Emotions and Their Purpose

All emotions, even uncomfortable ones, serve an important purpose in our lives.

Fear

Fear is nature’s alarm system. It lets us know that we might be in danger and helps us take the steps we need to protect ourselves. It provides a sense of urgency to act, often without thinking.

Example: Imagine you are crossing the street when you notice that a car is coming straight at you. This situation would instantly prompt fear for pretty much everyone. The feeling would be associated with physical sensations that prepare the body to flee such an unsafe situation, like an increased heart rate to pump blood to the arms and legs and pupils dilating to scan for danger. In this situation, you would likely jump out of the way onto the sidewalk. If you felt nothing, you might continue to walk leisurely across the street, possibly being run over. So, as you can see here, the uncomfortable emotion of fear actually plays an important role in keeping us safe.

Anxiety

Anxiety is the emotion that helps us prepare for the future. Anxiety alerts us to important or potentially dangerous situations that might occur. This emotion also prompts us to focus our attention on whatever is causing the anxiety so that we can prevent or decrease a negative outcome (or “threat”).

Example: Feeling anxiety before a big presentation at work or school lets you know that this task is important. It also prompts you to begin preparing so that you’re not caught off guard. Imagine if you didn’t feel anything as the day of this presentation approached. You probably wouldn’t feel motivated to practice and might not be prepared for difficult questions from the audience.

Sadness

Sadness is the emotion that naturally occurs after a loss or setback related to something or someone that is important to us. Sadness also appears when we notice significant differences between the way our life is and how we want it to be. Sadness is associated with physical sensations like heaviness in the body and feeling tired. Sadness signals the need to pull back so that the loss or setback can be processed. Sadness also naturally draws others toward us to provide comfort and support.

Example: We might feel sad about a job because we find ourselves not progressing like we had hoped, or we feel sad because we are experiencing struggles in a relationship that we really care about or the loss of a loved one. For example, feeling sad after a break-up lets you know that the relationship (or aspects of that relationship) was important to you. Withdrawing to process what went wrong and what characteristics you want to look for in a new relationship may help you find greater success with a future partner. This emotion also signals to others that we may need support and comfort. Humans are social animals, which means we sometimes need help to get back on our feet and sadness serves the important function of drawing others towards us.

Anger

Anger is the natural response when we feel we (or people we care about) have been wronged in some way. Anger (and the similar emotion of frustration) also occurs when we feel like we are being blocked from achieving important goals. This emotion alerts us that our boundaries have been crossed and motivates us to do something about it.

Example: Imagine you discover that your phone company has been charging you hidden fees for months and expects you to pay them right away or they’ll shut off your service. Feeling anger in this situation lets you know that something unfair has happened— you shouldn’t be expected to pay for services you

didn’t use. This anger would also probably prompt you to speak to a customer service manager to demand that the charges be reversed. Here the emotion of anger also signals to the other person that they have frustrated or wronged you. Anger has a bad reputation because it is can be associated with destructive behavior like yelling and breaking things. It is important to separate this possible response to anger from the experience of the emotion itself. It is very important to pay attention to anger when it occurs because it signals to you that you may need to defend yourself.

Guilt/ Shame

Guilt and shame occur when we fall short of some standard. Guilt occurs when we feel like we did something wrong and is based on our actions. Guilt helps people maintain important relationships by prompting us to make amends or apologize. Shame occurs when we feel like we are wrong or less than and feel “lesser in value.” Shame prompts us to withdraw from others. This withdrawal may give a person room to think about how they might achieve their goals going forward to feel better about themselves in the future. In both cases, these emotions motivate helpful behavior. However, our thoughts can produce inappropriate or excessive shame/guilt that becomes harmful to us.

Example: For example, you might feel guilty if you forget to pay your friend back after borrowing money. Guilt in this situation would likely prompt you to make amends by apologizing and getting your friend the cash. However, you may be unable to pay a friend back because you don’t have any money, which may trigger feelings of shame.

Positive Emotions

Positive emotions, like happiness, excitement, and pride, also communicate important information. Positive emotions help us identify what we value in life and how we want to be spending our time.

Example: If you pick up a new hobby that brings you a lot of joy, what are you likely to do? Keep doing it!

Sometimes people try to avoid positive emotions because they’re afraid that once the emotion ends, they’ll feel even worse than they did before. Or they’ll prevent themselves from getting excited because they worry that if things don’t work out, they’ll feel more disappointed than if they hadn’t gotten excited in the first place. Sometimes people with depression avoid positive experiences like socializing because they find it distressing that they don’t enjoy these experiences as much as they used to. Without positive emotions, though, we wouldn’t know what direction to go in our lives. It is important to allow ourselves to feel the full range of emotions, negative and positive.

Summarizing the Importance of Emotions

As you can see from these examples, emotions serve a necessary role in our lives. All of these emotions communicate very important information about the world around us and motivate us to act. Without them, we’d be unable to move successfully through life. In fact, we evolved to have emotions because they’re so important for the survival of our species. Emotions are hardwired into us— even if we wanted to, we’d be unable to push them away completely. That’s why this treatment focuses on accepting emotions and responding in more helpful ways when they come up.

Even though we know that all of these emotions are important in the normal course of everyone’s life,

sometimes they can come up in the wrong situations and they can feel too intense to be productive.

So how do our emotions go from something useful to something overwhelming? The short answer is in the way that we respond to them. In order to begin to explore how this process unfolds, let’s first break down what happens when we feel a strong emotion. Every emotional experience can actually be broken down into three components— what we think, how we physically feel, and what we do. Paying attention to this process is the first step in understanding how the experience of an emotion can go from informative to overwhelming.

