Autistic Burnout vs Depression — Insights of a

Neurodivergent Clinician

Sep 13 Written By Megan Anna Neff

Depression or Autistic Burnout?

When you come to an autism discovery late in life, it is often followed by a season of a thousand “ah-ha”
moments. It’s like all the unanswered questions of your life finally become answerable. It can be a powerful and
intense experience.

For me, one of those powerful ah-ha moments was around the concept of Autistic burnout. I have struggled with
fatigue my whole life, most intensely in the aftermath of childbirth/having young children. I’ve been diagnosed
with depression a handful of times. And yes, I was depressed, and it was good to be treated for depression.
However, each season of depression followed a particularly intense period of pushing, masking, and performing.
What I now realize is that each season of depression was instigated by a season of Autistic burnout.

If I had an accurate understanding of Autistic burnout, I believe my episodes of depression would have resolved
more quickly. It is incredibly important that we increase awareness of Autistic burnout within the mental health
world. Autistic burnout is one of the leading causes of depression and suicidality for Autistic people. So let’s dive
in!

The Connection Between Autistic Burnout and Depression

While autistic burnout is distinct from depression, it often leads to depression. Autistic burnout is a distinct
pathway to Autistic depression and suicidality. And so it is not hyperbolic to say that understanding the
difference and treating Autistic burnout can save lives. I realize that sounds dramatic, but that’s kind of the
point; this is really important for clinicians to understand.

So, if you’re a clinician reading this, consider ways to sharpen your eye so you can spot Autistic burnout. If you
love an Autistic, sharpen your eye and find ways to reduce their overall social/cognitive load when they start to
burn out. And if you are Autistic, take care of yourself, learn some of the strategies that will help prevent autistic
burnout, and know your triggers and early signs of burnout.

And now, moving on to the data. This is a long post, so to orient you, here is what is covered (I encourage you to
pick and choose sections to read based on what is relevant to you).

Autistic Burnout Overview and Definition

Characteristics and Symptoms of Autistic Burnout

Causes of Autistic Burnout

Recovery Tips

Prevention Strategies

Autistic Burnout Overview

Few studies have formally studied Autistic burnout, and thus it is largely missing from the academic and clinical
literature. It has recently become more widely talked about as autistic self-advocates are increasingly talking
about the internal experience of autism. Raymaker et al. recently published one of the first studies on autistic
burnout. Much of the following information comes from their research.

Autistic burnout is distinct from occupational burnout and from depression. This speaks to the need to have
specific training and education to address autistic burnout. Raymaker et al. suggest that education on autistic
burnout be included in clinical training and suicide prevention programs. Raymakers article is one
of the first to move toward a clinical definition of burnout; they define it as:

Definition: Autistic burnout is a syndrome conceptualized as resulting from chronic life stress and a
mismatch of expectations and abilities without adequate supports. It is characterized by pervasive, long-term
(typically 3+ months) exhaustion, loss of function, and reduced tolerance to stimulus. (Raymaker et al., 2021).

Characteristics of Autistic Burnout

The three primary characteristics of autistic burnout include:

Chronic exhaustion

Reduced tolerance to stimuli

Loss of skills (e.g., reduced executive functioning such as thinking, remembering, creating and executing
plans, performing basic self-care skills, and activities in daily living).

Other Symptoms: In addition to the intense emotional, physical, and mental exhaustion, it can also result in
difficulty managing emotions which makes a person more prone to outbursts or intense anxiety. It can also
result in an increase in autistic traits such as repetitive behaviors, reduced tolerance for sensory sensitivities,
and increased difficulty adapting to change.

Causes of Autistic Burnout

Autistic burnout is more common among autistics who have strong cognitive and language abilities and
frequently use camouflaging and masking to move through social space.

Autistic burnout is often considered to be one of the side effects of masking and camouflaging. It can be related
to the high demands of navigating the neurotypical world, sensory overstimulation, an overuse of executive
functioning fatigue following high executive functioning demands, or stress associated with significant changes.

Burnout Equation

Raymaker et al. provided a framework for understanding Autistic burnout. When life stressors and barriers to
support added up to a cumulative load that exceeded the person’s abilities, this resulted in burnout.

