Introduction
Emotional dysregulation is one of the biggest challenges Autistic folks grapple with, due to feelings of loss of control and shame associated with words said and actions taken. Emotional dysregulation refers to challenges in coping with and expressing one's emotional responses. While everyone experiences emotional ups and downs, Autistic folks often face more intense and frequent emotional changes. This blog post aims to provide insights into emotional dysregulation in the context of Autism, exploring key concepts like interoceptive awareness and Alexithymia, and offering practical support strategies.
The Role of Interoceptive Awareness & Alexithymia
Interoceptive awareness is the ability to sense internal bodily signals, with some examples including hunger, thirst, temperature, pain and emotional states. For many Autistic individuals, interoceptive awareness can be heightened or reduced, impacting their emotional regulation. Without a clear understanding or awareness of internal signals, recognising emotions becomes challenging. Difficulties in interoceptive processing can hinder recognition and interpretation of bodily sensations, impacting emotional awareness (Loureiro et al., 2024). For example, an autistic individual might struggle to identify that a racing heart means anxiety or that a grumbling stomach means hunger. This disconnect can lead to confusion and frustration.
Alexithymia is characterised by challenges in recognising and articulating one’s own emotions, which can lead to challenges in social interactions and emotional wellbeing. In a recent study conducted by Ben Hassen et al. (2023), it was revealed that Autistic folks tend to exhibit significantly higher levels of Alexithymia compared to their non-autistic peers. The research further highlighted that Autistic folks often experience lower interoceptive awareness, impacting on perceiving internal bodily signals that reflect emotional states. This reduced awareness can complicate their ability to regulate emotions, making it harder for them to respond to emotional situations. Moreover, the study found a correlation between lower interoceptive awareness and higher levels of Alexithymia, suggesting that enhancing interoceptive skills might be beneficial in improving emotional regulation in Autistic individuals. The relationship between emotional dysregulation, interoception, and Alexithymia is complex and significant. Alexithymia can exacerbate challenges in emotional regulation for Autistic folks, often resulting in meltdowns (Ben Hassen et al., 2023; Dell’Osso et al., 2023).
Phung et al. (2021) conducted research to understand the multifaceted nature of emotional dysregulation in Autistic youth, which was encapsulated by the concepts of Burnout, Inertia, Meltdown, and Shutdown (BIMS), which reflects the complexity and variability of Autistic emotional experiences:
Burnout: Burnout in Autistic individuals refers to a state of physical, emotional, and mental exhaustion resulting from prolonged stress and sensory overload. It may manifest as a reduced ability to cope with daily demands, leading to feelings of overwhelm and fatigue. Autistic folks may experience a decline in their usual daily functioning. Understanding burnout is crucial for developing strategies that help manage stressors and provide adequate rest and recovery time.
Inertia: Inertia refers to a state of being unable to initiate or sustain actions, often linked to emotional and cognitive overload. Autistic folks may struggle to start tasks or engage in activities they typically enjoy, leading to frustration and feelings of inadequacy. This can be exacerbated by external pressures or expectations. Recognising inertia as a valid experience can help create supportive environments that encourage gradual engagement rather than forcing participation.
Meltdown: A meltdown is an intense emotional reaction that occurs when an Autistic individual, feels overwhelmed by stress, sensory input, or emotional distress. According to Lewis & Stevens (2023), meltdowns are complex events linked to feelings of being overwhelmed, leading to strong emotions like anger, sadness, and fear, often coupled with cognitive challenges. These reactions can manifest as crying, shouting, or other forms of distress and often stem from an inability to cope with overwhelming stimuli. Meltdowns can be a way to release emotions, and it's important to recognise that internal experiences can differ greatly from outward expressions. Acknowledging the diverse experiences of meltdowns among Autistic individuals is crucial, as each person's experience can vary widely. Understanding the triggers and signs of impending meltdowns is crucial for Autistic individuals and their supporters, as this knowledge can help provide timely support and reduce escalation.