The three components of emotional experiences are:

1. Cognitive (What You Think): Your thinking in any given situation can really color how you feel about it. If you tell yourself that you don’t deserve to be in a loving relationship, you might feel ashamed or sad. The relationship between thoughts and emotions goes the other way, too. For example, when you feel sad, you’re more likely to have thoughts about the situation being hopeless, or being inadequate (“I always mess everything up”).

2. Physiological (How You Feel): Every emotion is associated with a physiological response. In other words, your body goes through physical changes every time you experience an emotion. For example, fear is often accompanied by a faster heart rate, a tensing of the muscles, and maybe even shortness of breath. Remember, fear’s job is to protect you from danger, and these physiological changes are the body’s way of getting ready to take action. Anxiety may be accompanied by sweaty palms, muscle tension, or perhaps a knot in the stomach. These changes alert us that something important is looming and that we should prepare. Sadness may be accompanied by a sensation of extreme tiredness and heaviness in the limbs, prompting us to withdraw.

3. Behavioral (What You Do): Whenever you feel an emotion, it is accompanied by the urge to act. We discussed some of the ways these behavioral urges can be helpful (e.g., jumping out of the way of an oncoming car in response to fear, standing up for yourself in response to anger). Sometimes, however, the things we do in response to strong emotions may not seem very useful.

Three Component Model of Emotion (ARC)

Emotions do not just come out of nowhere, even though sometimes it might feel like they do. Every emotional experience is triggered by some event or situation, which causes a person to react and respond. In turn, these responses have consequences. Sometimes it is difficult to identify these triggers, but with repeated practice, they can be identified.

The “As” (in the acronym ARC), or antecedents, are the events or situations that trigger emotional experiences. Triggers can be either something that has just happened, something that happened much earlier in the day, or even something that occurred in the past and is re-triggered. Finding patterns in the situations and events that prompt emotions may help you to feel less like you are on an unpredictable emotional rollercoaster. Being aware of your triggers can also help you prepare in advance when you know you might be faced with one. Finally, antecedents also can include things that make you vulnerable to experiencing emotions more strongly, such as being tired from a night of poor sleep, hormone changes, being hungry from not having time for lunch, or being generally stressed from a busy couple weeks at work.

Example: The woman who receives the text message from her friend cancelling their dinner plans had an argument or was rejected by a loved one in the morning, it could influence the way she thinks about and approaches the situation with her friend. She may be more likely to assume that she is “lame” and that this appraisal is indeed shared by her friend and the cause of the cancellation. She may not have reacted in the same way if the argument earlier in the morning had not occurred. The “A” in this case would be both immediate and distal— for example, receiving the text from her friend (proximal) and the argument with a loved one earlier in the day (distal).

The “Rs,” or responses, to emotional experiences include all of the responses that occur across the three main components of emotional experiences: thoughts, physical sensations, and behaviors.

The “Cs,” or consequences of emotional responses, are both short term and long term. When we experience strong emotions, they leave lasting impressions and influence how we respond to similar situations in the future. As humans, we repeat things that make us feel good and try to avoid things that make us feel bad. Unfortunately, the short-term consequences of unhelpful emotional behaviors are often negatively reinforcing (i.e., they lead to an immediate reduction in uncomfortable emotions), causing people to engage in similar behaviors in the future. For example, when someone leaves a party early because they are experiencing a great deal of social anxiety, this response results in an immediate reduction in anxiety, which reinforces this behavior in the future. This pattern of leaving parties early, or not attending at all, then results in long-term consequences like feelings of loneliness and isolation. However, this avoidance of situations and events because they might bring up strong emotions is what leads to problematic interference in your life.

Emotion Self-regulation

1. There is an optimal level of emotional arousal, which varies the situation/task;  too little and too much emotional arousal are both dysfunctional.

2. The ability to regulate one’s emotions and level of emotional arousal is necessary for adaptive functioning.

3. The ability to self-regulate emotion derives from early attachment experiences with caregivers.

4. Effective emotional self-regulation requires both the ability to access, heighten or tolerate emotion; and the ability to contain or distance emotion.

Adaptive Strategies for Accessing Emotion Include:

• Attending to emotion-related bodily sensations

• Remembering previous emotion episodes

• Presenting oneself with vivid emotional cues (words, images)

• Enacting emotion expression and action tendencies

• Monitoring level of arousal in order to maintain safety

 Adaptive Strategies for Containing Emotion Include:

•  Self-soothing (relaxing, self-comforting, self-supporting, self-caring)

• Seeking support and understanding from others

• Using containing or distancing language or imagery

• Temporarily distracting oneself with other activities

• Naming and understanding emotions

• Controlling expression of emotion (letting out a little at a time)
  
  

Anxiety: How Your Brain Assesses Danger

Emotions are the body’s way of telling us what it needs. Fear is a normal biological response meant to protect us from danger. Everyone has fears that guide decisions about what is safe and what isn’t. However, for perfectionists, our warning systems are working overtime, alerting us to danger when it doesn’t really exist. This is how we get trapped in our fears.

Fear is housed in the amygdala, the ancient, reptilian part of the brain that’s responsible for the stress response you experience when faced with danger—the urge to fight, escape from, or freeze in the face of whatever it is that stresses you out. If you’ve ever encountered a small lizard or snake in your yard, it probably froze or ran off as soon as it sensed your presence. It instinctively knows that it can’t win a fight with you, a much larger creature, so its best defense is to hold still and hope you don’t notice or to scurry under a bush to safety. In much the same way, when your brain perceives danger, it immediately must decide if the best response is to run away, freeze (or play dead), or fight. And in making this decision, the amygdala acts on instinct rather than rational thought.

