Autistic Burnout vs. Depression
*social withdrawal is typically maladaptive (harmful) in the context of depression however can be adaptive (helpful) in the context of Autistic burnout and therefore functions differently.
Depression or Autistic Burnout?
When you come to an autism discovery late in life, it is often followed by a season of a thousand “ah-ha” moments. It’s like all the unanswered questions of your life finally become answerable. It can be a powerful and intense experience.
For me, one of those powerful ah-ha moments was around the concept of Autistic burnout. I have struggled with fatigue my whole life, most intensely in the aftermath of childbirth/having young children. I’ve been diagnosed with depression a handful of times. And yes, I was depressed, and it was good to be treated for depression. However, each season of depression followed a particularly intense period of pushing, masking, and performing. What I now realize is that each season of depression was instigated by a season of Autistic burnout.
If I had had an accurate understanding of Autistic burnout, I believe my episodes of depression would have resolved more quickly. It is incredibly important that we increase awareness of Autistic burnout within the mental health world because Autistic burnout is one of the leading causes of depression and suicidality for Autistic people.
The Connection Between Autistic Burnout and Depression
While Autistic burnout is distinct from depression, it often leads to depression; Autistic burnout is a distinct pathway to Autistic depression and suicidality. So it is not hyperbolic to say that understanding the difference and treating Autistic burnout can save lives. I realize that sounds dramatic, but that’s kind of the point; this is really important for clinicians to understand.
So, if you’re a clinician reading this; consider ways to sharpen your eye so you can spot Autistic burnout. If you love an Autistic person, sharpen your eye and find ways to reduce their overall social/cognitive load when they start to burn out. And if you are Autistic, take care of yourself, learn some of the strategies that will help prevent Autistic burnout, and know your triggers and early signs of burnout.
And now, moving on to the data. To orient you to what is covered in this long post, I encourage you to pick and choose sections to read based on what is relevant to you.
Overview
Autistic Burnout Overview
Few scientists have formally studied Autistic burnout, and thus it is largely missing from the academic and clinical literature. It has recently become more widely talked about as autistic self-advocates are increasingly sharing their internal experiences of autism. Raymaker et al. recently published one of the first studies on autistic burnout. Much of the following information comes from their research.
Because Autistic burnout is distinct from occupational burnout and from depression, there is a clear need for specific training and education to address autistic burnout. Raymaker et al. suggest that education on Autistic burnout be included in clinical training and suicide prevention programs. Raymaker et al. study is one of the first to move toward a clinical definition of burnout; they define it as:
Definition: 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., 2021).
Depression and Burnout
Are You Depressed Or Is It Autistic Burnout?
A question I've often pondered, and one that is commonly encountered in the Autistic community, is distinguishing between depression and Autistic burnout. Throughout my life, I've sometimes found myself in the midst of what I believed was depression, only to realize later that it was actually Autistic burnout that eventually led to depression. It's not surprising that this misdiagnosis happens, as the symptoms can look remarkably similar:
Concentration Difficulties: Both conditions often present cognitive challenges like brain fog and executive functioning difficulties, making it feel like you're moving through life in slow motion.
Influences on Interpersonal Decision-Making: Both depression and burnout can result in social withdrawal. In depression, this may stem from low self-esteem, a sense of worthlessness and a loss of pleasure, while in burnout, the overwhelming sensory and social demands may feel insurmountable. Additionally, the decreased ability to mask during burnout can influence social interactions and decisions.
Emotional Sensitivity: In depression, emotional vulnerability might manifest as numbness or heightened sensitivity. During burnout, our already sensitive nervous systems are pushed to the limit, leading to more frequent sensory shutdowns and meltdowns.
Food and Appetite Changes: Appetite changes are a hallmark of depression. In burnout, there's often a greater reliance on safe foods, and sensory sensitivities can further alter appetite, as eating becomes a high-sensory activity.
Social Withdrawal: While social withdrawal is a symptom of depression, Autistic people also tend to withdraw more than usual in burnout. However, this withdrawal can actually be adaptive, helping to manage overwhelming sensory input.
Executive Functioning Difficulties: Tied to concentration challenges, this symptom reflects the brain operating more sluggishly.
Fatigue and Loss of Motivation: The overwhelming tiredness and lack of drive are common in both, making even getting out of bed a herculean task some days.
