are, which makes it much harder to feel safe in themselves. The challenges an AuDHDer can have 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. They can experience extremely high levels of anxiety and paranoia, they might also have very intrusive, racing thoughts - that can get louder and louder (sensory overload can also lead to hallucinations as can differences in neurotransmitters such as GABA and too much dopamine). 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 appropriate support. If they are diagnosed with ADHD, their medication (if they are prescribed ADHD medication) may need to be reviewed. 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 restraint and even 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 ending up in the criminal justice system; their needs as a vulnerable person (autistic people are considered vulnerable under the law) and their different sensory, social, emotional, communication and executive functioning needs are not understood or met.

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