The brain has a negativity bias, which means we’re more likely to think about what might go wrong than what might go right, and we’re more likely to remember negative experiences than positive ones. For example, if you watched a news story about a plane crash that killed three hundred people and a heart-warming story about a seventy-five-year-old great-grandmother finally graduating from high school, you’re more likely to remember the plane crash. The negativity bias was an evolutionary advantage that developed to help us stay alert and aware of potential dangers.

Fears, however, don’t always give us an accurate assessment of danger. Sometimes the amygdala overreacts, and we feel afraid when there is actually little or no danger. This is particularly true when you’ve experienced a trauma or an upsetting event that you perceived as overwhelming and out of your control. After such an experience, we develop a heightened sensitivity and increased fear to protect ourselves from being hurt again. The amygdala becomes like a super-sensitive smoke detector that goes off every time you burn your toast. We’re counting on it to alert us of actual danger, not something as minor as blackened toast. An overly sensitive smoke alarm, like an overly sensitive amygdala, makes it challenging to distinguish between real and perceived danger.

Sometimes our fears aren’t so much of physical harm, but of emotional harm. From a biological standpoint, situations where we might be criticized, rejected, or embarrassed feel just as dangerous as a bull charging right at us. So the fear you feel when presenting a disastrous sales report to your boss is alerting you to the danger of being criticized and embarrassed, but your brain is likely exaggerating the danger in this situation.

When we let fear drive us, we miss out on opportunities and underestimate our ability to cope with setbacks. And because fear increases if we try to ignore it, the only way to get beyond our fears is to confront them. In the next sections, we’ll work on recognizing our fears, challenging them to see if they’re warranted, and learning to cope with uncomfortable situations and feelings. We’ll do this in small chunks, so you can gradually increase your tolerance for anxiety-provoking situations.

Anxiety Tips:

• Use your calm breathing before the feared event to help with anxiety: square breathing (inhale for 4, hold for 4, exhale for 4, pause for 4), deep belly breathing (https://www.anxietycanada.com/sites/default/files/CalmBreathing.pdf) or ground yourself using your senses and identify what you can see, hear, smell, feel, and taste in your environment. If you start to feel anxious during the event, you can step away to the bathroom and use these strategies.

• Cold also helps lower your heart rate and calm anxiety. When you don’t have access to ice, you can use cold water over the veins in your inner wrist in the bathroom.

• People with social anxiety tend to focus on themselves during social situations, which tends to make them feel even more anxious. When socializing with others, try to pay attention to what other people are doing or saying.

• People with social anxiety disorder tend to have negative thoughts about themselves and about what will happen in social situations. If you believe that social situations are threatening or dangerous, then you are more likely to feel anxious.

• However, it is important to realize that your thoughts are guesses about what will happen, not actual facts. People with social anxiety disorder tend to over-estimate the degree of danger in social situations.

• It can be helpful to ask yourself whether your thoughts are based on facts and whether they are helpful. Are you having any cognitive distortions (catastrophizing, black and white thinking, should statements). If they aren’t, try and identify more accurate and helpful thoughts.

• By evaluating your negative thinking, you may realize that some of the things you fear are very unlikely to actually happen, or that if something does happen it’s not as bad as you may think and that you can cope.

• People with social anxiety disorder often hold some unrealistic beliefs. Common examples include: I need to be perfect to be liked. I should never make mistakes. It is important for everyone to like me. Or It’s not okay to be anxious

• However, no one is perfect and everyone makes mistakes. Also, it’s unrealistic to think everyone will like us - Do you like everyone? Have some people “done everything right” and you still didn’t like them? That is normal and bound to happen. Remind yourself that what others think about you is not your business.  Also, anxiety is often a private experience that others don’t notice. Even if they do, it doesn’t mean that they will think less of you – Haven’t you ever seen someone else anxious? It’s normal. It’s okay to be imperfect and to feel anxious. It’s part of being human! Rather than fighting these things, try working on accepting them.

• It’s normal to want to avoid situations that cause you anxiety. Avoiding feared social situations reduces anxiety in the short-term. However, avoiding social situations increases your fear in the long-term because it prevents you from learning that your feared expectations are either unlikely to actually happen or aren’t as bad as you think. Therefore, an important step in managing your social anxiety is to face the situations that you have been avoiding because of social fears. Repeatedly facing those situations reduces distress in the long-term and helps build up confidence.

• Tips on effective communication: https://www.anxietycanada.com/sites/default/files/EffectiveCommunication.pdf
  
  

Signs of Autism in Women

Autism spectrum disorder (ASD), known also as “autism,” is a neurodevelopmental condition typically diagnosed in childhood. Traditional estimates find that boys are four times as likely as girls to receive an autism diagnosis. However, experts are now realizing that almost as many females as males may have autism, they are simply missed or diagnosed later in life. Recent research shows that nearly 80% of autistic females are undiagnosed as of age 18.

Experts believe family, teachers and primary care physicians may miss the signs due to numerous reasons. First, women tend to have fewer repetitive behaviors or more subtle stimming behaviors, and fewer restricted interests or more “socially acceptable” interests (e.g., human behavior, pop culture, animals) as compared to boys.