Sense of Emptiness: Depression is often characterized by a deep sense of emptiness. In burnout, the inability to engage with interests can lead to a similar feeling, especially when those interests are closely linked to one's identity.
Distinguishing between Autistic burnout and depression is crucial, yet challenging. Raymaker et al.'s research sheds light on two key differences: the profound loss of interest and significant sleep changes more closely associated with depression.
The nuanced use of withdrawal in these conditions is also critical. Understanding whether withdrawal is adaptive or maladaptive can be a vital clue in differentiating between depression and Autistic burnout.
Social Withdrawal
Recognizing the Nuances of Social Withdrawal: Adaptive vs. Maladaptive
When it comes to depression, withdrawal often serves as a red flag, signaling that the depression is deepening and the person is isolating. In depression, a person may withdraw due to a lack of interest, pleasure, and motivation. This type of withdrawal can lead to a loss of meaning and purpose, and deepen the depression.
As a result, mental health professionals tend to focus on addressing avoidance behaviors. Understandably, when we witness someone withdrawing, it can raise concerns, as it often signifies a deeper descent into unwellness.
However, Autistic burnout introduces a nuanced perspective that is frequently misunderstood by those seeking treatment and those around them. This perspective revolves around the concept of what I refer to as adaptive vs. maladaptive (helpful or unhelpful) withdrawal.
Understanding Social Withdrawal: A Functional Approach in Autistic Burnout
When discussing Autistic burnout, it's crucial to understand the role of social withdrawal. Recent research by Mantzalas et al. (2022) offers an enlightening perspective on this. For many Autistic adults, managing energy is a daily reality. In this context, social and sensory withdrawal is not merely avoidance; it's a strategic coping mechanism.
Each day starts with a limited number of energy units, with every interaction and sensory experience costing a bit of our battery’s power. The cost for Autistic individuals can be significantly higher than for neurotypical individuals, making strategic withdrawal essential. It's a way to conserve energy for meaningful activities and interactions that bring joy and a sense of belonging.
Yet, this form of withdrawal is often misunderstood. Seen by many as avoidance or disengagement, it is actually a functional form of self-care, a way of knowing and respecting one's limits. External pressures from family, friends, and therapists to engage more socially may not fully grasp the sensory and emotional toll of that social interaction. They miss that this withdrawal is about preservation and recovery, not disconnection.
In my experience, finding a balance is key. It's important to stay connected to energizing and fulfilling activities, hobbies, causes, or nurturing relationships. Equally crucial is knowing when to step back, to recharge, and to protect our energy. This balance isn't about cutting oneself off from the world; it's about engaging on our own terms, in sustainable and nourishing ways.
Understanding social withdrawal in the context of Autistic burnout is key for untangling depression vs. Autistic burnout. In the context of Autistic burnout social withdrawal is not a sign of maladaptation, but a strategic, adaptive response to the unique challenges faced by Autistic people. Recognizing and respecting this approach can lead to more empathetic and effective support, helping Autistic adults navigate life while keeping our energy reserves protected!
Can Autistic Burnout Cause Depression?
The intersection of Autistic burnout and depression is an area of significant concern. It's indeed possible for Autistic burnout to lead to depression, resulting in an individual experiencing both conditions simultaneously. This overlap is understandable. During burnout, motivation levels plummet, making it challenging to engage in activities that usually bring meaning, joy, pleasure, and interest. This lack of engagement is a known precursor to depression.
Moreover, the difficulties in accomplishing basic life tasks, a common feature of Autistic burnout, can trigger a spiral of negative self-perception. Feelings of worthlessness or inadequacy often accompany this struggle, heightening vulnerability to depression. It's a complex interplay where the cognitive and emotional challenges of burnout feed into depressive thought patterns.
Recognizing and addressing Autistic burnout early is therefore crucial. Timely support can not only alleviate the symptoms of burnout but also reduce the likelihood of it escalating into severe depression. It's about providing the right kind of support – one that understands the distinct experiences of Autistic individuals and addresses both the burnout and the potential onset of depression.
By approaching Autistic burnout with this dual awareness, we can create a more robust support plan where we prioritize sensory safety, foster a deeper engagement with Autistic culture, ensure time is dedicated to personal interests, and carefully craft a plan for gradual re-engagement in meaningful connections and activities.
Characteristics
Characteristics of Autistic Burnout
Autistic burnout, as defined, has three primary characteristics:
(1) First, there's that pervasive exhaustion, a fatigue that seeps into every aspect of life.
