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ASD and that Damn Anxiety Problem

"Why is it that people with autism spectrum disorder seem to have more than their fair share of anxiety? I have suffered with this damn thing my entire life – as far back as I can remember. And it doesn’t get any better with age by the way. Suggestions!?"

People with ASD (high-functioning autism) are particularly vulnerable to anxiety. This vulnerability is a basic trait of the disorder due to (a) the breakdown in circuitry related to extinguishing fear responses, (b) social skills deficits, and (c) specific neurotransmitter system defects.

Reasons for anxiety include the following:
  • Lack of displayed empathy (another Asperger’s trait) significantly limits skills for self-directed social problem solving.
  • Limitations in generalizing from one situation to another contributes to repeating the same social errors.
  • Social skills deficits related to Asperger’s make it difficult for “Aspies” to develop coping techniques for calming themselves and containing difficult emotions. 
  • Their inability to grasp social cues and their highly rigid style act together to create repeated social mistakes (e.g., saying the wrong thing at the wrong time). 
  • In the workplace, it is not uncommon for the Aspie to be bullied and teased by his coworkers, yet he can’t mount effective socially adaptive responses, which often results in both anxiety and learned helplessness.

Several medications have been tried for treatment of anxiety. SRIs, buspirone, and alpha-adrenergic agonist medications (e.g., clonidine or guanfacine) have been tried. The best evidence to date supports use of selective serotonin reuptake inhibitors. One relatively new drug that seems to be having remarkable success in alleviating anxiety is Fetzima.

As a side note, people on the autism spectrum may be more vulnerable to side effects – and may exhibit unusual side effects. For example, disinhibition (i.e., a temporary loss of inhibition) is particularly prominent and can be seen with any of the serotonin reuptake inhibitors. Also, excessive doses may produce “amotivational syndrome” (i.e., a psychological condition associated with diminished inspiration to participate in social situations and activities).

Self-help strategies to reduce anxiety include the following:
  • avoid “what if” thinking (e.g., ‘What if I fail?’ … ‘What if I get sick?’)
  • avoid black-and-white (all-or-nothing) thinking 
  • avoid talking in absolutes (i.e., using words such as always, never, should, must, no one and everyone)
  • develop a daily log to plan out your days (include healthy activities)
  • develop a sense of self-trust (i.e., the ability to believe that you can handle what life throws at you)
  • don’t be a “people-pleaser” (e.g., when do you say ‘yes’ to someone when you really want to say ‘no’)
  • practice yoga
  • realize and accept that you can’t control life, you can only control yourself
  • realize that you’re responsible for your happiness and your life
  • reduce your perfectionistic tendencies
  • stop relying on others for approval

Lastly, but most importantly, distinguish fact from fiction. Fear is being afraid of something, and you know exactly what it is that you’re afraid of (e.g., heights). Anxiety is being afraid of something, but you’re NOT sure what it is. Anxiety is fiction. It’s an anticipation of things going wrong in the future. But since the future doesn’t exist (except as a mental construct), then anxiety about a future event is fiction.

Resources for Neurodiverse Couples:

==> Online Group Therapy for Men with ASD

==> Online Group Therapy for NT Wives

==> Living With Aspergers: Help for Couples 

==> One-on-One Counseling for Struggling Individuals & Couples Affected by Asperger's and High-Functioning Autism  

==> Online Group Therapy for Couples and Individuals Affected by Autism Spectrum Disorder