Second, girls and women on the spectrum are more likely to “mask” or camouflage their differences. For example, girls may watch others and mimic their behavior to better blend in. This is particularly the case when girls have an average or high range IQ.  Because young women have a greater expectation or desire/motivation to fit in with their peers and be social, they are more likely to engage in “masking” than their male peers. Those efforts can delay diagnosis and cause exhaustion, stress and anxiety.

Accordingly, many women on the spectrum are first diagnosed with anxiety or another mental health disorder. However, traditional anxiety psychotherapy and psychopharmacological intervention may not lead to significant improvement in their symptoms since the underlying disorder is being missed.

As a result, women who have late-diagnosed autism tend to judge themselves harshly for finding life more difficult than their peers or feeling different, but not knowing why. Leading to greater rates of mental health issues and suicidal ideation among women with autism. In contrast, women who do receive a diagnosis often find that it has a positive impact on their confidence and self-esteem, with many becoming advocates or mentors for other women with autism. Receiving an autism diagnosis can be a relief for many adults. It may explain symptoms they’ve always had but have never been able to explain. It can also open doors to much-needed health resources and support.

 Autism is a highly individualistic disorder and females with autism may experience the following and more:

Camouflaging or Masking

• Women on the spectrum are known to be exceptional 'social blenders' camouflaging into the background ensuring they get no attention, so more likely to be ignored or overlooked. This is also referred to as 'social masking' and can have significant and detrimental long-term mental health side effects

• Due to not inherently understanding social conventions, many females with autism learn or mimic socially acceptable behavior by watching television shows, movies and the people around them.

• Adults on the spectrum may be uncomfortable making eye contact but force themselves to do it even though it is difficult and uncomfortable. Thus, a woman with autism may be OK at making eye contact because she's learned to, but if it feels unnatural or hard, it could potentially be a sign of autism.

• They may copy the facial expressions of others to hide social communication challenges.

• They practice or rehearse conversations before having them, to feel more comfortable or ease anxiety.

• Individuals on the spectrum may feel like they become whoever they are around the most due to their subconscious and conscious camouflaging.

Social and Communication Difficulties

• Women on the spectrum often have trouble reading and responding to social cues and body language, leaving them anxious before a social situation and after.

• They often feel socially anxious, ruminate on their social interactions, and may end up feeling left out and lonely, despite their best efforts to be sociable.

• While autistic women may interact well in one-on-one situations, they often find it very hard to be in groups and may feel exhausted after too much social interaction. In particular, they struggle in large groups due to the number of social cues, body language and tone of voices that need to be decoded to understand the social interaction (and possibly sensory challenges that need to be managed/drowned out).

• They may have preferred the company of older or younger peers throughout their life, as opposed to same-aged peers.

• They may have a preference for alone time and be seen as shy or introverted.

• They may display difficulties with starting or maintaining a conversation, especially about something that does not interest them.

• They may have difficulty recognizing social cues and non-verbal forms of communication. They may miss sarcasm or subtleties while others are speaking.

• They may have difficulty understanding the social hierarchy and what is appropriate behavior.

• They may be seen as too literal or have difficulty understanding metaphors or sayings.

• They may talk excessively about a select subject, even if others are not responsive.

• They may have a reduced ability to express emotions or display facial expressions that do not match the situation. For example, they may have flat or blunted affect, exaggerated facial expressions (e.g., smile), or inappropriate body language.

• They may be seen as socially or emotionally immature for their age.

• They may have difficulty making or keeping friends. They may have difficulty getting along with others despite their best efforts to be liked. They may have few close friends and not many acquaintances

• They may not understand why blunt honesty is seen as rude.

• They may feel as though they are always on a stage and not like “being perceived” by others.  

• They may struggle to keep track of fast conversations.

• They may prefer to communicate over text or email than by phone or in person.

• They may perfectionistic traits and/or be extremely strong-willed. They may respond or present themselves in a passive-aggressive manner and insist that everything has to be done 'their way'.

Literal Thinking and Social Justice Focus

• They may be rigid or black and white thinkers, and have a problem being “too literal” (e.g., taking a joke very literally) and not understand teasing.

• They may have a strong justice sensitivity. This refers to an individual’s sense of fairness, equity, and inclusion, as well as their need to address and correct injustices. They may obsess about situations that feel unfair or wrong.

• Women on the spectrum often experience a high sense of social justice and concern about the 'rules', (often too rule-bound). They may struggle with other people breaking rules.

Sensory Sensitivities

• They may experience sensory input more powerfully than others (e.g., notice smells that others do not, or flickering lights that others see as solid).

• They may have a heightened sense of smell, light, sound or touch which can overload the senses.

• Some sensory sensitivities may be so strong that they must remove themselves from the trigger.

• They may have food aversions or limited food preferences, especially in relation to textures.

• They may be a very picky eater with few preferred foods.

• They may be especially bothered by others eating food around them, either by the sound or smell.

• They may be overwhelmed by the lights of grocery stores and malls, or by large crowds.

• They may be more aware of their clothing on their skin and be bothered by certain types of clothing or tags.

• They may display a resistance to touching or hugging, not liking being touched.

Sleep Issues

• Many women with autism experience difficulty sleeping. Often, this is caused by sensory issues, including a high sensitivity to noise at night and problems feeling comfortable in their bed. They may use white noise machines to block out noise.

• The presence of another person can exacerbate sleep issues (e.g., a partner’s breathing).

• They may struggle to settle their body down enough for restful sleep.

Difficulty With Executive Function

• Autism can make it hard to stay organized or finish tasks, especially if the person affected doesn’t find those tasks interesting. Their working memory, self-control and ability to adapt thinking may present challenges, especially at work. Executive dysfunction is also experienced  by those with ADHD, and ADHD and Autism co-occur at high rates.