Shutdown: Shutdown is a response to overwhelming situations where the individual withdraws and becomes non-responsive, often as a protective mechanism. This may involve a complete cessation of communication and activity, where the individual may appear to "zone out" or become unresponsive to their environment. It can be a way to cope with excessive stress or sensory overload. Recognising shutdowns as a legitimate response can help support people to respond with patience and understanding, allowing the individual the space they need to recover.
The BIMS framework (Phung et al., 2021) promotes a holistic view of emotional dysregulation, recognising that these experiences are interconnected and can vary greatly among individuals. It emphasises the need for tailored support strategies that address the unique needs of each Autistic individual, rather than using a one-size-fits-all approach. Raising awareness among support people and peers about these experiences can create a more supportive environment, reducing stigma and misconceptions surrounding emotional dysregulation in Autistic individuals. By understanding the complex nature of emotional dysregulation, supporters can better assist Autistic folks in managing their emotions, ultimately improving their well-being and quality of life.
Meltdowns and Shutdowns in the Context of Polyvagal Theory
The Polyvagal Theory, developed by Stephen Porges, posits that the autonomic nervous system (ANS) has a significant influence on our emotional experiences and behaviours (Chua, 2023). It consists of three main pathways:
Ventral vagal system: Associated with social engagement and calmness
Sympathetic nervous system: Associated with fight-or-flight responses
Dorsal vagal system: Associated with immobilisation or shutdown
Neuroception is the subconscious process by which the nervous system evaluates the safety of the environment. It operates without conscious awareness, allowing individuals to quickly assess whether a situation or person is safe, dangerous, or life-threatening. Vagal tone refers to the activity of the vagus nerve, which is a key component of the parasympathetic nervous system. A well-regulated vagal tone is associated with better emotional regulation, social engagement, and overall wellbeing (Chua, 2023).
If an autistic individual perceives their environment as threatening (due to loud noises, crowded spaces, etc), their nervous system may trigger a fight-or-flight response or immobilisation, leading to behaviours associated with meltdowns or shutdowns. Additionally, research indicates that many Autistic individuals exhibit dysregulated vagal tone, which can manifest as difficulties in social interactions, emotional expression, and self-regulation (Chua, 2023). During a meltdown, an Autistic individual may experience overwhelming emotions or sensory overload, triggering a shift from the ventral vagal system to the sympathetic or dorsal vagal systems. This shift can lead to heightened anxiety, panic, or a complete shutdown, affecting their ability to communicate or engage socially.
Viewing meltdowns and shutdowns as physiological responses rather than merely behavioural issues fosters a greater sense of empathy towards Autistic individuals experiencing them. Understanding that meltdowns and shutdowns often stem from overwhelming sensory input or emotional distress encourages supporters and peers to approach the situation with compassion. This perspective shifts the focus towards creating safe and supportive environments that can help prevent meltdowns and shutdowns in the first place.
Strategies to Support Emotional Regulation
Utilising the neurodiversity paradigm that respects and seeks to understand Autistic perspectives, is essential to understanding individual experiences of emotional dysregulation (Phung et al., 2021). Effective support for increasing emotional regulation for Autistic individuals, involves shifting focus from simply eliminating behaviours to addressing the underlying emotional distress they face (Lewis & Stevens, 2023). Holistic tailored approaches that harness individual strengths for emotional regulation, while also increasing interoceptive awareness, can better assist Autistic individuals in managing emotional dysregulation (Lewis & Stevens, 2023).
Building a Supportive Environment
It's important to understand the relationship between emotional dysregulation and sensory overwhelm to support the creation of supportive sensory friendly environments that help reduce meltdowns (Beneytez, 2023). Creating a supportive environment involves understanding the unique needs and preferences of each Autistic individual. This can encompass sensory-friendly spaces designed to minimise overwhelming stimuli, such as quiet areas with soft lighting and calming colours. Consistent routines help establish a sense of stability, allowing individuals to navigate their surroundings with confidence. Additionally, tools like visual schedules and social stories can offer structure and predictability, making transitions smoother and helping individuals anticipate daily activities, ultimately fostering a more inclusive atmosphere.
