Could It Be Neurodivergent Burnout?

Written by Miranda Jane, Neurodivergent Affirming Nervous System Coach

Miranda Jane is a Neurodivergent-Affirming Somatic Coach and Consultant, specializing in the masked and late-identified Autistic and ADHD experience. Their personal crusade is to help recently identified AuDHDers understand and appreciate themselves, mind, body, and nervous system!

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The alarm is going off, but my legs are made of lead. It is like one of those nightmares where I am trying to run, but I am paralyzed. The thin light from dawn burns my eyes, and immediately, I feel rage pulsing through me. I imagine the day ahead and start taking inventory of my spoons. There are not enough to make it out of bed, let alone through all the tasks and demands of the day. Do I have the flu? Am I depressed? In an instant, the rage turns to a unique mix of panic and despair that I know well. Uh oh. Could it be neurodivergent burnout again?

What even is neurodivergent burnout, exactly?

The term burnout can refer to many things, but all of them convey the experience of losing your energy and motivation to the point that you are unable to enjoy or perform the tasks of your life or work. It has been used to describe what happens to people using substances chronically to the point that they are unable to function in their daily lives or even find pleasure in the substance anymore. It has also been used in the context of work to describe when people get so exhausted, bored, or overwhelmed by their jobs that they simply cannot force themselves to show up.

Autistic and ADHD burnout, or neurodivergent (ND) burnout, are not technically medical conditions, but they are well-known and feared by anyone who has experienced them. While research is ongoing, the current working definition for Autistic burnout is chronic exhaustion, loss of skills, and an increase in sensory sensitivities. ADHD burnout is known to be exhaustion and a collapse in functioning, often accompanied by depression. As a coach and consultant working with recently diagnosed Autistic and ADHD adults, many of them entrepreneurs and small business owners, I see the devastating effects of neurodivergent burnout all the time. I also have firsthand knowledge of the experience, having been through it myself and having witnessed my close friends and loved ones navigate it as well.

Exhaustion

The strange thing about the exhaustion of ND burnout is that rest does not help, and often sleep can become impaired. It is like there is a hole in the sleep bucket, and no amount of sleep at night or naps in the day will make a difference because there is just no way to absorb or metabolize it. Furthermore, the sheer amount of rest required can become frustrating and demoralizing, and because the days are so miserable, it is easy to fall prey to revenge bedtime, staying up late even though you are exhausted, to try to have a moment of pleasure in your day.

I remember during my first major burnout, in college, I spent about six weeks primarily in bed. Before that, I had attended almost all of my classes and participated in numerous extracurricular activities and social events. But it was like one day I just broke. My friends would bring me food from the dining hall, or I would drag myself there in my pajamas. I did not even realize I had stopped going to class until it was time to study for my finals, and I realized my copious notes ended at mid-term. I had not been back to my classes since then.

In my most recent burnout, a few years ago, my sleep became exhausting. It was as though instead of resting at night, my brain became more active when I slept. I had very intense dreams, and they were unlike my usual dreams. They were often deep explorations of subjects, some of which I have no real knowledge of in my waking life, like geology. My dream would literally be words scrolling by as though I were reading or writing about the topic. No images or silly dream logic. I would wake up even more tired than I had been the night before.

My clients have described the exhaustion as feeling like a freeze response, like they are literally paralyzed and unable to get out of bed. Or they drag themselves through the day on a steady drip of caffeine on top of their stimulant medications. Often, their doctors will change or increase their medications, trying to find a cure. They will test for mono and do lab work, and often they find that they do have an infection or a resurgence of an old virus, and they are low on vitamin B and D, and their thyroid numbers are out of whack. Dr. Mel Houser at All Brains Belong describes how burnout can even show up in our mitochondria, affecting our energy on a cellular level. But simply changing the medication or adding in the vitamins, while necessary, is not the whole picture, and the lack of energy remains.

