Hello, friends. In this episode, I answer two very different questions relating to extreme burnout and whether this can cause trauma, and seeking a diagnosis in adulthood when you suspect you have autism.
Two years ago I had a breakdown due to extreme burnout. After I returned to work, I was never really the same. I haven’t felt the passion for what I’ve dedicated my life to, phone calls from work make me panic, depression, and daily anxiety about work just to name a few. Even though it’s been two years and I no longer work in the same place, I still get these overwhelming feelings of dread.
I started a new job a few weeks ago and they have the same paper towel dispenser. The first time I used it, I jumped. Although silly, I work in kitchens, so paper towels are a constant.
This paper towel event and my continued feelings (this is now my second job after leaving the one mentioned) in regards to my career have me thinking, could this be PTSD? Is severe burnout considered trauma? If so, could we burn ourselves out so deeply we end up with PTSD?
This thought has been bouncing around and I thought it would be an interesting conversation to have as well as the potential positive implications it could have on worker burnout. Burnout is “just being tired” (I say that with IMMENSE sarcasm), right? but ptsd is put into its own category, potentially heightening the perceived severity of burnout.
Thanks for taking the time to read this! I hope you and your family are well.
Hey! Thank you for the really good question. Sorry to hear that you were driven to such an extreme burnout that you had a breakdown. That’s terrible and it’s too bad you were in a situation that didn’t allow you to prioritize your health.
To your question of could this be PTSD? Let’s have a look at the diagnostic criteria: In the DSM V – the first criteria is “exposure to actual or threatened death, serious injury, or sexual violence. This is where the PTSD diagnosis gets a little tricky, because that is a little narrow. I have been reminding people often that trauma is not the event that happened, but the body’s response to it – so how do you reconcile that with the fact that someone’s experience might not meet diagnostic criteria for a given disorder. The answer is really that the diagnosis is a shorthand. It doesn’t tell the whole story. If someone had an event that gave them all of the other diagnostic criteria, but their triggering event doesn’t fall within those bounds, I would hesitate to tell them that they don’t have PTSD.
PTSD is really about how the brain stores memories and the way it re-experiences the trauma when recalling the memory. They are stored in a way that feels dangerous and immediate. Beyond the event itself, with PTSD you get one or more of the following: recurring intrusive distressing memories of the event, recurrent distressing dreams, dissociative reactions such as flashbacks, intense psychological distress at exposure to internal or external cues, and strong physiological reactions to internal or external cues. You also get persistent avoidance of stimuli and triggers associated with the traumatic event, negative alterations in mood and cognition about the event, and changes in arousal and reactivity. These need to last for more than a month and cause a significant disruption to someone’s social life, occupational functioning, or other important areas of functioning.
By these criteria, it’s possible that you wouldn’t qualify for a diagnosis of PTSD, though I could be wrong – obviously, I’m going off limited information here. I’m not sure if you are getting full flashbacks, hypervigilance, etc. BUT there are more types of traumatic reactions than just PTSD and I think it’s also important to just consider the power of association.
Association is the brain’s ability to group things together. Classical conditioning is what Pavlov did to his dogs. If you have a pet, you have probably seen classical conditioning in them too. If your pet (or kid) comes running like a bat out of hell at the crinkling sound of a bag because they think they are getting treats, that’s classical conditioning. The sound of crinkling has nothing to do with food instinctually, but over time, they learned to associate that sound with the receiving of treats, so now they have a whole reaction to the sound on its own. This happens to us in many ways as humans. For a lot of people, if they see blinking or colored lights while driving their body has an immediate stress reaction because they think they are being pulled over. Have you also noticed that the urgency to pee gets much worse the closer you are to the toilet? Also association. Our brains are really really good at finding shortcuts. This is one of the things that helped us survive as a species, but sometimes those associations are too strong or irrelevant and get you in trouble.