(2) Second, there's the heightened sensitivity to sensory input, making the world feel even more overwhelming.
(3) Finally, there's the unsettling loss of skills, something that can be quite disorienting for those experiencing it. (e.g., reduced executive functioning such as thinking, remembering, creating and executing plans, performing basic self-care skills, and activities in daily living).
Other Symptoms: In addition to intense emotional, physical, and mental exhaustion, burnout can also lead to difficulty managing emotions and increase behavioral outbursts or intense anxiety. It can also increase autistic traits such as repetitive behaviors, reduced tolerance for sensory sensitivities, and increased difficulty adapting to change.
Autistic burnout isn’t a fleeting phase. To meet the clinical definition of Autistic burnout syndrome, it's got to stick around for three months or longer, as pointed out by Raymaker and their colleagues in 2020.
Causes of Burnout
What Causes Autistic Burnout?
Autistic burnout doesn't just happen out of nowhere; it's the result of a complex web of causes and contributing factors. It doesn't just happen suddenly, either; rather, it builds up as a result of continued strain and stress in navigating a world primarily designed for allistic (non-autistic) individuals. Let's explore the key contributors:
The Stress of Navigating a Neurotypical World: For many Autistic individuals, the constant effort to adapt to allistic expectations is a major factor in burnout. This is particularly true for those who frequently employ camouflaging and masking techniques in social settings.
Sensory Overstimulation: Continual bombardment with overwhelming and exhausting sensory stimuli.
Executive Functioning Demands: The ongoing need for high levels of executive functioning can lead to significant fatigue.
Co-occurring Conditions: The presence of other mental health conditions or health issues can exacerbate the effects of burnout.
Life Transitions and Stressful Events: Major life changes such as puberty, transitioning into adulthood, or experiencing menopause, can act as catalysts.
Incomplete Stress Cycles: Continuous nervous system activation without adequate resolution can contribute significantly to burnout.
Alexithymia and Interoception Challenges: Difficulties understanding and processing emotions and internal bodily sensations can be an additional stressor.
Autistic burnout is often seen as a side effect of the intense effort to meet neurotypical expectations, combined with sensory overstimulation and high executive functioning demands. It's especially prevalent among Autistic individuals with strong cognitive and language abilities who engage in camouflaging and masking in social contexts. Essentially, it's akin to our continuously trying to fit into a space that was never designed for us, leading to chronic life stress and eventual burnout.
The Burnout Equation: A Framework by Raymaker et al.
In their groundbreaking research, Raymaker et al. offered a crucial framework for understanding Autistic burnout. They describe it as a consequence of life stressors and barriers to support accumulating to a point where they surpass an individual's coping abilities.
Put simply, when the expectations placed upon us exceed our abilities (and the support available), we find ourselves in an unsustainable situation, leading to burnout. This rings particularly true for those of us in the Autistic community who navigate neurotypical standards and environments through masking– whether it's in our personal lives, workplaces, or educational settings.
According to Raymaker's research, the most common stressors contributing to this imbalance include masking, suppressing Autistic traits, pretending to be allistic, and the constant pressure of social expectations. One participant in their study described it vividly:
“The metaphor I use is that long-term camouflaging and masking leaves behind a kind of psychic plaque in the mental and emotional arteries. Like the buildup of physical plaque over time can result in a heart attack or stroke, the buildup of this psychic plaque over time can result in burnout.”
This research also shed light on a troubling aspect: many participants faced difficulties in accessing accommodations and resources. This challenge was often exacerbated for those with high cognitive and verbal skills, who might appear less in need of support due to their ability to mask effectively. A significant stressor identified was the tendency of others to dismiss or “gaslight” the struggles of Autistic individuals as unreal, largely due to the invisibility of their efforts to conform. This dismissal not only invalidates their experiences but also adds to the overall stress and burden, hastening the path to burnout.
Raymaker et al.’s research further highlighted the difficulty many of their participants experienced accessing accommodations and resources (likely associated with high cognitive and verbal skills). They identified that the tendency for people to “gaslight” the struggles of autistics as unreal (due to the invisibility of masking) was a significant contributor to stress and overall load buildup.
Autistic Burnout Triggers
While there are many chronic causes of Autistic burnout it is helpful to identify triggers that can cause burnout, and it is particularly helpful to know your specific triggers.Some people have mild burnout every time their schedule changes or perhaps after a season of high social demand.