Symptom flares

In addition to exhaustion, ND burnout brings symptom flares of all kinds. Whatever you are susceptible to, chances are it will flare up when you are in burnout.

Physical health

As described above, ND burnout often interacts with multiple physical health symptoms, and it is essential to work with your healthcare providers to diagnose and treat all of the physical things going on for you. This includes chronic health conditions like Mast Cell Activation Syndrome, fibromyalgia or other types of pain, long COVID and other post-viral syndromes, and immune over or under-functioning. During burnout, you may be diagnosed with myalgic encephalomyelitis or chronic fatigue syndrome (ME or CFS). Your post-exertional malaise, which refers to a dip in energy after using up your resources on mental or physical tasks, may become extreme or so chronic that you lose track of what tired you out. Everything becomes exhausting. Moreover, due to the hit to the immune system, you may be more susceptible to colds and allergies. You may have trouble regulating your body temperature and blood pressure.

Learning you are Autistic and ADHD is one thing, but learning about all of the associated differences in your health is another. Dysautonomia, dyspraxia, hypermobility, and metabolic differences mean you may have been living in ways that are actually not great for your particular body your whole life without even realizing it.

It can be very hard to tell the chicken from the egg with the experience of ND burnout and symptoms. Sometimes the burnout precedes the symptoms, and sometimes the struggle of managing all of your symptoms is what leads to the ND burnout. This is why building a life that supports your unique needs and limits is so critical to long-term health for neurodivergent people, to avoid or manage both burnout and all the other issues.

Mental, emotional, or psychological health

When you are in burnout, it is very common to experience new mental health conditions or a flare of those you have had in the past. Depression, anxiety, and PTSD are all extremely common in neurodivergent people, and they are likely to show up when you are burning out. In addition to that, the inability to work or perform the tasks expected of us in neurotypical culture during burnout can bring up self-loathing, suicidality, and an emotion I call panic despair, which many of my clients and I have experienced. It seems to be a reaction to the realization that there are things you absolutely must do in order to survive, and you simply cannot do them. The panic is very similar to a panic attack, but it often comes when we are so exhausted we cannot even panic in our usual way, so it looks more like an Autistic shutdown. Just quietly weeping while resting, your mind spinning in circles as your body merges with the bed. The impulse to fight or flight is there, but the energy is inaccessible, so you are stuck in freeze. It is similar to if you slammed the gas pedal and the brake to the floor at the same time, flooding your engine and going nowhere.

Neurodivergent

Finally, there is an increase in our neurodivergent symptoms. So if you have sensory sensitivities, those may skyrocket, with even tiny stimuli becoming unbearable. I remember noticing that the weight or texture of the sheet, without any blankets, created a burning sensation in my skin which I had never experienced before. The low-wattage bedroom light felt like a stadium floodlight. And the sound of the television, music, or audiobooks was physically painful to my ears, even when the volume was so low that the words were indistinguishable to me.

For ADHDers, the symptoms are often the ones we typically suffer from, but tenfold. Fragmented attention, hypervigilance, hyperfocus, unreliable cognition and memory. Time agnosia, where we are losing days or weeks instead of minutes and hours. Emotional regulation problems where small frustrations spark instant rage or even annihilation reactions. Obsessions, compulsions, and rumination can take up more and more of our thoughts. It may feel like we have to figure things out, so we keep thinking about them, not realizing that our cognitive capacity for effective problem solving is completely inaccessible, so really we are just ruminating when we think we are putting our mental energy into something useful.

In burnout, I lose my ability to organize both my external and internal environments. It becomes difficult to find things. I lose track of my thoughts over and over again. The mental boundaries that keep various trains of thought separate from each other fall away, and my brain can feel like Grand Central Station, with thoughts flying past each other in all different directions. Basic tasks like making coffee or getting dressed become fraught, and sometimes I give up in the middle. Crying on the floor in front of my closet becomes the norm instead of the exception.

