It’s common knowledge that anxiety is woven into the story of many autistic people. One study puts the prevalence of anxiety disorders among autistic people at 40 Percent, but it wouldn’t surprise me if it was much higher, due to the lack of diagnosis of both autism and of most mental health conditions.
Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Phobias, the forms that “anxiety” take in someone vary in their labels, and to some degree in their presentation, but the effect they have on the quality of someone’s life, whether autistic or not, remains profound when hidden by shame, ignorance, or a tragic lack of resources.
What is anxiety?
Everyone who lives with an anxiety disorder has a different way of describing their experience. For some it’s a monster or malicious creature that rears its head up when you least want it.
For others it’s a feeling, a cheese grater in the chest, a heaviness dragging you down by your forehead, by your breath, or by the sweat of your palms. For others it’s just pain, plain and simple. Pain in your body, yes, but pain too at the things missed out on, the gatherings unattended, the jobs unapplied for, the trips outside not taken.
Our brains and sympathetic nervous systems have a mechanism colloquially called the fight-or-flight response, the powerful tool our bodies use to wash out our thoughts when danger requires action over examination.
The speeding car, the attacker, the rising flood water. Our brains take in images and other information, categorize them, interpret them, and channel them past our brain stem and our amygdala before moving on to our prefrontal cortex. This works exactly as planned when you need to dodge a speeding car before you can ask yourself “why is this car moving towards me?”.
However, such a system is prone to mistakes in attribution. In a more modern world where fears are more abstract or interpersonal, the streamlined pathway from “I’m feeling fear” to “there must be something for me to be afraid of because I feel fear” leads to a more dysfunctional and damaging relationship with our body’s emotion-based protection system that we collectively call “anxiety.”
A famous study conducted in the 1970s demonstrates this cognitive propensity for mistaken attribution. It had participants walk over bridges where they were stopped to take a survey. In the middle of these bridges, they were asked to write a creative story based on a photograph. Their responses were then judged on the amount of romantic or sexual content. One of the bridges was firm and solid, and the other was suspended and swung wildly in the breeze. The participants on the shaky bridge had a dramatically higher prevalence of romantic/sexual content in their stories, among other factors the researchers were testing. The conclusion of the study was that the participants’ brains had perceived fear from the shakiness of the bridge. Their “thinking mind,” however, the parts of ourselves that we think of as our “decision-making selves,” had taken the fear in them and misattributed it to attraction-based arousal, directly coloring their perception of what was happening when they were performing a task superficially unconnected with their position on a rickety bridge.
For those with anxiety disorders, a similar misattribution process happens every day.
Just as the participants falsely attributed their heightened physiological state to romantic or sexual arousal, people with anxiety disorders falsely attribute their feelings of discomfort or apprehension to the presence of acute danger. Skills to process normal discomforts like rejection, failure, or feelings of inadequacy are rarely taught to children. Examples could be seeing upsetting content on social media, walking past an acquaintance on the sidewalk who doesn’t return our gaze, or close contact with a “contaminated” object for those with OCD.
These moments in reality are harmless or very low risk, but due to the misattribution process behave like an allergic reaction, activating our self-protection behavioral mechanisms such as avoidance or compulsive reassurance seeking with the same intensity, focus, and often conviction as if a speeding car was barreling right towards us. Just like the students on the bridge, we believe that because there is discomfort and apprehension in us, that there must be some reason that it’s there. This tragically often leads to people “shrinking their lives behaviorally,” so to speak, to avoid activating the presence of these feelings, which they do not know are not sources of danger.
For autistic people, there is much about life that can create these moments, perhaps more than would occur to a Neurotypical person. Some of it is sensory, never knowing when you will be expected to perform socially while dealing with noises or textures that you’re expected to simply “get over.” It could be a conditioned history of social rejection, a sense that you are just around the corner from condemnation for breaking a rule you didn’t know existed or were expected to abide by. It could be rooted in one’s perfectionism; the desire to do well on a test or to perform well at work, but also the sense that being perfect at expected tasks is a condition of acceptance, success, and survival. Autistic life for many unfortunately acts as a backdrop of unsteadiness and uncertainty that, like a swaying bridge, elevates one’s baseline stress level, an easy environment for an anxiety disorder to grow in.
Luckily there are tools that anyone, provided the right accommodations and understanding from treatment specialists, can benefit from. The most up to date Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and other treatments give a strong evidence-based pathway for those suffering from anxiety disorders to make their lives larger, something that both neurotypical patients and autistic patients equally deserve.