• Whether in the workplace or at home, it can be hard for women to complete tasks that are deemed less interesting, like keeping a clean house, maintaining healthy habits, or carrying out daily tasks such as showering and eating breakfast.

• They may struggle with forgetfulness and inattention.

Difficulty with Emotion Regulation

• Adults with autism may struggle to manage their emotions and stay emotionally in control. Due to a poor connection between the frontal cortex and amygdala, women with autism may find it hard to rationalize situations and stay in control.

• Women on the spectrum can be highly sensitive, anxious and may get upset easily, in addition, they tend to over-apologize and be told they over-react. Many describe having meltdowns: extreme emotional reactions to situations that might result in losing their temper, crying, or going into shutdown mode.

• Women on the spectrum have been observed to internalize their thoughts, be compliant and well-behaved at work/school. When they get home, however, or feel safe, they tend to release their valve with their partner or family.

• For women, a large majority of those on the spectrum experience pre-menstrual dysphoric disorder, or extreme changes in cognition and affect in the two weeks before their cycle. Meltdowns and mood changes are more common during this time.

Intense Interests

• While boys’ and men’s interests often focus on specific objects or things, women often display an intense interest in a wider range of subjects—including how the mind works or people (particularly romantic partners, “crushes,” or celebrities). Their interests may also be to collect information instead of things.

• Females with ASD tend to obsess over their interests, even in adulthood they need to know every fact about their interest and focus on every detail. They may have typical or mainstream interests similar to their peers but be more intense in their pursuing their interest.

• People with autism display “what if-then” thinking and often want to get to the bottom of how something works. Many women with autism are skilled researchers and may gravitate toward careers or hobbies which require a high level of intense focus.

Repetitive Behaviors

• Autistic people may adopt certain repetitive behaviors, “stimming” or self-stimulating behavior, to help them self-regulate.

• Among males, typical stimming behavior includes rocking, repeating words or phrases and hand flapping. However, women often adopt more subtle behaviors like skin/nail picking, feet rubbing, pacing, bouncing their legs, or twirling their hair.

Co-Occurring Mental Health Conditions

• People on the spectrum, especially undiagnosed, often develop other mental health disorders after living with autism for some time. Coexisting conditions are more common in females than in males, especially when diagnosed later in life. Common co-occurring conditions include anxiety, ADHD, depression, eating disorders, OCD, sleep disorders, and tic disorders.

• There is also a far higher than average rate of suicidality in women with autism, which appears to be related to the degree of camouflaging they engage in.

Perception Difficulties or Differences

• They may be overly sensitive to pain, or extremely under sensitive to pain.

• They may have trouble knowing how they are feeling internally, including hunger and thirst cues, sometimes forgetting to eat.

• Because of the sensory integration differences in ASD, they can have a harder time with visuo-spatial processing which may account in part for clumsiness or bumping into things.

• They may struggle to process visual or auditory information.

Routines

• Individuals on the spectrum tend to like to stick to their routines and often not respond well to sudden changes in their routines without warning.

• They often find change of any kind more difficult to manage and may struggle in situations that are unfamiliar.

• They may have routines that don’t seem to have a real purpose.

During Childhood, Girls with Autism Tend To:

• Spend playtime alone, walking around in the library, or looking for opportunities to help others rather than socialize with peers.

• Position themselves as the class helper, and be called 'the teacher's pet', or spend a lot of time following or being with teachers, preferring the company of older people to peers (or younger children).

• Generally, lack reciprocity in social play and find back and forth conversation challenging and tend to flitter between groups or people or may have one best friend (female or male) that they find difficult to share.

• Be described as 'intense', quiet, mute, or even that talk too much if co-occurring with ADHD. They may appear to be bossy, or rude or take on the teacher or custodian role telling others what to do.

• Have an intense focus and determination and have a high sense of social justice and concern about the 'rules', (often too rule-bound) and be too interested in what others are doing.

• Have imaginary animals or friends who are very real; often very imaginative and creative; 'off in their own world'.
  
  

ADHD & The Interest Based Nervous System

ADHD brains are motivated by novelty, urgency, challenge, or interest. This is why boring, everyday tasks (like showering or brushing your teeth) can be so difficult to complete. People without ADHD or executive dysfunction have the proper neural wiring and neurotransmitters to complete these tasks without much effort, but for ADHD brains these tasks are much harder than even the most difficult task.

The concept of an interest-based nervous system was coined by Dr William Dodson. He explains that “a person with an interest-based nervous system must be personally interested, challenged, find it novel, or urgent right now or nothing happens.” It is either ‘I must do this right now’, or procrastination. This is the case among individuals with ADHD.

It differs from the importance-based nervous system, which is often how neurotypical brains are programmed. This system allows individuals to complete tasks according to their importance, which may not be immediate and may be important to someone else (e.g. a boss) rather than themselves. They are also able to prioritize the tasks and complete them in order of priority. They are motivated by rewards and consequences, such as knowing they won’t get a refund if they don’t return a parcel.

 Understanding the interest-based nervous system means that individuals can adapt tasks to fit into one of the four motivators, in order for tasks to be completed.

Novelty:

• How can you make the task seem new?
  e.g. come up with a new routine to follow until it becomes old, then make a new one.

• Find a new way to complete the same task.
  e.g. try making dinner in a new way.

• Pair new things with old tasks.
  e.g. listen to a new podcast or watch a new episode of a TV show whilst getting ready or leaving the house.