Identifying Triggers
Identifying triggers is key to preventing meltdowns and shutdowns. Common triggers include loud noises, bright lights, changes in routine, or social demands. Keeping a journal can help to pinpoint specific triggers and patterns. If you are struggling to identify your triggers it may be helpful to seek support to identify your triggers. Therapists should adopt individualised approaches that tailor strategies to the unique triggers and responses of each Autistic individual (Chua, 2023).
Coping Strategies
Strategies that address both Alexithymia and interoception, such as mindfulness and body awareness exercises, can significantly enhance interoceptive awareness (Ben Hassen et al., 2023; Brett et al., 2024; Hatfield et al., 2017). Furthermore, using strategies like mindfulness and emotion regulation techniques can effectively decrease the frequency and intensity of meltdowns (Dell’Osso et al., 2023). During a meltdown, reducing stimuli, utilising comfort items, and employing calming techniques such as deep breathing can be helpful. Furthermore, finding alternative ways to express emotions through art, music, or writing provides a valuable outlet for emotions, enabling Autistic individuals to process and communicate their feelings non-verbally. If you are struggling to identify your suitable coping strategies and/or finding it difficult to implement them it may be helpful to seek therapeutic support. Collaboration with families and support networks is also essential for ensuring consistent strategies across various environments, ultimately leading to improved outcomes for Autistic individuals (Chua, 2023).
Conclusion
Navigating emotional dysregulation as an Autistic person requires understanding, patience, and effective strategies. By enhancing interoceptive awareness, addressing alexithymia, understanding meltdown and shutdown triggers and implementing support strategies, Autistic folks can be empowered to navigate their emotional landscape.
References
Ben Hassen, N., Molins, F., Garrote-Petisco, D., & Serrano, M. Á. (2023). Emotional regulation deficits in autism spectrum disorder: The role of alexithymia and interoception. Research in Developmental Disabilities, 132, 104378–104378. https://doi.org/10.1016/j.ridd.2022.104378
Beneytez, C. (2023). Intolerance-of-uncertainty and anxiety as serial mediators between emotional dysregulation and repetitive patterns in young people with autism. Research in Autism Spectrum Disorders, 102, 102116-. https://doi.org/10.1016/j.rasd.2023.102116
Brett, J. D., Becerra, R., Whitehouse, A., Preece, D. A., & Maybery, M. T. (2024). The valence-specific empathy imbalance hypothesis of autism: The role of autistic traits, alexithymia, emotion dysregulation, and gender differences. Personality and Individual Differences, 218, 112493-. https://doi.org/10.1016/j.paid.2023.112493
Chua, C. K. (2023). Using Polyvagal Theory to Understand Autistic Meltdown. Asian Journal of Interdisciplinary Research, 6(4), 10–17. https://doi.org/10.54392/ajir2342
Dell’Osso, L., Massoni, L., Battaglini, S., De Felice, C., Nardi, B., Amatori, G., Cremone, I. M., & Carpita, B. (2023). Emotional dysregulation as a part of the autism spectrum continuum: a literature review from late childhood to adulthood. Frontiers in Psychiatry, 14, 1234518–1234518. https://doi.org/10.3389/fpsyt.2023.1234518
Hatfield, T. R., Brown, R. F., Giummarra, M. J., & Lenggenhager, B. (2019). Autism spectrum disorder and interoception: Abnormalities in global integration? Autism : The International Journal of Research and Practice, 23(1), 212–222. https://doi.org/10.1177/1362361317738392
Lewis, L. F., & Stevens, K. (2023). The lived experience of meltdowns for autistic adults. Autism : The International Journal of Research and Practice, 27(6), 1817–1825. https://doi.org/10.1177/13623613221145783
Loureiro, F., Ringold, S. M., & Aziz-Zadeh, L. (2024). Interoception in Autism: A Narrative Review of Behavioral and Neurobiological Data. Psychology Research and Behavior Management, 17, 1841–1853. https://doi.org/10.2147/PRBM.S410605
Phung, J., Penner, M., Pirlot, C., & Welch, C. (2021). What I Wish You Knew: Insights on Burnout, Inertia, Meltdown, and Shutdown From Autistic Youth. Frontiers in Psychology, 12, 741421–741421. https://doi.org/10.3389/fpsyg.2021.741421
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