Something interesting happened to me this week – I had a 2-day long anxiety attack.
Which I guess is not something one would normally write about in a blog, but in fact, once you remove the fear of judgement (and get over the self-absorbed ‘why me?’ thing), it’s actually quite a fascinating phenomenon. And I wanted to share because it made me realise how many misconceptions I had (and presumably lots of other people have) over the topic.
First off, I did not equate what was happening to me as ‘anxiety’ at all.
To me, anxiety is that feeling somewhere between worry and fear that precedes an event you are dreading. That kind of anxiety serves a useful purpose – it makes you just uncomfortable enough to knuckle down and do what you need to do (e.g. revise for that exam, practice for that interview, etc.). Or it makes you so uncomfortable that you realise you’d be better off avoiding the dreaded event altogether. I know that feeling.
This was something different. The way I would describe it is having a nervous system in hyperdrive. Everything was amped up to the max, like switching to a more powerful battery. My thoughts were faster, more repetitive, and loud enough to miss half of what people were saying to me. Talking came easier than usual, though – faster and more impulsive. I had an intense need to keep moving (tapping my fingers, jiggling my knee, springing up and going for a walk), to release nervous energy. I felt myself starting to sweat. If someone had touched me from behind I would have jumped out of my skin. That first night I barely slept, but the next day I wasn’t drowsy – I was still wired.
It could almost have been fun, except that I was at work and I could have done without having my colleagues see me in that state, agitated and jittery. Would they think me a nervous wreck? And yes, when your thoughts are circulating, repeating, escalating, the smallest of negative thoughts can become a monster. A minor frustration expands until it truly feels like the end of the world. I didn’t get as far as a panic attack, but approached too close for comfort.
I wouldn’t have called the experience anxiety, though, because that’s putting things the wrong way round. It wasn’t anxiety causing physical symptoms, it was the physical symptoms – the hyperarousal of my nervous system – that was causing small anxieties to escalate.
Do you see the distinction? It’s important, if you’re thinking about treatment, because confusing the two types of anxiety might make you think, for example, that counselling sessions of the ‘talk about what’s worrying you’ kind are going to help prevent this kind of attack. They won’t.
So what was going on?
When I tried to explain to someone what was happening and they mentioned anxiety, my knee-jerk reaction was to deny it was any such thing. But then, being me, I googled it to check. Did what was happening to me match any type of anxiety disorder? Here they are:
Generalised Anxiety Disorder (GAD) – excessive, uncontrollable worry about a range of ordinary situations like health, work or finances? Nope, this was an acute attack not a chronic condition. That doesn’t fit.
Social Anxiety Disorder (SAD) – avoidance of social or performance situations for fear of being embarrassed or rejected? We-ell, I had considered this in the past to explain my difficulties with social interaction, but then I realised I had the letters the wrong way round; not SAD but ASD. So, no.
Panic disorder – associated with regular panic attacks, which are sudden, intense episodes of irrational fear, shortness of breath, dizziness and other physical symptoms? Not that acute, no.
Obsesssive Compulsive Disorder (OCD) – unwanted thoughts and impulses (obsessions), causing repetitive, routine behaviours (compulsions) as a way of coping with anxiety? No. Well, OK, I did mention repetitive thoughts but I’m pretty sure that’s the ASD again.
Post-Traumatic Stress Disorder (PTSD) – a group of stress reactions that can develop after witnessing a traumatic event. Symptoms include (1) Re-experiencing the trauma, (2) Avoiding reminders of the event, (3) Negative changes in thoughts and mood after the event, (4) Feeling ‘on edge’ and overly aroused? Well… yes. Number 4 would fit. Except that I haven’t been in a situation traumatic enough to produce PTSD.
One thing I was pretty sure of was that however one might label this attack, it was related to ASD. Certainly it had the usual hallmarks of being bizarre, nonsensical and inexplicable. Truth be told, it’s happened a few times before, though I was less aware at the time, and it seems to be a cyclical thing, with an acute incident every few weeks.
All my internet searches were telling me was that autistics are at increased risk of anxiety. But what kind of anxiety and why? Googling was getting me nowhere; I couldn’t find a single site that could offer an explanation that fit.
And I really, really wanted to know, with all the existential angst triggered by thoughts such as: “Why is this happening to me now, when I never had a problem before?” And “Oh shit, is this going to get worse?”
And then I found something, in Temple Grandin’s book “Thinking in Pictures”, and I realised why the author is held in such high esteem; she has remarkable self-awareness and insight. Though my few attacks have been blessedly brief and mild in comparison to the levels of anxiety she’s dealt with her whole life, I recognise the same underlying mechanism at work:
“…I started living in a constant state of stage fright, the way you feel before your first big job interview or public speaking engagement. But in my case, the anxiety seized me for no good reason…”
“I now realise that because of the autism, my nervous system was in a state of hypervigilance. Any minor disturbance could cause an intense reaction. I was like a high-strung cow or horse that goes into instant anti-predator mode when it is surprised by an unexpected disturbance.”
“I figured out that my nerve attacks came in cycles… I also knew from past experience that the attacks would eventually subside. The first relapse occurred during a new equipment startup at a meat plant. Stress can trigger a relapse. I just toughed out the nerve attack, and it finally went away….”
“I realised that I often had periods of several months when my anxiety was quite low, and then suddenly a panic attack would flip a metabolic switch and my nerves would go from a tolerable 75 mph to a horrible 200 mph. It would then take several months for them to subside to 75 mph. It was like switching the speed on an industrial-strength fan by pushing a button. My nervous system instantly jumped from a brisk breeze to a roaring hurricane.”
“Dr Jack Gorman and his associates at Columbia University describe a process called kindling, which may explain such sudden increases in anxiety. In kindling, repeated stimulation of neurones in the limbic system of the brain, which controls the emotion centers, affects the neurones and makes them more sensitive. It’s like starting a fire in kindling wood under the big logs in the fireplace. Small kindling fires often fail to ignite the logs, but then suddenly the logs catch on fire.”
“Most of my problems were not caused by external stresses such as a final exam or getting fired from a job. I am one of those people who are born with a nervous system that operates at a perpetual state of fear and anxiety. Most people do not get into this state unless they go through extremely severe trauma, such as child abuse, an airplane crash, or wartime stress. I used to think it was normal to feel nervous all the time, and it was a revelation to find out that most people do not have constant anxiety attacks.”
Funny how much more insight one can get from reading the personal account of one sufferer than from any number of internet articles. Makes me think, you know, for all the scientists who are studying autism spectrum conditions, they seem no closer to getting the full picture than I am to producing the Unifying Theory of the Universe.
Oh, and if reading Ms Grandin’s words makes you concerned for me, don’t be. Unlike Ms Grandin, I wouldn’t say I feel nervous all the time or live in a perpetual state of anxiety. The occasional high-jinks of my nervous system have been little more than an inconvenience.
Anyhow, I do have two thoughts from all this.
The personal one is that, thanks to some stressful life events combined with my ASD, I seem to have developed an intermittent (and hopefully temporary) nervous condition with similarities to PTSD. Lucky me!
My other thought is that, if this kind of attack is what is meant by autistics being prone to anxiety, I think that ‘anxiety’ is the wrong word. Or at least, it is woefully inadequate to describe what’s going on. Wouldn’t it be better explained as autistics having a more sensitive nervous system, so that sometimes a seemingly minor trigger can lead to a prolonged state of hyperarousal, including heightened levels of anxiety?
If you have to reduce it to a label, call it autistic hyperdrive. That sounds so much cooler.