Interest:

• How can you adapt the task to fit your interests or link it to your interests?
  e.g. if you like creating things but hate cooking, create a recipe book of each meal that you make.

• Make the task itself seem more interesting.
  e.g. use nice stationary or pretty highlighters when reading a report.

• Do something else at the same time that interests you.
  e.g. listen to your favorite music.

Urgency:

• How can you make the task seem more urgent?
  e.g. try to introduce fake deadlines

• Introduce fake consequences for not meeting deadlines
  e.g. get someone to hold you to account and say if you don’t do x by x time, then they won’t make you dinner etc.

• Incentivize yourself to complete tasks.

Challenge:

• How can you make the task seem like more of a challenge?

• Turn the task into a competition or game.
  e.g. compete with your partner to see who can empty the dishwasher faster

• Challenge yourself
  e.g. challenge yourself to wash x amount of dishes in 10 minutes, or record the number and try to beat yourself the following day.

YOU ARE NOT ALONE! Remember to be patient with yourself and celebrate every small victory along the way. Give yourself some grace – and follow these tips – and you’re sure to see a change over time!

Premenstrual Dysphoric Disorder and ADHD

A woman’s mental health can be dramatically affected by alterations in the natural fluctuation of hormones that occur during the menstrual cycle. The dips in estrogen after ovulation and right before your period can lead to worsened ADHD and PMDD symptoms. As can the drastic changes in your progesterone levels across your luteal phase. Further, the peaks of estrogen prior to ovulation and mid-luteal phase can lead to increased histamine and worsened PMDD symptoms. Read more to learn why:

Why do these hormone changes affect some women more than others?

Premenstrual dysphoric disorder (PMDD) is a more serious and debilitating form of premenstrual syndrome (PMS) that is more likely to affect neurodivergent women. PMDD is defined by debilitating affective and physical symptoms that affect women during the luteal phase of their menstrual cycle including:

·        Depressed mood, sadness, hopelessness, worthlessness, decreased interest in normal activities

·        Increased anxiety, tension, or the feeling of being on edge

·        Mood swings, Increased irritability, anger, or both

·        Self-critical thoughts, increased sensitivity to rejection

·        Frequent or sudden tearfulness

·        Conflict with family, coworkers, or friends

·        Concentration problems

·        Fatigue, lethargy, or lack of energy

·        Changes in appetite, such as binge eating, overeating, or craving certain foods

·        Changes in sleep pattern, such as excessive sleeping or difficulty sleeping

·        Feelings of being overwhelmed or out of control

·        Physical symptoms: breast tenderness, headaches, joint/muscle aches, weight gain, bloating

If you have these symptoms, consider using this screening tool to learn more.

Causes of PMDD Symptoms

Premenstrual dysphoric disorder (PMDD) is under-researched and not fully understood, but it is thought to be caused by numerous factors that affect your brain’s neurochemistry and communication circuits (e.g., hormones, inflammation, stress, genetics, sensitivity to hormones and hormonal changes). Sufferers typically notice severe mood changes one to two weeks before the start of their period, that resolve within a few days after their period arrives.

PMDD is linked to unstable progesterone concentrations and may also reflect a hypersensitive or abnormal reaction to changes in progesterone and estrogen. Further, the changes in hormone levels across your cycle can lead to debilitating PMDD symptoms by affecting important neurotransmitters such as serotonin and dopamine.

Changes in progesterone levels can alter one’s mood and sense of well-being. Further, progesterone can decrease dopamine in the prefrontal cortex, which can modulate emotional responses. Decreased dopamine in the prefrontal cortex is already a problem among those with ADHD, making emotion regulation (e.g., irritability, anger, mood swings) and executive dysfunction symptoms worse for those with PMDD.

 Serotonin is an important contributor to well-being, playing a role in sleep, sexual behavior, mood, and cognitive functions. Estrogen promotes synthesis, prevents degradation, inhibits the reuptake of serotonin, and promotes the expression of serotonin receptors. Thus, estrogen plays a large role in the overall mood of women. Drops in estrogen mid-cycle and right before your period can lead to a serotonin deficiency.

Furthermore, estrogen increases dopamine synthesis and decreases its degradation and reuptake. It improves working memory, decision-making, and pleasure. Thus, the dips in progesterone and estrogen during your cycle affect dopamine availability in the prefrontal cortex and both dopamine and serotonin throughout the brain. Accordingly, some people may feel worse after ovulation when estrogen and progesterone are low, then feel a bit better during their mid-luteal phase, and worse again when both drop near the start of their period. Still others may be sensitive to progesterone changes and may feel the effects of PMDD across their full luteal cycle (~15 days).

 Other Complicating Factors: Mast Cells and Histamine

Mast cells are a type of white blood cell, one of our immune cells, with different receptors that can bind different things and trigger the release of its contents, histamine being one of them. Histamine is an immune signaling amine and a neurotransmitter. Histamine, in its role as a neurotransmitter, works to control the sleep-wake cycle. It is excitatory and can increase norepinephrine and epinephrine levels, leading to anxiety and insomnia. As an immune signaling amine, histamine is released by mast cells. Histamine may then be received by four different receptors (H1 through 4), playing many roles in the body and brain.

Histamine has a strong connection to our hormones through mast cells. Mast cells have a receptor for estrogen which stimulates the release of histamine and down-regulates the DAO enzyme that clears histamine. Histamine release can then stimulate the ovaries to make more estrogen, resulting in what can be a vicious cycle of estrogen → histamine → estrogen → histamine.