Essentially when expectations outweigh abilities (+support), this is unsustainable and leads to burnout. This
happens more often for folks who are holding themselves to neurotypical standards/living/working and
schooling in neurotypical spaces.

In Raymaker’s research, the most common stressors included: masking, suppressing autistic traits, pretending
to be allistic and social pressures and expectations. As another participant put it:
“The metaphor I use is that long-term camouflaging and masking leaves behind a kind of psychic plaque in the
mental and emotional arteries. Like the buildup of physical plaque over time can result in a heart attack or
stroke, the buildup of this psychic plaque over time can result in burnout.”

Raymaker et al. research further highlighted the difficulty many of their participants experienced in accessing
accommodations and resources (likely associated with high cognitive and verbal skills). They identified that the
tendency for people to “gaslight” the struggles of autistics as not real (due to the invisibility of masking), was a
significant contributor to the accumulation of stress and overall load.

Autistic Burnout Triggers

While there are many chronic causes of Autistic burnout it can also be helpful to identify the triggers that can
cause burnout.

It's helpful to know your specific triggers. Some people have mild burnout every time their schedule changes, or
perhaps after a season of high social demand.

Knowing your specific triggers for burnout will help with burnout prevention and help you to understand your
needs better.

Autistic Burnout Recovery

Recovery depends on the person and the specific causes. In the situation of acute burnout (like the person who
gets tunnel vision while at a party), they need to go home and rest for the night and will likely regain vision and
skills in the morning.

For a more prolonged season of burnout, a person may need to significantly restructure their lifestyle and
remove themselves from the causes of their burnout. It may become more difficult to recover the older a person
is.

Dr. Neff’s Tips for Autistic Burnout Recovery:

Practice boundaries and reduce unnecessary workload

Find ways to reduce sensory input (use noise-canceling devices, sunglasses, etc.).

Rest. Try to focus on rest that feels restorative. Binge-watching T.V may feel restful but likely not restorative.
Reading or listening to a book related to a special interest, engaging in activities that you experience as soothing
to your sensory system.

Find alternative ways to express yourself. Many Autistics have alternative ways of expressing emotions. Writing,
art, making a collage, writing a poem, or finding music that matches your mood are just a few examples of
alternative ways of expressing yourself. And, if you feel empty and if there isn’t anything to express, that’s okay
to.

Don’t let the routine go. In burnout, we’re tempted to lose the routine altogether. However, routines are soothing
to our nervous systems and minds because they tell us what to expect. The routine can be “wake up, make coffee
and rest on the couch for two hours while reading,” it doesn’t have to be rigorous, but having a few anchor points
during the day will be helpful.

Engage in activities that are soothing to your senses. Gentle movement is likely helpful; finding gentle and
soothing ways to move your body.

Nature is particularly restorative for autistics. If you have access, take time to go and sit by a lake, the Ocean, or
a beautiful meadow, or simply listen to nature songs.

A list of potential solutions to autistic burnout also emerged from the Raymaker research. Here is a list of
potential solutions that they proposed:

Autistic Burnout Recovery Tips (Raymaker et. al.)

Acceptance and access to Social Support: individual and community support, peer support, attending to
autistic needs, unmasking.

Leaning into Autistic Strengths: Using autistic strengths, advocating for, and receiving reasonable
accommodations and instrumental supports such as respite support.

Formal Supports: Mental health supports, Time Off/Breaks, ability to socially withdraw

Reducing Load: Reducing activities, setting boundaries, asking for help

Self-Advocacy and Health: Focusing on a healthy lifestyle, early recognition, and receiving an Autism
diagnosis

Self-Knowledge: Understanding patterns and triggers and making strategic decisions to be preventative.

Engagement with the autistic community: Engagement with the autistic community can help a person
name and validate their experience of burnout.

Autistic Burnout Prevention

Prevention is the best strategy for Autistic burnout. Self-knowledge is critical for this--knowing your triggers and
identifying early signs of burnout. For some people, early signs will be increased sensitivity to sensory input; for
others, it will be depersonalization and detachment; or vision changes such as tunnel vision.

Such signals can inform a person that it’s time to remove themselves from the situation and arrange some
sensory detox and downtime. Self-Knowledge can also help a person self-advocate, seek out appropriate
supports and accommodations, and plan travel and daily rhythms in such a way that builds in sensory
detox/downtime.