Your heart is beating too loud and too fast. Cold sweat forms on your neck, sending shivers all over your body. You feel your mind disconnect from reality, going into dissociation. Your nervous system goes into survival mode and activates “freeze.exe” or “flight.exe”. If this sounds too familiar to you, then here are the most important facts first: You are not alone and there are ways to deal with this.

How you react to the breakdown is crucial to its length and intensity. It’s not always easy to recognise the cause and therefore decide how to counter it. There are differences, and what works for panic attacks may not work if it’s actually a meltdown.

For years, I thought I had panic attacks (Anxiety, anyone?…) but as my research into Autism and ADHD progressed, I became aware that at least half of these panic attacks had been autistic meltdowns and shutdowns in reality.

What is the difference, in medical terms?

Before we dive into the subjective experiences of these, let’s have a look at their medical definitions.

A panic attack is defined by the DSM-5 as an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four or more of the following symptoms occur: Palpitations or accelerated heart rate, Sweating, Trembling or shaking, Sensations of shortness of breath or being smothered, Feeling of choking, Chest pain or discomfort, Nausea or abdominal distress, Feeling dizzy, unsteady, lightheaded, or faint, Derealization (feelings of unreality) or depersonalization (being detached from oneself), Fear of losing control or going insane, Sense of impending doom, Paresthesias (numbness or tingling sensations), Chills or heat sensations

And here’s another snippet of information: One possible cause of panic attacks is a dysfunctional amygdala. And what to we know about the relation of the amygdala to ADHD? The amygdala of ADHDers is smaller that average and therefore can’t cope as well with emotions as a normal-sized amygdala. That’s why emotional dysregulation is a core symptom of ADHD. Add a dash of childhood trauma and voilà: volatile personality.

A meltdown (autism and ADHD) and shutdown (autism) are defined as overstimulation either through overwhelming sensory input or emotional distress. The person concerned looses the ability to control themselves and their nervous system goes into survival mode (fight or flight mode) when they are experiencing a meltdown. A shutdown (also survival: freeze mode) can follow as a consequence, or can come instead of a meltdown. Adult autists sometimes develop masking strategies so if they have a crash, it’s not necessarily noticeable from the outside. It’s also not necessarily evident what caused the breakdown. Often, the affected person can’t really tell either at first. Often it’s a combination of too much sensory input. It takes a lot of self-monitoring to get to know one’s own triggers.

How do I recognise the difference?

Disclaimer: To help you differentiate, I will describe to you how this feels to me. It may very well feel different to others. But I’m writing this down in case you recognise yourself in these symptoms. If I can help just one person who reads this blog, then it’s worth all the work and research. Because no-one should have to suffer a crash without a rough idea on how to get to the other side.

What a panic attack feels like for me:

• a sudden life-threatening fear that something terrible is happening right now
• heart palpitations
• a sudden burst of cold sweat
• nausea
• cold shivers crawling up and down my spine
• loss of the ability to breathe freely and deeply
• I dissociate

What a meltdown feels like for me:

• also an intense fear but it doesn’t happen suddenly but rather builds up over a couple of minutes (or, if I notice it earlier, builds up over hours)
• an overall, unspecific feeling of danger
• every noise, every light, every touch is too much
• a feeling that something is not right in my body but without the cold sweat and palpitations
• usually triggers a flight response first. The sudden urge to get away from wherever I am as fast as possible. If somebody happens to get in my way, survival mode changes to fight. Suppressing the urge to actually fight takes a lot of energy.
• I dissociate
• the urge to curl up and bawl my eyes out to release the pressure

What a shutdown feels like for me:

• an intense feeling of absolute overwhelm
• every noise, every light, every touch is too much
• a very strong aversion to talking because creating words and sentences in my mind and getting my muscles to articulate them feels exhausting. When in company, I can still force myself to talk but inwards, it feels like hell.
• a very strong aversion to moving because every kind of movement feels like lifting heavy weights
• I dissociate
• the urge to curl up and bawl my eyes out to release the pressure

What helps which?

In all three cases, the nervous system goes haywire. But because the causes are different, the way out is a little different, too. There are things that may help for both panic attacks and autistic/ADHD breakdowns like

• breathing exercises (e.g., parasympathetic breathing: your exhale lasts longer than the inhale)
• going to a calm place
• having a supportive person at your side for co-regulation
• knowing and using your resources for regulation (e.g., having your favourite blankie/plushie, fidget toy, stimming, …)
• anything that can help you feel safe

But a neurodivergent breakdown needs additional care. Because it gets caused by massive sensory overstimulation or emotional stress, a first aid is always cutting off all unnecessary sensory input. If possible, go to a quiet place with soft light. What helps me is putting a soft blanket over my head. This helps shutting off light and noise and also helps me by feeling the boundaries of my body. Let’s now look at some other methods for calming down in a breakdown situation.

Here’s what’s often recommended for dealing with panic attacks:
Orienting (looking at surroundings, consciously taking in details, feeling the earth beneath you, …)

Why it’s helpful during a panic attack:
It counters the “impending doom” feeling by making you realise that you are not in immediate danger. There is no tiger in the room, there is no meteorite crashing into the earth.

