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Oct 10 2023
Autism and Paranoia: Autistic pattern recognition when it runs away

Autism is not something that is generally associated with paranoia, but as you will see from previous writing on the topic, it is an issue that needs to be given consideration. Research as far back as 2011 (King & Lord, 2011) has indicated that there is a growing belief that autism and schizophrenia may be part of a single spectrum. As an Autistic and Schizophrenic person, I am inclined to believe they might be, the relationship between the two feels complex and nuanced, so it should come as no surprise that paranoia is a topic that needs attention.

Is there a difference between Autistic paranoia and Schizophrenia paranoia?

Research has indicated that paranoia in Autistic people occurs at a similar rate to Schizophrenic people, but Autistic people experience it more on the basis of social cynicism (Pinkham et al, 2012). Social cynicism is a broad category, but to my mind it has to do with our pattern recognition skills. Autistic people grow up in a world that is inherently traumatic, and learn to predict outcomes in order to defend the small amount of wellbeing afforded to them.

This elevated sensitivity in pattern spotting can at times get out of hand. When we are in meerkat mode or atypical burnout, we may start seeing data points that would usually be considered anomalous background noise as something meaningful and connected to real world occurrences. This associative thinking can create feelings of paranoia and persecution, which in turn adds to our dysregulation, making it more likely that we will form these abstract connections. When we combine this with a cynical attitude towards our society, it is easy to see where the problem begins.

How does this differ to people who are Autistic and Schizophrenic?

In my own experience, my paranoia is considerably more bizarre than the average burnt out Autistic person. I experience delusions that are often abjectly impossible as opposed to many Autistic people who experience paranoia that has a more tangible and realistic pattern to it. Mazza et al (2022) found that Schizophrenic people struggled to understand social scenarios, as opposed to Autistic people who were more likely to misunderstand people’s intentions in social situations. We can consider that the additive effect of this is an increased susceptibility to gaslighting, which as a traumatic occurrence in itself may well feed into our paranoia. When you are Autistic and Schizophrenic, the people around you have a great deal of influence on your wellbeing. Paranoia can be intimately connected to the views of the people in your life.

Autism, paranoia, and co-regulation

Autistic people experiencing paranoia often (anecdotally) report decreased interoceptive sensitivity and struggle to regulate their own emotions. This is where co-regulation with a safe person is absolutely vital to recovery. When we are unable to create feelings of safety on our own, it becomes necessary for another person to share their calm and rationality with us. This can be particularly problematic for households where dysregulation is the norm, heightened emotions of those around us can elevate feelings of paranoia and create self-fulfilling prophecies.

Social factors in Autistic paranoia

Minority stress plays a significant role in the psychological wellbeing of Autistic people (Botha & Frost, 2020). When considering minority stress, we have to consider the cumulative stressors that come together to create minority stress. Howlin (2013) discusses how Autistic people have less positive educational outcomes, as well as being poorly served by health and social care settings. We also have to consider the class divide, intersection with race, gender, and sexuality, and social isolation. We are a population who face very negative socioeconomic outcomes. This can create strong feelings of distrust in the system and a sense of persecution by a society that dictates our assimilation regardless of whether it is the right thing for us.

This is just a brief look into the world of autism and paranoia, but I believe it highlights some key issues that deserve further research and support. In the meantime, the best thing we can do for our Autistic loved ones is to create a safe and accepting space, free from the demands and alarming patterns of our abusive society. For the issue to be solved, society needs to be changed at it’s foundations.

David Gray-Hammond 0 Comments
Aug 3 2023
Alexithymia and Autistic Burnout: Too tired to feel it

Autistic burnout is perpetually a hot topic (pun intended) within the Autistic community. From the earliest stages of our discovery journey through to the people who are seasoned veterans of the neurodiversity movement; burnout is an issue prevalent for any Autistic person currently in existence. Unfortunately, we often use observational techniques to try and quantify burnout. This may not be as helpful as some might think due to the dynamic and wide-ranging presentations of autism that exist within our community. We have to consider that not all burnout looks the same.

What is burnout?

“Autistic burnout is a syndrome conceptualized as resulting from chronic life stress and a mismatch of expectations and abilities without adequate supports. It is characterized by pervasive, long-term (typically 3+ months) exhaustion, loss of function, and reduced tolerance to stimulus.”