Anonymous said… All part of autism? Get used to it and fight it best you can! This is where the tiredness and long sleeps are relevant!
Anonymous said… as long as autistics are perceived and treated as diseased toys, they`re going to have a much higher rate of mental health issues. as long as autistics try to live like people who aren`t autistic, they`re going to have a higher rate of mental health issues. it`s really pretty simple. the solutions are more complex, however.
Anonymous said… Easier said than done. The adult Asperger want to achieve some balance and sometimes accumulative PTSD feeds into the situation, too, with triggers that appear out of left field. Overwhelming.
Anonymous said… I can only speak for myself, but my anxiety is "out there" so fast, I can never "control" it; it's too dam quick, damage done, and I'm already in wtf-mode before realizing I'm palpitating and acting like an idiot. Which makes me more anxious! I don't know how to forewarn myself to try to stop it; it just happens
Anonymous said… I love how when I went to a doctor all they wanted to do was treat the anxiety and when I asked "what about the other symptoms like innattention and sensory issues and social issues" they just ignored even trying to get me a diagnoses suggesting that anti anxiety meds would be "the cure" instead of what it really did - make me suicidal
Anonymous said… It is a hard question to answer,, but the best thing is to try and find an outlet.. to not let the anxiety spiral and take hold.
Anonymous said… Ive warned all of people around me to get away when i get angry because i really cant stop my rage 
Anonymous said… Meditation helps
Anonymous said… right it's like a nightmare coming true times 100.
Anonymous said… Why do we have anxiety? Because from birth we have been being told we aren't normal. Don't do that, dont say that, look here, go there, sound like this, look like that. When you have to think about everything just to comprehend what's going on around you, and then add in being the best actor/actress everyone has seen, because otherwise you make them uncomfortable, go figure we have anxiety!
•    Anonymous said… as long as autistics are perceived and treated as diseased toys, they`re going to have a much higher rate of mental health issues. as long as autistics try to live like people who aren`t autistic, they`re going to have a higher rate of mental health issues. it`s really pretty simple. the solutions are more complex, however.
•    Anonymous said… Have any of y'all tried Cognitive Behavioral Therapy? I'm looking into it for my 22 years old son. His meltdowns are so violent and I'm terrified he's going to end up in jail one day. Any thoughts?
•    Anonymous said… it might help, if the therapist is experienced and knowledgeable enough about autistics. but his meltdowns at this point are probably ptsd. that`s very hard to recover from. i have a similar issue myself. what he needs to learn are appropriate personal and social boundaries for himself, and how to live like an autistic. cbt might help with boundaries. it won`t help much with living like an autistic.
•    Anonymous said… My anxiety is off the hook! My doc put me on some med that I will need to purge off of but it isn't helping me stop biting my nails and having bad anyone here having the same symptoms?
•    Anonymous said… The push for uniformity of human beings in our world is most disturbing. The simple frustration of growing up with people always trying to change your fundamental personality and the stress of trying to fit in ... and failing ...

Please post your comment below…

25 Self-Help Tactics for Adults on the Autism Spectrum

“Any suggestions on what a person with AS can do to stop beating up on oneself. I berate myself often for not measuring up. I feel like I let people down a lot. I would also say I have a lot of anger built up inside (which I am forever trying to keep in check). Some of this can’t be helped, I know, based on AS (I’m on meds for anxiety and depression). But, I still feel like I should be doing better in my relationships with other people.”

So you frequently criticize yourself (internally)? If so, you're definitely not alone. As a man or woman with Asperger’s (high functioning autism), you've weathered a lot of storms in life. And as you dealt with all the difficulties that come with the disorder, your image of yourself changed. Lots of people on the spectrum have trouble coping, and this affects their sense of self-worth. Being bullied as a child, social problems on the job, relationship break-ups, anxiety, depression, and meltdowns – they all take a toll on a person over time.

Here are some self-help tactics to help you rid yourself of disapproving, defeating self-talk:

1. You would be surprised at how many “Aspies” suffer from anxiety and depression. You are in good company, and your discouraging, negative emotions are not a hopeless case. Even though it can feel like your unwanted feelings will never leave, they eventually will when you learn to talk to yourself (about yourself) differently.

2. Avoid 'should' and ‘should not’ statements. If you find that your thoughts are full of “I should do this” … or “I should not do that” … then you are putting unreasonable demands on yourself — or on others. Getting rid of these kinds of statement from your thoughts will lead to more realistic expectations.

3. Many Aspies are tempted to drink or use drugs in an effort to escape negative feelings and get a "mood boost" – even if just for a short time. But, chemical abuse not only makes anxiety and depression worse, it causes you to become even more anxious and depressed over time. Substance abuse can also increase suicidal feelings. Look diligently for another source to boost your mood!

4. Aspies can create change in their life just like anyone else. Change for some people on the spectrum means personal growth and evolution in understanding and learning. For others, it may be more about finding productive and workable “compensatory strategies.”

5. When you hear a destructive comment coming from within yourself, tell yourself to stop. Then immediately replace it with 3 compliments about yourself (e.g., “I’m smart” … “I’m strong” … “I’m a hard worker”). While you're at it, think of 3 things that really give you pleasure (e.g., the way the sun felt on your shoulders, the taste of your favorite food, the way you laughed at that joke you heard earlier, etc.). By focusing on the positive things you do and the good aspects of your life, you WILL change how you feel about yourself.

==> Living With Aspergers: Help for Couples

6. Reassure yourself. Give yourself credit for the positive changes you have already made (e.g., "My presentation wasn’t perfect, but my associates asked questions and remained engaged, which means that I accomplished what I set out to do").

7. What “typical” people call “dysfunction” can be turned into your own understanding of numerous ways that you actually DO function.

8. Understand that self-worth is all about how much you value yourself, the pride you feel in yourself, and how worthwhile you feel. Self-worth is important, because feeling good about you affects how you act. An individual who has high self-worth will make friends easily, is more in control of his or her emotions and behavior, and will enjoy life more.

9. Always remember that you are NOT disabled – you are “differently abled.” The key is changing the way you think about difference and being the one that is different.