Why this won’t work as good for a meltdown:
Because a meltdown is caused by overload it’s not recommended to overload yourself any more by too much sensory input. What does help is having very specific sensory input that helps to regulate you, i.e. for stimming. In the end, stimming serves the same purpose by anchoring you and helping you understand that you are not in danger but it’s much more specific than the common advice: “Count three green objects in your surroundings.” or “Find the colours of the rainbow in your surroundings.”

Another good recommendation for panic attacks:
Your supportive person (if there is one) may talk to you for bringing you back into the here and now, for grounding you. Your supportive person may touch or hug you once the initial panic has subsided.

Why it’s helpful during a panic attack:
Co-regulation is the most helpful factor for regaining a sense of safety and most important factor for self-regulation overall.

Why this won’t work as good for a meltdown:
Autistic persons also benefit from co-regulation but it has to follow strict rules that can be very different between individuals. For me, it’s absolutely no touching, no hugging. Try to touch me during a meltdown and I may start flailing. Try to touch me during a shutdown and I’ll freeze and become totally unable to move. Also, don’t talk to me. Or better put: Don’t ask me anything. I cannot ground myself when forced to socially interact while I’m still overwhelmed.

Many autistic persons avoid being touched like the devil avoids holy water during a breakdown because the sensory input becomes unbearable, even painful. Like it’s setting your nerves on fire or something. But it can help us to know there is another person in the room that we may turn to once we’re ready for this. If you want to help somebody and aren’t sure whether it’s a meltdown or a panic attack, ask the person if it’s okay to touch them. When they’re too far gone, this question has become obsolete and you can try to gently guide them to a quiet place if they allow. Explain to them that you are going to a calm, safe place.

Very crude tool for first aid: If you’re experiencing a breakdown and don’t know what to do, ask yourself the following question: Would I tolerate to be touched or even hugged right now? Example: If you’re experiencing panic, would you tolerate if a doctor touches you for examination? If the answer is yes, it’s likely a panic attack. Try any of the above mentioned methods for regulation.

If the answer is “Hell, no!” it’s most likely a meltdown. If possible, go to a calm place, shut off sensory input. Breathe. Cry if you need, never feel ashamed for it. Find your safe person if it feels right for you. If you are in a public environment and have control over yourself, go to a toilet and close the door. This little cubicle is now your safe space for however long you need it.

Funfact: you can have a panic attack and a shutdown at the same time, I can confirm this because it happened a couple days ago. Yay me.

The aftermath

No matter which distress you’re going through, you’ll likely undergo exhaustion afterwards. In all you do, be patient and kind to yourself. Your body needs a while to integrate the experience. If possible, take a nap even if it’s only short. Give your body time to rest and process all those pent-up hormones and neurotransmitters. You may feel drained for a couple of hours, days, or in severe cases, even weeks. Allow your body and mind to settle down. Never feel ashamed or guilty for taking a break or nap.

Remember, you experienced a state of emergency and your body does not differentiate whether there was a real tiger in the room or not. For your body, the threat was real. Your nervous system just did what is is meant for, protecting your life.

If you feel too much pressure in your life and experience these states and have no idea where to start in countering them, please seek professional help. Don’t accept only medication. It’s a good starting point but it won’t self-empower you, won’t build the confidence that you can actively react to these states instead of just suffering through them. If you suspect that you may be an autistic person (or a person with autism if this resonates better with you), find a psychotherapist that you can trust and work with them. I found out the hard way by trial and error and don’t recommend this way – the fun of being late-diagnosed and uninformed. Getting help can save you years of suffering.

Nice to meet you, Myself!

The journey of a late diagnosed adult – all parts of the blog series:

1. Disclosure – You have what?! – Harmful prejudices in society
2. Childhood – Growing up being different – Factors that influence ADHD
3. Hyperfocus – An ADHD superpower that comes with a price
4. Excitement and Connecting – The Ugly Duckling
5. Stages of Grief – making peace with what could have been
6. At the doctor’s – The first appointment wasn’t quite what I expected
7. Medication – Pros and cons and common misconceptions about meds
8. Diagnosis – Finally getting confirmation

★ to be continued ★

additional articles related to neurodivergence,
basic everyday stuff and life hacks

Disclaimer: I am not a doctor or qualified medical person. If you experience health issues, mental or physical, please get help from a professional. This website is not meant to give medical advice, just some basic information and examples about what it means to live with Autism or ADHD. Symptoms vary strongly between individuals.

My sources

When I’m writing about symptoms of neurodivergent disorders, the information comes from several sources: One of my main sources is ADXS.org, a site available in English and German. I also consult other sites, preferably with professional medical background. I usually don’t consult blogs of private persons if information can’t be verified.

Some things are my own observation and have been compared with other sources. I strive for accuracy and verified information. It’s not easy as a lot is still unknown about neurodiversity and many clichés are still being published that have been proven wrong years ago. If you stumble about somethings that you know for a fact is wrong, please get in touch by using either the comment form or the contact form.