“What is anxiety?” was one of the top Google searches of 2014. Anxiety affects almost everyone at some time in their lives, from pre exam jitters to full blown can’t leave the house agoraphobia and panic attacks. We can all relate to some extent to the physical pit of your stomach nerves that run like spikes through your body, so it may come as a surprise to learn that anxiety as a disorder is very much a man-made concept. Fear is an innate state which drives most animals to survive, but in humans this takes on a life of its own. In fact the term anxiety disorder only came about after the drugs intended to cure it were discovered as a by-product from other treatments (Stossell, 2014). From this point onwards we were sold anxiety as a disorder to be cured, an affliction of the modern mind. After all, what really is the danger of leaving one’s home? Now drugs can treat specific types of anxiety, Propranolol for social anxiety, Sertraline for panic, Fluvoxamine for OCD, the list is endless. But it seems we are missing something here, because it does make sense why someone may become agoraphobic, for our cavemen ancestors would surely have survived longer if they stayed close to home, much like our snake fearing and height fearing ancestors. Anxiety is what kept us alive. Studies have shown the reckless behaviour of individuals who lack fear, and indeed these survival phobias are hereditary (Menzies and Clarke 1995). With an involving world it seems that the fears which drive our survival have changed also, and are no more man made than those which drove our ancestors. The only difference being is that we can help those who have become so afflicted they can no longer function and it is detrimental to their survival. We are not always the best regulators of our emotions and instincts.
This is all the more true for those with autism, a population in which many are categorized as having some form of anxiety disorder. However, it is fair to say that the quality of this anxiety can be really quite different. I have suffered with quite a relentless anxiety since I can remember, more than chronic, it is ingrained. It took on many forms, each as stubbornly untreatable as the last. Out of nowhere they would pop, and then just as quickly as they came disappear, ready to wreak havoc in some other form. It started when I was three and could not bear to be separated from my mother and became what has since been termed ‘selectively mute’. In public my mouth would freeze and there were only certain people I would speak to. In silence I would listen to the register being called out at school, not saying a word no matter how many times my name was called. I would like to be able to explain to all those worried parents out there with selectively mute children why I could not speak, but all I can remember is the great pressure that was put under me to speak, and how this would make me even muter. I eventually naturally overcame this, but throughout my primary schooling developed several odd phobias, experienced my first panic attack and developed quite severe hypochondria leading to obsessive hand washing. I spent my later primary school years solely preoccupied with fainting, and would do everything in my power to prevent this from happening, which mostly involved going home sick from school if I knew any lengthy standing was involved. By this point I was also washing my hands so often they had become scaly and sore, as soon as I touched anything, it had to be washed off. Again, as suddenly as it came this also went. I do not remember an epiphany moment of the anxiety lifting, nor did I receive therapy or drugs to make it shift, instead it just gradually left my conscious until one day I realised it was no longer there. It didn’t take long for the rebirth, this time in the form of paranoia and fear of what others were thinking of me. Convinced someone was watching me, everything I did and said became a painfully conscious process. This was followed by Irritable Bowel Syndrome, thought to be caused by anxiety, followed by agoraphobia, panic attacks, food phobias and difficulty swallowing.
Despite this eclectic mix of anxiety disorders I was not diagnosed with anything specific other than General Anxiety Disorder, despite there being evidence of OCD, Psychosis, Social Anxiety and Agoraphobia. The reason being that unlike those who do suffer with those conditions, the manifestation and presentation of mine was quite atypical, and this is true for a lot of individuals on the spectrum. All these different anxiety conditions were driven by a much deeper anxiety, which is why they shifted their expression so often. My anxiety was developed from oversensitivity to sensory stimuli and difficulties with social communication, two key problems that come with autism. Many of the odd behaviours I developed were a coping strategy for a bigger problem I could not label at the time. Strangely, or perhaps predictably, since realising this my anxiety has calmed dramatically and now just sits as it is. Instead of being pelted by stressors the size and density of baseballs, they are instead small soft balls I can bat away with ease, and when they do hit they don’t leave half as much a bruise.
Moving away from my own story and weird analogies (it’s getting quite late), and looking at the differences in people suffering with OCD with and without autism, the underlying mechanisms driving the behaviours can be really quite different. If you imagine an individual with OCD who obsessively needs to turn a light switch on and off or he believes his family will be hurt or something equally as bad will result in not performing these actions, and compare it to someone who obsessively needs to turn a light switch on and off a certain number of times to calm themselves down, it becomes apparent that it is only the specific action and repetitive nature that the two have in common. People with autism do things obsessively and repetitively that they enjoy or which gives them comfort, it is a result of a different anxiety than OCD anxiety. I recently attended a fascinating lecture on the topic by Dr Tim Williams (2014) who explained that the way to separate these two anxieties apart was to ask the patient if they liked their obsessions. Inevitably those that have OCD and do it because bad things will happen otherwise, despise them and it is a great burden to their lives, whereas those with autism indulge themselves in them to cope. Having said this I certainly would not say I enjoyed my obsessive hand washing phase, although it certainly disappeared quicker than someone with actual OCD, and with no intervention.
So how do we treat an anxiety which does not behave like typical anxiety? The answer certainly is not CBT (Cognitive Behavioural Therapy), for reasons I have argued many times (See previous blog post). The answer may be drugs, but not always and with much more care. The key is to understanding the sensory and communication difficulties from which anxiety manifests itself. It is no use being taught how to overcome a busy shopping centre without actually addressing the fact that it is not the shopping centre you hate, but rather the unpredictability of the people, lights, smells, and noises; everything that a neurotypical would not need to think about. I have not found solace in meditation or yoga, I have found it mostly in acceptance of it being present in my daily life and understanding why it is there. I don’t necessarily challenge it like I ought to, like all the books and therapists say, I do what I can to soothe it instead. It is a bit like having a neurotic and volatile pet dog at your side wherever you go, I wouldn’t go as far as to say it has become my friend but I can certainly make it think it is.
I thoroughly recommend the following books for more information on anxiety:
‘My Age of Anxiety’ by Scott Stosell
‘Asperger Syndrome and Anxiety: A Guide to Successful Stress Management’ by Nick Dubin