Raymaker et al, 2020

The above mentioned definition is useful for a basic understanding of Autistic burnout, but there are nuances to this conversation that need to be addressed. Burnout is usually the result of being in a prolonged state of monotropic split. When such states of being happen, we are exceeding our cognitive resources and traumatising our brains. This traumatic overworking of our mind beyond what it is capable of doing is what creates a state of burnout. This state of burnout can then be understood as the brain shutting down demands around our functioning and engagement with demands in order to recover the cognitive resources it needs to carry on.

What happens when a person can’t feel themselves burning out?

Childhood trauma has been linked to body dissociation, and as such represents interoceptive issues in terms of feeling and identifying emotions (Schmitz et al, 2023). Given the very high rates of trauma throughout the Autistic lifespan, it is unsurprising that we often have issues with recognising and articulating our emotions, presenting issues for emotional regulation and the recognition that we are in burnout.

Because we often don’t recognise that we are experiencing Autistic burnout, we may not know that it is time to take our foot off the accelerator and recover those precious cognitive resources. We also have to consider at this point that half, if not more of Autistic people are ADHD (AuDHD as the community might say) (Leitner, 2014). For those of us who are ADHD, we may struggle to stop even if we know we are burnt out. The constant need for stimulus drives us to push onward and ignore any internal signals that we may receive from our body (Adkin & Gray-Hammond, 2023).

Autistic burnout for people in situations such as that described above may actually appear to be hyperactive or even manic as they struggle to regulate their emotions, and seek out a natural monotropic flow-state. Adkin (2023) refers to this as meerkat mode. This presents an issue for a society that has conceptualised burnout as looking similar to depression as the person experiencing this atypical presentation of burnout (Adkin & Gray-Hammond, 2023) will not necessarily appear depressed.

What are the risks associated with this kind of burnout?

“There is a growing under-current in various circles questioning the validity of the diagnosis of Emotionally Unstable Personality Disorder (formerly known as Borderline Personality Disorder). We know that this is commonly misdiagnosed in Autistic people (Fusar-Poli et al, 2022). We also know that there is a huge amount of sexism involved in the identification of EUPD; women out-number men 3 to 1 in the diagnosis of EUPD (Bjorkland, 2006).

When we reverse that lens, men out-number women 4 to 1 in the formal identification of autism (Rynkiewicz, 2016). Considering the high co-occurence of ADHD and EUPD (Philipsen, 2006) and the well-known co-occurrence of autism and ADHD; is it possible that we might be looking in the wrong direction? Could many of these people be experiencing a protracted, atypical, Autistic burnout?

Adkin & Gray-Hammond, 2023)

Misdiagnosis is anecdotally, a significant issue for Autistic people, in particular, Autistic people who were assigned female at birth and socialised as girls. These atypical forms of burnout often seem to be identified by mental health professionals as bipolar and personality disorders. The issue with this is that many Autistic people find these diagnoses are weaponised against them, and provide no meaningful route to recovery from the burnout that they are experiencing.

There is also a significant risk of an Autistic person being institutionalised in this state, with a significant portion of inpatients being Autistic. This is problematic for many reasons, but in particular I worry about the sheer number of abuse scandals that come out of inpatient units year on year. We also have to consider that inpatient settings are often traumatic in their own right due to the upset to routine and having a familiar space that Autistic people often appreciate.

Conclusion

There is no quick fix to the development of burnout in Autistic people. The driving factor behind burnout is that our world is not well designed for people with a monotropic attentions style. If we want to reduce rates of burnout, we have to decrease the likelihood of people experiencing extended periods of monotropic split. Such endeavours may sound simple on paper, but require a fundamental change to the way our world is structured.

Autistic burnout can have severe impacts that resonate throughout the person’s life for many years, and as such, we as a community need to know how to recognise and respond to our neurokin in distress.

References where link not available

Rynkiewicz, A. (2016). Autism spectrum disorders in females. Sex/gender differences in clinical manifestation and co-existing psychopathology (Doctoral dissertation, PhD Dissertation. Retrieved from Medical University of Gdansk Bibliography Database 2016).

David Gray-Hammond 0 Comments
Jun 30 2023
What is alexithymia?