For you, you had a really tough season of your life where you really endured some psychological harm. It makes sense that there are certain things that you associate with that. For instance, if someone worked in an abusive workplace that always had the same songs playing in the background, they may have a really hard time hearing those songs anymore. It sounds like you hit a bottom while you were working and in a very real way have a strong negative association to work itself. It still elevates you body, decreases your mood, and causes you stress. Ideally, this is something that would fade with time if you are able to avoid avoidance and stick with your job, provided that it is a healthier environment. If you are able to experience success and treat yourself well in this new job, it may be the perfect platform to unlearn some of those negative associations you have. But if you are just in another spiral or working yourself to the bone and barely holding off burnout, I don’t think that will happen.
It may also be that the previous experience with work was simply the triggering event that kicked off a clinical depression or something like that. In which case, I think the best thing to do would be to try to stick with the job (again, provided it’s actually a healthy environment) but enlist the help of a professional to help you work THROUGH some of this stuff. To identify the negative thoughts, associations, etc going on and learn some skills to cope with them. Our bodies are good at a lot of things, but enduring chronic stress is not one of them. If your previous work environment caused you to be in a chronic stress reaction, your body may have physiologically been burned out as well. If you’re still working in kitchens, it may be an uphill battle to get things back to a manageable level, just since I know they can be intense places. Please don’t feel like you’re doing something wrong for feeling the way you do, but please also pay attention to this and use it as an opportunity to do some healing, preferably with the help of a professional.
I believe I am autistic. Here is some background info on me — I am 23 years old, in University, I was assigned female at birth but I am nonbinary/ trans masculine, so I grew up in the world perceived as a girl. My relevant diagnoses are ADHD (and sensory processing disorder as a part of my ADHD), and GAD (including social anxiety). I also deal with a mood disorder and in the past have been diagnosed with an eating disorder and OCD. It’s a lot of shit. And I don’t feel like that all truly describes me and my experience. I’ve watched hundreds of videos about all of these disorders, many of which about autism (which I don’t believe is a disorder but rather a neurotype), and I relate profoundly to the autistic folks, especially the experience of those who went undiagnosed in childhood. I am almost sure I am autistic but I have gone under the radar because I have gotten really good at masking my traits. I watch what other people do and copy. I spend hours rehearsing conversations in my head. Many of my friends are autistic and I relate to them and communicate with them much better than with my neurotypical peers. However, when I told my therapist that I think I am autistic, she literally laughed in my face and said no. She was also not a good therapist and I am seeing someone better now but I’m nervous to tell them because of how I’ve been invalidated in the past. What should I do?
I’m going to keep this one relatively short. Thank you for trusting me with this question. I think that it’s absolutely valid that you would be considering whether you may have autism. You are the expert on yourself.
It is actually often the case that there are many diagnoses that are thrown out there over the years before something more concise and overarching is recognized. For instance, the sensory processing issues, differences in cognition, trouble operating in social situations, trouble coping with a world that doesn’t feel like it was built for you etc. might all point back to autism. I’m not saying that they do definitively, but you need to consider Occam’s razor and think about whether the solution with the fewest assumptions would be a possibility.
Your therapist is an idiot for laughing at you and telling you no. Even if you aren’t, that is not the way that someone in the mental health profession should be treating you. I have certainly had potential diagnoses (or neurotypes) thrown at me unexpectedly in the course of working with someone. Even if I doubt it, I don’t laugh at them. I give it a fair shake and if it seems like a good idea, try to help them get an assessment. I think that’s probably what is called for here.
There are formalized assessments that can be done, even for adults, to help identify if you are autistic vs other potential unique attributes. I would suggest you hop on google and do some searching for autism specialists, autism centers, autism assessment, etc. in your local area to see if you have resources. In southern California, we are spoiled and have many resources available, so you may not. In which case you may need to broaden your search or get creative.
I do think it’s important that you push for this though because it’s like someone who strongly suspects they have ADHD simply having their primary care tell them that they don’t. A PCP is familiar with ADHD, but really is not qualified to make that diagnosis unilaterally. So don’t let your therapist’s missteps make you feel deflated or foolish. Look for people who know what they are talking about to help you get evaluated so that you may be able to find some answers about your experience.
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