Individuals can have varying levels of tolerance to histamine. Those with lower tolerance or mast cell activation (more common in neurodivergence) may have elevations in measurable histamine that can cause the following symptoms: allergies/congestion, heart palpitations, cold/ heat intolerance, skin changes including itchy skin, flushing or hives, heavy/painful cycles, headaches, and breast tenderness.

If your histamine bucket is full or you are sensitive to changes in histamine, you may not tolerate estrogen fluctuations seamlessly. Accordingly, histamine symptoms are more common in women and often track with the menstrual cycle, occurring when estrogen is high at ovulation and then again in the mid-luteal phase a few days before your period. That’s why mid-cycle and premenstrual mood symptoms can be aided by antihistamines (e.g., H1 and H2 blockers). If taking antihistamines helps some of your symptoms, then histamine may be contributing to your PMDD symptoms.

It is important to track your symptoms daily for a few cycles to understand the unique response you have to these fluctuations in your hormones across your cycle. See more about PMDD, treatment resources, and tracking options here.

ADHD: Strategies for Improving Focus

• Work for shorter intervals of time and use a visual timer to help you see how much time you have left. Try to beat the timer by getting something done before you expected to (novelty and excitement help with focus).

• Breaks typically need only be a few minutes in duration. “Attentional breaks” are often best taken with a motor activity or a relaxing activity. For example, you might take a brief walk or run a short errand, or complete a few moments of mindfulness or progressive muscle relaxation. Limit phone use during your breaks.

• Use exercise either before or during your work activity when possible (e.g., slow pace on a desk treadmill)

• Create artificial deadlines for items that do not have deadlines to promote your completion of the task. For accountability, tell someone when you will have the item/project to them. For bigger projects, create mini-deadlines along the way. This can help boost confidence and keep you from feeling overwhelmed.

• Use body-doubling if working with others helps to motivate you (instead of distract you).

• Changing from one task to the next sooner can help restore your focus for a brief period of time. Tasks can be rotated such that you might work for 10 minutes on one task, 10 minutes on another task, and then return to work for another 10 minutes on the first task.

• Try the Pomodoro Technique: Set a timer for 20 minutes and begin working on your task. After 20 minutes, take a 5-minute break and repeat again. Give yourself a check mark for every cycle completed. The use of a Pomodoro timer might help with this task. More information about using a Pomodoro timer can be found at: https://pomofocus.io

• Limit distractions by putting your phone on silent or not checking notifications for the 10 minutes you are working. Check notifications on your breaks.

• Lengthy tasks, particularly those that are tedious or monotonous, should be interspersed with more frequent breaks or other, more engaging tasks.

• Use visual organizers such as pictures, schedules, planners, or calendar boards, which can help to establish and anticipate the routine for the day.

• Create a reward system for yourself and accountability with your partner for time spent focused at work and activities accomplished.

• Reframing: Combat unhelpful thought patterns by reframing tasks in a positive or more realistic way. For instance, if you are delaying beginning a project and your initial thought is, “there’s so much work it’ll take forever,” try checking yourself with a less negative and more realistic thought like, “if I begin this today, I’ll feel better, and there will be less work tomorrow.”

• Positive Self-talk: Meet your negative inner voice with an encouraging one. Try phrases like “I tried my best and that’s enough”,  “nothing is perfect, it’s ok to be human”, or “I am strong, capable, and I can get through anything.”

• Phones are one of the biggest distractions, especially for people with ADHD. Use a timed lock box to put away your phone when you have important tasks to do! Tik Tok will still be there when you’re done.

• Get stimulated: ADHD minds often feel understimulated which can lead to dropping boring tasks for more exciting ones. Add in a fidget spinner, soothing music, slime, exercise, a podcast or anything that helps you get going. It’s perfectly ok to pair activities as long as it helps you move closer to your goal.

• Eat protein-rich foods and foods rich in Omega-3s.

• Rule out medical causes of inattention such as anemia, vitamin D, and magnesium deficiencies that make ADHD symptoms worse.

• Practice meditation daily, even for just a few minutes, to increase your ability to focus via neural changes.

• Complete harder tasks at your best time of day and save easier tasks for when you are hitting a wall. For example, you may start your day with tasks requiring greater focus if you tend to fatigue in the afternoon.

• For tasks where you are not sure where to get started, seek support or input from others about your approach.  

ADHD is so much more than the inability to focus on non-preferred activities! It can be debilitating but there is help and hope, learn more here.

Coping with Rejection Sensitive Dysphoria

Rejection-sensitive dysphoria (RSD), while not a formal diagnostic category, describes experiences that often occur among those with ADHD. RSD reflects an increased sensitivity to rejection, real or imagined, as well as a greater tendency to perceive rejection even in neutral situations. RSD can be extremely painful and lead to intense suffering among those who experience it. Further, RSD thrives in an information vacuum, in us not knowing what others think about us, our work, and our place in the world. Read on to learn more about coping with RSD.

 Understanding RSD

Many neurodivergent individuals can recall every intense moment of hurt and rejection they have experienced like it was yesterday. Those with RSD are often haunted by past hurts/rejection. They also remain on guard for future rejection, so much so that they sometimes perceive rejection or criticism, where there is none, or have a response that others deem an over-reaction, not understanding the deep pain it has caused. RSD can also reflect a personal belief that you have let someone down. Because many ADHD children and adults may already experience a feeling of otherness, these slight rejections hurt all the more.