Knowing your specific triggers for burnout will help with burnout prevention and help you to better understand your needs.
Autistic Burnout Recovery
Recovery depends on the person and the specific causes. For a prolonged season of burnout, a person may need to significantly restructure their lifestyle and remove themselves from the causes of their burnout. It may become more difficult to recover, too, as one grows older.
Dr. Neff’s Tips for Autistic Burnout Recovery:
Practice boundaries and reduce unnecessary tasks and work. Practicing good boundaries is key for dropping unnecessary social and work demands.
Find ways to reduce sensory input (use noise-canceling devices, sunglasses, etc.).
Rest. Try to focus on rest that feels restorative. Binge-watching television may feel restful but is likely not restorative. Reading or listening to a book related to a special interest, engaging in activities that you experience as soothing to your sensory system are examples of rest-providing activities.
Find alternative ways to express yourself. Many Autistics have alternative ways of expressing emotions. Writing, art, making a collage, writing a poem, or finding music that matches your mood are just a few examples of alternative ways of expressing yourself. And, if you feel empty and if there isn’t anything to express, that’s okay, too.
Don’t let the routine go. In burnout, we’re tempted to lose the routine altogether. However, routines are soothing to our nervous systems and minds because they tell us what to expect. The routine can be: “wake up, make coffee and rest on the couch for two hours while reading;” it doesn’t have to be rigorous, but having a few anchor points during the day will be helpful.
Engage in activities that are soothing to your senses. Gentle movement is likely helpful; find gentle and soothing ways to move your body.
Nature is particularly restorative for autistics. If you have access, take time to go and sit by a lake, the ocean,a beautiful meadow, or simply listen to nature sounds.
A list of potential solutions to autistic burnout also emerged from the Raymaker research. Here is a list of potential solutions that they proposed:
Recovery Tips
Autistic Burnout Recovery Tips (Raymaker et. al.)
Acceptance and access to Social Support: individual and community support, peer support, attending to autistic needs, unmasking.
Leaning into Autistic Strengths: Using autistic strengths, advocating for, and receiving reasonable accommodations and instrumental supports such as respite support.
Formal Supports: Mental health supports, Time Off/Breaks, ability to socially withdraw
Reducing Load: Reducing activities, setting boundaries, asking for help
Self-Advocacy and Health: Focusing on a healthy lifestyle, early recognition, and receiving an Autism diagnosis
Self-Knowledge: Understanding patterns and triggers and making strategic decisions to be preventative.
Engagement with the autistic community: Engagement with the autistic community can help a person name and validate their experience of burnout.
Prevention Tips
Autistic Burnout Prevention
Prevention is the best strategy for Autistic burnout. Self-knowledge is critical for this – knowing your triggers and identifying early signs of burnout. For some people, early signs will be increased sensitivity to sensory input; for others, it will be depersonalization and detachment or vision changes such as tunnel vision.
Such signals can inform a person that it’s time to remove themselves from the situation and arrange some sensory detox and downtime. Self-knowledge can also help a person self-advocate, seek out appropriate supports and accommodations, and plan travel and daily rhythms to build in sensory detox/downtime.
Autistic Burnout Resources
For additional information on Autistic burnout here are some follow up resources.
Books
Autistic Burnout Workbook: Check out the comprehensive Autistic Burnout Workbook and Tool Kit or the Autistic Burnout Recovery Workbook Bundle.
Burnout: The Secret Of Unlocking The Stress Cycle: While not specific to Autistic people this is a great book on burnout, completing the stress response cycle and how to recover from burnout.
Podcasts
Podcast: Autistic Burnout by Divergent Conversations
References
Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew”: Defining Autistic Burnout by Dora Raymaker, Alan R. Teo, Nicole A. Steckler, Brandy Lentz, Mirah Scharer, Austin Delos Santos, Steven K. Kapp, Morrigan Hunter, Andee Joyce, and Christina Nicolaidis (Autism In Adulthood, 2020).
A conceptual model of risk and protective factors for autistic burnout by Jane Mantzalas, Amanda Richdale and Cheryl Dissanayake (Autism Research, 2022)
What is Autistic Burnout? A thematic Analysis of Posts on Two Online Platforms by Jane Mantzalas, et al. (Autism Adulthood, 2022).