10. Stay optimistic. Think about the good things that are going on in your life. Remind yourself of the things that have turned out O.K. recently. Consider the talents you've used to cope with demanding circumstances.

11. Anxiety and depression can take a big toll – even leading to suicidal thoughts. Talk to a counselor if life becomes too overwhelming.

12. Spend time with a friend who is active, upbeat, and makes you feel good about yourself. Avoid hanging out with those who make you feel insecure.

13. Try to limit the time you spend playing video games or surfing online. Instead, seek real-life, face-to-face connections with trusted individuals.

14. Many people with Asperger’s possess extensive knowledge of a specific interest, and therefore are capable of major accomplishments. Consider taking your area of expertise to a new level (e.g., sharing your knowledge on a blog, writing a book, uploading informative YouTube videos, etc.).

15. Forgive yourself. We all make mistakes, and mistakes are not permanent reflections on you as an individual. They are simply isolated moments in time. When you make a mistake, say to yourself, "Yes, I made a mistake, but that doesn't make me a failure."

16. Making healthy lifestyle choices does wonders for your mood. For example, diet and exercise have been shown to help anxiety and depression. You actually get a rush of endorphins from aerobics or lifting weights, which makes you feel instantly happier. Exercise can be as effective as medications or therapy for anxiety and depression. Any physical activity helps – even a short walk.

==> Living With Aspergers: Help for Couples

17. Knowing what brings you happiness and how to meet your goals will help you feel adept, resilient, and in control of your life. A positive frame-of-mind and a healthy lifestyle (e.g., exercising and eating right) are a great combination for building good self-worth.

18. Relabel troubling thoughts. You don't need to react negatively to troubling thoughts. Rather, think of these thoughts as signals to try new, healthy patterns. Ask yourself, "What can I think and do to make this situation less nerve-racking?"

19. Remember that a lot of what people on the spectrum do differently – or the ways in which they think differently – can be positively framed in realizing their ability to function in - and through - what is a different capability.

20. If your emotions are overwhelming, tell yourself to wait 24 hours before you take any course of action. This will give you time to really think things through and give yourself some distance from the intense feelings that are troubling you. During this 24-hour period, talk to someone—anyone (e.g., a parent or a friend).

21. When you’re depressed, you probably don’t feel like seeing anyone or doing anything. Just getting out of bed in the morning is a problem, but isolating yourself will make depression even worse. Stay social – even if that’s the last thing you want to do. As you get out into the community, you may find yourself feeling better.

22. If there are aspects about yourself that you want to change, make goals for yourself. For instance, if you want to get in great shape, make a plan to exercise every day and eat healthy foods. Then track your progress until you reach your goal. Meeting a challenge you set for yourself is perhaps the best method for boosting self-worth!

23. For many Asperger’s adults, common assets include high intelligence and a robust interest in at least one area of narrow focus. While this narrow focus can have its downsides, it can also be harnessed as a strength in many ways (e.g., a lover of gardening may write a “best-selling” eBook on the subject someday).

==> Living With Aspergers: Help for Couples

24. Married life can sometimes influence self-worth. For example, your spouse/partner may spend more time criticizing you and the way you behave (possibly through no fault of your own due to the symptoms of Asperger’s) than complementing you, which can reduce your ability to develop a healthy sense of self-worth. So, if your spouse/partner is overly critical, tell them that you need some encouragement from time to time. They may not realize they have been coming down hard on you. As one Aspie husband stated, "My wife just doesn’t understand. She thinks I should ‘try harder’. But trying harder to re-wire my brain hasn’t worked so far.”

It may seem like there’s no way your spouse/partner will be able to help, especially if they are always nagging you or getting hurt over your behavior. The truth is that they hate to see their “significant other” suffering. They may feel frustrated, because they don’t understand what is going on with you or know how to help. Some don’t know enough about Asperger’s to know how to deal with it. Thus, it’s up to you to educate them.

25.    Employ hopeful statements in your self-talk. Treat yourself with compassion and encouragement. Negativity can be a self-fulfilling prophecy. For instance, if you think your presentation is going to suck, you may indeed fumble through it and fall flat on your face. Tell yourself things like, "Even though it's rough, I can handle this issue."

People who think negatively of themselves tend to view the world as a hostile place and themselves as its victim. Therefore, they are hesitant to express and assert themselves, miss out on experiences and opportunities, and feel incapable of changing things. All this creates even more negative self-talk, pulling them into a downward spiral.

If you feel that you are overly critical of yourself, use the suggestions listed above so that you can boost yourself and, hopefully, break out of the downward spiral. You may already be using some of these ideas, and you definitely don’t need to be doing them all. Simply do those that you feel most comfortable with.

==> Need some crucial self-help strategies for reducing and eliminating anxiety? You'll find them here...

==> Living With Aspergers: Help for Couples

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