Skill loss or loss of function

Skill loss and function loss can look a lot like what I described above, as executive functioning gets more and more disrupted. In some cases, the choice to consider it an ADHD flare or a skill loss is a matter of how it feels to the individual. During one burnout, my memory was so impaired that I had to add “brush your teeth” to my to-do list because the behavior, which had been an ingrained habit for decades, was suddenly lost to me. I no longer remembered how to start my day. This could be considered an exacerbation of memory impairment, or “losing my morning routine,” if that feels more accurate to the individual. In one of my burnouts, I lost the concept of writing “to do” at the top of a page and listing the things I needed to accomplish underneath it. I had relied heavily on to-do lists my whole life, but for several months, the entire concept disappeared from my awareness. It felt like a miraculous discovery when I found myself creating a to-do list for the first time as I was recovering from that one.

Sometimes it looks more like skill regression, where things that used to be manageable are no longer possible. For example, most people seem to lose some important self-care skills during burnout. Often, food becomes inaccessible because it has so many steps involved. You have to decide what to eat, purchase food at a store, prepare it, and eat. Household chores are often lost too, like the ability to do the dishes, laundry, schedule appointments, and show up to appointments. This exacerbates the other ND burnout symptoms like exhaustion and symptom flares because you may not be able to access nutrition, medical care, or bedtime routines the way you used to.

Specific skill losses that many NDs experience are related to loss of brain functions, like sensory processing or language processing. “Losing verbal” is short hand for when you lose the ability to speak. This can be intermittent, which is particularly confusing to people who have seen you speak before and simply think you are being rude or unnecessarily complicating things when you go silent or try to shift to writing. You can also lose degrees of vision processing, or stereopsis, so that you are no longer able to tell where objects are in space, or you may have blurred or double vision.

You can lose bizarrely specific skills in burnout, like the ability to understand numbers and math, the ability to mask as neurotypical, or perform social interactions in the way you used to. I think of it almost like a brownout as opposed to a blackout. Your brain is trying to function without enough energy to go around, so it just cuts off certain functions it has been maintaining, and all of a sudden, you realize how much energy it took to do them. Sometimes these things are related to topics or activities that were a major source of stress, like finances, work, or relationships.

What causes ND Burnout?

We do not have clear data on direct causes of ND burnout, but there are a number of factors that appear to be relevant. Big picture, I see it as a deficit in the demand to capacity equation. That is, burnout happens when we have been doing more than we can for too long, and the wear and tear on the body and nervous system reaches the point that it shows in our daily performance. You remember those cartoon characters that would run off the edge of a cliff and keep going? That is you leading up to burnout. Then the burnout hits, and it is like you are looking down and realizing you ran out of road a long time ago, and you start to free fall.

So what are these demands that use up our capacity? Physical and mental activity and background stressors. That includes self-care and social connection, work, and environmental factors like sound, light, air quality, and the degree of anxiety in your family and community.

Masking is a major energy suck, so learning to unmask whenever it is safe enough to, and surrounding yourself with people who allow you to be your authentic self, is a healthcare issue for neurodivergent people, not a luxury.

And of course, fighting off illness or having an overactive immune system uses a huge amount of energy, so when those things go on for too long, they can drain your energy reserves and put you into burnout.

What can we do about ND Burnout?

The best thing you can do to heal from burnout and prevent it in the future is to get to know your true needs and limits and accommodate them. This often entails making changes on a practical level as well as deep emotional and psychological work to remediate internalized ableism and make peace with the body and nervous system that you have.

Most of the people I work with are inveterate self-helpers. They are driven by a deep sense that they should do better, and they are always trying to find ways to improve. I think it is a natural side effect of being an undiagnosed Autistic ADHDer just trying to do a good job at life and be loved and accepted. They have learned to mask and people-please. They hide their true limits in order to show up for people or social expectations in a way that gains them validation. But deep down, they sense that if they let people know what their needs really are, they would be abandoned or exiled.

