I’ve never had a panic attack
Late diagnosis, misdiagnosis, and autism
I had my first panic attack when I was seventeen.
I’ve always had anxiety, but I had never felt it with such acute ferosity before that afternoon. It made my skin seem like it had been electrified. I felt every racing heartbeat as my body pumped boiling blood around my body. I was losing control of my thoughts, like when you are running down a hill and suddenly realise you can no longer stop: your only two choices are to keep sprinting at full pelt or to crash and die.
I knew I was spiraling over something silly, but the more I tried to rationalise with myself, the more anxious I felt. The original anxiety started mixing with guilt and shame, making me feel even worse. I couldn’t speak. I couldn’t move.
I don’t remember how I broke out of that thought spiral, but I do know that I didn’t end up in hospital like so many people do when they’re having their first panic attack. I didn’t feel like I was having a heart attack and I wasn’t concerned that I might be dying, which Google told me were common symptoms. But when I went to the doctor and described my experience, he said it was a panic attack, so that was that.
When I was four or five, I went to the newsagency with my mum. There was a record-breaking Lotto jackpot upcoming, and a local reporter was staking out the cash registers with a camera crew, waiting for a cute soundbite to capture so they could pack up for the day.
This stranger asked me why I hoped we’d win the Lotto. “So my dad doesn’t have to work anymore, and he can stay home with us every day,” I replied. The journalist laughed. “Can she say that again on camera?” they asked my mum. My mum agreed, but alas, I was hiding behind her legs now. I refused to repeat my cute quip, and the reporter’s dreams of heading back to the office early were dashed.
I have always been an anxious person. I stopped being camera shy as I grew older, but my anxiety persisted in many other areas of my life. Particularly, I feel anxious when I have no control over a situation. Waiting for an outcome — a diagnosis, a text message, or an assessment grade — is an all-consuming sort of agony.
I’m better at coping with my anxiety than I used to be. I’ve learned techniques to rationalise with myself and break out of anxious spirals before they fully take over (most of the time). I’ve discovered that meditation isn’t just about sitting still and emptying your mind; it can take many forms, like long walks through nature or lazy afternoons creating intuitive art in my journal. I’ve done a bunch of therapy — some successful, and some frustrating. And I take an antidepressant.
I first tried a selective serotonin reuptake inhibitor (SSRI) when I was twenty-four, after deciding I was finally too frustrated with how anxiety was impacting my sleep. Most nights I would wake up multiple times, unable to breath because I was having night terrors that left me panic-stricken. It didn’t matter how capable I felt at managing my anxiety during daylight hours; if I was asleep, all bets were off.
SSRIs immediately had a positive impact for me. Not only did they help stop my night terrors, but they also reduced my headaches and jaw pain. I also found that, while other techniques were useful for recovering from anxiety quicker, SSRIs made it easier for me to avoid reacting as quickly or irrationally to stimuli in the first place.
I’m still on SSRIs now. I occasionally take a break from them to see how my brain is doing without pharmaceutical intervention, but I’m met with the return of nightmares, panic spirals, and overstimulated shutdowns. My brain seems to benefit from the extra serotonin it has at its disposal when my SSRI blocks my nerve cells from reabsorbing it.
I was a seventeen year old in a doctor’s office, and he was running through the K10 Anxiety and Depression Test with me for the first time. In the last thirty days had I felt nervous? Restless or fidgety? Tired? Hopeless? Depressed?
Didn’t everyone?
I was diagnosed with generalised anxiety disorder and depression, and my doctor sent me to see a psychologist. I don’t remember the woman’s name, but I do remember the only advice she gave me during that session: you are the sky and your depression is the clouds. The analogy was designed to teach me that anxiety is temporary and I am constant, but I knew that already. I didn’t want metaphors; I wanted solutions.
I left that session with two things: a bad analogy and a confident assurance from a second healthcare professional that I’d been having panic attacks. I did not return for session two.
When I was twenty-nine, I discovered that the panic attacks that I’d been having for over a decade weren’t panic attacks at all. Actually, I am starting to think I’ve never had a panic attack in my life. Despite what both a doctor and a psychologist told me, it’s more likely that each of these experiences was actually an autistic meltdown.
Meltdown
Informal. a sudden loss of control over one’s feelings or behavior:
My toddler had a meltdown when I tried to leave the house.
- Dictionary.com
I hate the term meltdown. It has a certain connotation, like it’s a synonym for ‘tantrum’. But “tantrums usually end once the person gets what they want or don’t see a benefit to continuing” whereas meltdowns are an involuntary response to sensory overstimulation. While both tantrums and meltdowns could be attributed to someone’s inability to express their emotions in a more productive way, tantrums will usually cease if they don’t have an audience (such as a concerned parent), whereas meltdowns are likely to continue without anybody else present. In fact, I can generally force myself to hold my composure until I’m alone or with trusted companions before the first crack forms in my mask and my meltdown commences.
They might not be panic attacks, but my meltdowns — or ‘episodes’ as I prefer to call them—still aren’t pleasant. I start to lose control over my thoughts and actions, I spiral into self-hatred and guilt, and I struggle to communicate. During my worst episodes, I can’t verbalise, make eye contact, or properly comprehend what is happening around me. I often hit myself, not because I am trying to harm myself but because I am trying to shake my thoughts loose, like you might hit an old television to clear the static. All of these actions are entirely involuntary. It’s a wildly frustrating experience because I feel like my rational and reasonable self is still in my brain and is observing my actions, but has been locked away from the controls.
I understand why these episodes were misdiagnosed as panic attacks. Both panic attacks and autistic meltdowns share some commonalities — such as feeling extremely anxious, overwhelmed, and overstimulated — and it’s hard for a doctor to classify your experiences without witnessing them firsthand. When I first presented with these symptoms, I also hadn’t been diagnosed with autism yet, and unconscious bias within the medical system means doctors are unlikely to consider ASD when assessing girls and women. But this misdiagnosis wasn’t just an incorrect label; it led to a decade of inaccurate communication and ineffective treatment.
Just as the symptoms of panic attacks and autistic meltdowns are different, so are the causes and effective care techniques. Understanding whether somebody is having a panic attack or an autistic meltdown can help friends and family offer meaningful and appropriate support. But what hope do bystanders have if the individual doesn’t know what they’re experiencing or what they need to feel better? My autism diagnosis — and subsequent realisation that I have autistic meltdowns — has made me more informed and empowered. I’ve been able to research how my brain works, explain my experiences to others, and articulate my needs to my loved ones and myself.
Read more
Interested in hearing more about my autism diagnosis and how it’s changed my life? Check out my unconventional memoir, Becoming Wild: Essays on Self and Society.
Extra resources
- PubMed: The lived experience of meltdowns for autistic adults
- Psychology Today: What Is an Autistic Meltdown?
- Psychology Today: Adults Have Meltdowns, Too
- Blossom ABA Therapy: Autistic Meltdown vs Panic Attack: Understanding the Differences
- NCBI: What I Wish You Knew: Insights on Burnout, Inertia, Meltdown, and Shutdown From Autistic Youth