As a result, many neurodivergent people develop into people pleasers and perfectionists, going to great lengths to attempt to avoid rejection. They may also tend to ruminate after interactions with others, replaying events over and over in their head, or seeking reassurance from others that what they said or did was okay. This can lead to obsessions, shame, stress, humiliation, feelings of otherness, loneliness, and sadness.

Why does this happen? As humans, we are biologically wired for connection and acceptance, so rejection/criticism is viewed by our brains as a deadly threat, cueing your survival response! Think fight, flight, freeze, and fawn! Further, the emotion regulation challenges that come with ADHD, as well as previous experiences of rejection that come with neurodivergence, make it all the more painful.

Having ADHD and Rejection Sensitive Dysphoria does not make you a human who is weak or incapable. You are just wired to feel things more intensely and replay unpleasant interpersonal interactions over and over because RSD is linked to social insecurity. But empowered with the knowledge about how and why this happens, and the tools below, you can work to overcome RSD. Here are some great tips to help you work with rejection sensitivity and reduce its tumultuous effects in your life.

Believe In Yourself And Focus On Your Strengths

If you’re struggling to cope with rejection sensitivity, it can help to focus on your strengths. Remind yourself of your accomplishments and the things you’re proud of. If someone asked your loved one what was so special about you, what would they say? What about what you love to do? Or what you do well? If you struggle to identify strengths, ask the loved ones in your life. Whatever your strengths may be, make sure to focus on them regularly. This will help you to feel good about yourself and to build up your self-confidence.

Reframe Your Thinking and Work to Stop Taking Things Personally

Many adults with ADHD struggle to separate when a statement is directed specifically at them or when it’s something more general. They often take things personally that may not be personal. Remember that other people can say thoughtless or hurtful things sometimes that are more about them than you. The rejection you perceive may not be purposeful or personal. Instead of seeing rejection as a personal failure, try to see it as an opportunity to learn and grow, or a reflection of someone’s issues rather than your own. This will help you to accept failures and setbacks as a normal part of life, rather than taking them personally.

Develop Affirmations

One helpful strategy is to develop affirmations. Developing mantras or affirmations assists in reducing the noise of negative thoughts that can come with Rejection Sensitive Dysphoria. These are positive statements that help you to reframe your thinking and feel better about yourself. Affirmations can be short or long, but the important thing is that they’re meaningful to you. So take some time to think about what would help you to feel better in situations where you’re feeling rejected. Then start using those affirmations on a daily basis, both in your head and out loud. With time, you’ll find that they make it easier for you to deal with rejection in a more constructive way. Try positive phrases like: “I am stronger than I think.” “My mind is uniquely wired and creative.” “I can make a mistake and be a good person.” “I can take risks and see what happens.”

Build Supportive Relationships and Lean into Your Supports

Focus on building strong relationships with people who will support, encourage, and care for you, even when times are tough. These relationships will provide a buffer against the pain of rejection.

These people can provide a listening ear when you need to vent about a rejection. They can also help you identify if it was a real or just a perceived rejection and help you to see the situation in a more positive/balanced light. With the right support in place, you’ll be better equipped to deal with rejection and move on from it.

Ditch The Negative Self Talk and Replace it with Self-Compassion

It’s easy to get caught up in a negative feedback loop when you have ADHD. You feel like you can’t focus, so you get behind. Then you berate yourself for being “lazy,” which makes it even harder to focus. But the truth is, ADHD is a real neurological condition that makes it difficult to focus and stay organized. It’s not your fault. It’s important to ditch the negative self-talk and give yourself some credit for managing your ADHD. Remember that you are capable and competent, even if you sometimes have trouble staying on task or make mistakes and you have your own unique strengths that compliment your unique challenges. Be patient with yourself and give yourself grace when you make mistakes. Then, celebrate your accomplishments.

Give Yourself At Least One Positive Piece of Feedback Each Day

Give yourself at least one positive piece of feedback each day. For example, you might tell yourself that you did a good job of staying on task during a meeting, or that you handled a difficult situation well.

Stop The Comparison Cycle

Everyone has their own unique set of strengths and weaknesses. However, when you are neurodivergent, it can be all too easy to focus on your shortcomings and compare yourself to others.

This can lead to feelings of inadequacy and low self-esteem. One way to boost your self-esteem is to break the comparison cycle. Instead of comparing yourself to others, focus on your own unique gifts and talents. Celebrate your successes and remind yourself that you are just as worthy and deserving as anyone else. Also, keep in mind that when you are comparing yourself to others, you are not getting the full picture of that person as everyone has different challenges that are not always visible to others.

Give Yourself A Sense Of Control In Your Life

When you live with ADHD, it can often feel like you are out of control. Your thoughts may race, making it hard to focus, and you may feel impulsively drawn to activities that are not productive. This can lead to a sense of powerlessness. One of the most important things is to create structure for yourself.

This may mean setting regular times for breakfast, lunch, and dinner; making a daily schedule for yourself; or setting aside time each day for exercise. By creating structure, you will be able to stick to a routine and avoid the feeling that your life is spinning out of control.

Find Your Passions

Searching for your passion in life can be tough. But if you have ADHD, it’s important to find something that lights a fire inside of you. When you’re passionate about something, you pour your heart and soul into it. This blood, sweat, and tears approach not only makes you feel good about yourself, but it also builds character and resilience.

YOU ARE NOT ALONE! Remember to be patient with yourself and celebrate every small victory along the way. Building your self-esteem, changing your negative self-talk, and learning to cope with RSD is a process and won’t happen overnight. Give yourself some grace – and follow these tips – and you’re sure to see a change over time!