Recently i wrote about alexithymia and it’s ramifications for our mental health. Since publishing that post, it has come to my attention that many people feel this is an underdiscussed area and weren’t sure exactly what it means.

So, what is it?

Simply put, it means that you can’t match up the internal signals of your emotions with words to describe your emotions. For example, I can’t tell the difference between anxiety and excitement. This means that when I’m experiencing either of these emotions, I don’t know what I am feeling.

This is because alexithymia relies on one of our senses called interoception. This sense allows us to feel the internal state of our body. Interoception covers more than emotions as it also tells us things like how fast our hearts are beating, whether we’re the right temperature, or if we’re thirsty or need the toilet.

Because Autistic people experience interoception differently, it affects our ability to identify and describe our emotions.

Alexithymia appears to have links to atypical burnout, meerkat mode (as conceptualised by Tanya Adkin), and psychosis. Alexithymic people might not recognise their burnout, and therefore will not take time to recuperate. Alexithymia has been seen in around 50% of Autistic people studied, although studies tend to only look at those with a formal diagnosis.

Alexithymia is perhaps one of the least understood aspects of Autistic experience among autism professionals; therefore representing an area requiring a great deal of attention for those working with Autistic service users. In particular, mental health professionals.

David Gray-Hammond 4 Comments
Jun 6 2023
What is meerkat mode and how does it relate to AuDHD?

This article was authored by Tanya Adkin

“

Lovingly dubbed “meerkat mode” by Tanya due to the heightened state of vigilance and arousal it presents, it involves constantly looking for danger and threat. It is more than hyper-arousal, Tanya believes that it is actually an overwhelmed monotropic person desperately looking for a hook into a monotropic flow-state.

This is not just sensory hyper-arousal, it is the tendency of monotropic [AuDHD] minds to seek out a natural and consuming flow-state to aid recovery from burnout and/or monotropic split. Because of the heightened sensory-arousal and adrenal response that comes with it, monotropic flow becomes difficult to access, leading into monotropic spiral.”

Adkin & Gray-Hammond (2023)

Recently David and myself have written a few articles on atypical burnout (Adkin & Gray-Hammond, 2023) and the burnout to psychosis cycle (Adkin & Gray-Hammond, 2023). In those articles I’ve mentioned something that I refer to as “meerkat mode”. People seem to relate to the concept as discussed in the articles, so I thought it may be wise to dedicate a whole article to what I mean by this concept.

Firstly, I want to explain that I am a very visual thinker, who happens to be plagued with good ol’ imposter syndrome. Said imposter syndrome tells me I should have thought of a more academic terminology, but that’s not the way my brain works. Truthfully, I can’t think of a much better visual representation for what i’m about to describe.

Meerkat modes presents an answer to the diverse forms of burnout I have witnessed through my work with a wide range of neurodivergent people. David agrees with the assessment as a fellow “autism professional”. I don’t set out to reinvent the wheel or change entire paradigms, this is and was a way for me to simply explain a phenomenon that is more common than people realise. A phenomenon that I see described on an almost daily basis as hypervigilance or a trauma response, but in my experience is more than that.

What is meerkat mode?

  • Hypervigilance
    • Hypervigilance is not a diagnosis. Rather, it is the brains biological adaptation to ongoing stress and trauma, which we know that Autistic people experience at a higher rate than non-Autistic people (Gray-Hammond & Adkin, 2023). It is the way it maintains a state of high alert on the look out for threat. It’s a description of a state of being that is commonly seen in diagnostic criteria for things such as PTSD, anxiety disorders, schizophrenia spectrum disorders, psychosis and psychotic phenomena, some personality disorders, and much more.
    • Interestingly, a lot of these mentioned diagnoses are seen to be co-occurring with Autistic experience.
  • Seeking a monotropic flow-state (Hyperfocus)
    • Flow-state in terms of monotropism refers to the tendency for monotropic brains to fall into deep attention tunnels that are intrinsically motivating. It has been reported by Autistic people that entering this flow-state is beneficial to monotropic peoples mental wellbeing.
    • Flow-state and hyperfocus are often used interchangeably and there is a general acceptance of it’s occurrence but no solid definition.
    • Anecdotally, when we see this as a person seeking to be in a constant flow-state, it can often indicate dysregulation or adaptations needed within the environment. Sometimes (when dysregulated) this flow state can be quite negative and turn into a monotropic spiral.
    • Because of hypervigilance people experiencing “meerkat mode” have a significantly more difficult time accessing flow-state.
    • Hyperfocus/flow-state is reported in autism, ADHD, and schizophrenia (Ashinoff & Abu-Akel, 2021).