The work we do is often about recognizing how young they were when they learned it was not OK to be exactly who they are. While learning and honing your skills is innately fun and interesting, if it is coming from a place of feeling not good enough, it may be activating your adrenals and stressing you out. I always want my clients to get to a place of self-acceptance so that any growth or change they engage in is coming from love instead of fear, and is a choice and not a demand.

Often, when my clients accept that they cannot keep going at their current pace and start to slow down, they are able to come back into their bodies. The numbness and chronic dissociation wear off, and they are able to feel the depths of their pain and exhaustion. This is the second level of the work, deep rest. It is hard to access the degree of rest they truly need because their lives are built on the premise that they can do more than they can. They have bills to pay and relationships to maintain. The demands feel like the absolute truth, and they are used to simply ignoring their capacity and powering through to do what is being asked of them.

At NDFL, we say “Capacity is real.” This is a way of putting what will keep you healthy front and center and putting expectations and cultural norms on the back burner. You may find you cannot work full-time, or need 10 hours of sleep a night, or can only have one close relationship in your life. Whatever your needs and limits are becomes the foundation for how to build a life that works for you.

Will it ever get better?

The scary thing with the ND burnout symptoms is that we never know. Will my vision come back this time? Or is it permanently altered? Will I ever enjoy music again? Or is that pleasure gone forever? Will I ever wake up refreshed again?

It is a particularly complex question because of the interplay with health conditions. When we live beyond our means metabolically and psychologically for years and decades on end, we put our bodies under extreme duress. We are flooded with cortisol and adrenaline, and we are not accessing the healing state of rest and digest the way we need to to keep ourselves vibrant, strong, and healthy. The state of burnout we eventually reach can coincide with long-lasting infections, bacterial overgrowth, and other health conditions that have damaging effects on the body. And the burnout aspect of the situation makes it hard to take care of ourselves, seek and follow through on treatment, and do what we need to do to get better.

I emerged from my first burnout, at 19 years old, with primary ovarian failure, now called ovarian insufficiency, unable to bear children. Did the hormonal disorder cause the burnout? Or vice versa? There is no way to know for sure if my body would have shut down my ovaries if I had been aware of my neurodivergent needs and limits and honored them. Then again, at 19, I might not have been ready to honor my limits, whatever they were. While I lost vision temporarily during that burnout, it rapidly bounced back, and I did not think much about it.

But in a later burnout, my vision was impacted to a much greater degree. I am sometimes able to drive now and sometimes not, depending on how well my nervous system is doing. I have good days and bad days with reading, but I can almost always manage a large print book.

The one thing that has always come back for me after every burnout is my joy and will to live. In fact, it usually happens as soon as I figure out what is putting me into a state of exhaustion and overwhelm in the first place and decide on some changes to make it better. When I have been resting deeply, pacing myself, and living within my means in terms of my energy, I start to get my strength back. I cannot promise that your capacity will expand, but I can say that living in a constant energy deficit is not giving your body or mind time to catch up. I share my experience because if I can show you that there are serious consequences to over-functioning, maybe you will pull back on your reins before you go over that cliff.

If you want some help listening to your body, identifying or accepting your needs and limits, or building a life that supports you better, Amy Noyes and I are ND affirming coaches and consultants who do exactly that. We would love to help you find what works better for you.

Visit my website for more info!

Read more from Miranda Jane

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Miranda Jane, Neurodivergent Affirming Nervous System Coach

Miranda Jane is a late-identified Autistic ADHDer with a passion for helping people like them lead more pleasurable and fulfilling lives. They work with adults who are “twice exceptional” (2e), in many ways brilliant and in many ways struggling to function and disabled in their everyday lives. This particular blend of special skills and (often invisible) disability is particularly dangerous, leaving those who are 2e feeling thwarted in achieving their goals and leading to high rates of self-loathing, despair, and suicidality.