“Refers to a state of being engrossed in a task that is intrinsically motivating during which task performance improves, there is a tendency to shut out external environmental stimuli, and internal signals”

Ashinoff & Abu-Akel (2021)
  • Increased Sensory Dysregulation
    • Interoception
      • Interoceptive differences do not only occur in Autistic people. They are thought to be largely caused by early-life stress (Löffler et al, 2018) and trauma (Schulz, Schultchen & Vögele, 2021).
      • Interestingly, interoceptive differences are seen to occur in ADHD people, Schizophrenic people, eating disorders, anxiety disorders, emotionally unstable personality disorder (EUPD), and more.
      • I am not stating that Autistic interoceptive differences are created by trauma, rather that the generic understanding of interoceptive differences is attributed to stress and trauma.
    • Alexithymia
      • Alexithymia refers to the difficulty or inability to sense or decipher one’s own emotions or the emotions of others. It could be described as a subcategory of interoceptive differences.
      • The general view is that alexithymia is created or arises from extreme stress or trauma, some research does suggest it could have biological or developmental links (Thompson, 2009).
      • Again, alexithymia occurs in more or less every diagnostic category I have pointed out previously, including ADHD, or any situations that create stress or trauma.
    • Link between interocetion (alexithymia), vestibular, and proprioception
      • Those that are displaying “meerkat mode” (in my experience) will generally seek proprioceptive and vestibular input, e.g. bouncing on a trampoline, rough play, being upside down. They may be “clumsy” or meet criteria for developmental coordination disorder (dyspraxia).
      • Interestingly, the above sensory profile is highlighted in guidance to be of clinical significance with a PDA profile of autism (PDA Society).
      • Generic advice for someone experiencing “meerkat mode” would be to increase proprioceptive and vestibular input in order to regulate interoception.
      • Interoception takes the leading role in emotional regulation.

“Interoception works the vestibular and proprioceptive senses to determine how an individual perceives their own body. Well-modulated interoception helps the individual detect proprioceptive and vestibular sensation normally.”

sensoryhealth.org
  • May be unable to stop or rest
    • As David and I have discussed previously in our articles on atypical burnout and the burnout to psychosis cycle those that appear to be meerkatting may not be in a position to stop and recover.
    • This could be due to co-occuring ADHD (AuDHD) or life demands such as parenting or work, maybe interoceptive differences mean that the person does not “feel exhausted”. They could be in a monotropic spiral of flow-state which is shutting out everything else.

Concluding thoughts

There are infinite possible interactions between an AuDHD person and their environment. And this is why I think we often struggle to define our experiences through something that can be outwardly observed and measured.

This is just one explanation for something that I have witnessed in a sea of possibilities.

References

Adkin, T. & Gray-Hammond, D. (2023) Creating Autistic Suffering: The AuDHD Burnout to Psychosis Cycle- A deeper look. emergentdivergence.com

Adkin, T. & Gray-Hammond, D. (2023) Creating Autistic Suffering: What is atypical burnout? emergentdivergence.com

Ashinoff, B. K., & Abu-Akel, A. (2021). Hyperfocus: The forgotten frontier of attention. Psychological Research, 85(1), 1-19.

Gray-Hammond, D. & Adkin, T. (2021) Creating Autistic Suffering: In the beginning there was trauma. emergentdivergence.com

Löffler, A., Foell, J., & Bekrater-Bodmann, R. (2018). Interoception and its interaction with self, other, and emotion processing: implications for the understanding of psychosocial deficits in borderline personality disorder. Current Psychiatry Reports, 20, 1-9.

Schulz, A., Schultchen, D., & Vögele, C. (2021). Interoception, stress, and physical symptoms in stress-associated diseases. European Journal of Health Psychology.

Thompson, J. (2009). Emotionally dumb: An overview of alexithymia.

Tanya Adkin 4 Comments
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