What would happen if fear became your predominant mood?  For many autistic individuals fear is an ever-present state of mind. Patients with autism live in fear that “nothing is what it seems”, that the world around them doesn’t make sense.  For them the world is a construct born in response to challenging events.  Their repetitive behaviors and routines, meant to reduce stress, are frequently broken. Worse still, autistic individuals do not take these rule breaking events as learning experiences.  Such events do not deepen an understanding of their surroundings, nor do they stimulate self-awareness.

It is difficult for autistic individuals to embrace failure or take risks.  Instead, patients see themselves as confined in a drama dominated by shadow archetypes, mystery, and chaos.  This engenders an unpleasant emotion; one caused in anticipation of danger.  Indeed, anxiety is the biggest source of stress for those in the autism spectrum.  For many, it is their constant companion.  Anxiety thus establishes an intimate relationship with a person only to be interrupted by occasional bouts of intense fear or even panic.

Strong emotions excite the nervous system and, when repeated, they become hardwired into aspects of an individual’s personality.  Coping mechanisms for these strong emotions are provided by our human constitution.  We have an autonomic nervous system that allows us to face life’s challenges with a “fight or flight response”.  This is not a positive coping mechanism. In a naturalistic setting fear by itself becomes a motivating factor, part and parcel of our fight or flight response. At physical examination many autistic individuals bear witness to this sympathetic arousal; their pupillary size and heart rate are abnormal, they are inattentive, and they complain of an inability to sleep.  Some studies from our laboratory suggest that this autonomic abnormality may even be responsible for cardiac arrhythmias and sudden death.

When fear and frustration become repeatedly paired with neutral stimuli, the latter becomes a secondary activator. Fear in this regard grows, generalizes, does not respect boundaries, and traumatizes the patient. Those affected understand that such fears are inappropriate, and often harmful.  Although they do not know when fear will overcome them, they are nevertheless certain that it will happen sometime.  This makes the negative emotions all that stronger (see autistic burnout).   Even when not consciously recognized, free-floating fear is a noxious stimulus capable of reducing life expectancy. Have you ever heard of the saying, “you can worry yourself to death”? This is the emotionally draining world of some autistic individuals.

We are all born afraid and scared. Some fears are universal, e.g., our own death.   This universality of fear makes the emotion credible.  Monsters become real in a world ruled by fear. Under this emotional environment there is seldom a successful long-term resolution to the problem that caused the inciting fear. You become closed towards pursuing new experiences and seek solace by hiding in a room and interacting with a computer.  Innate fears and caution take over the life of an individual thus disturbing his/her identity.  Ultimately the psyche fractures under the stress of trauma. These feelings cannot be repressed but neither can they be properly expressed by somebody having difficulties in communication.  The result being maladaptive behaviors.

Maladaptive behaviors serve as a reminder of the destructive power of unresolved fear and trauma.  Fear is a highly conserved evolutionary mechanism that has helped in the preservation of our species; unfortunately, fear can also control our lives. Overcoming our fears allows us to grow as individuals and become more productive members of society.

People ruled by fears need treatment. Although early intervention provides the best outcomes, it is never too late.  Both medication and talk therapy can help in treating the symptoms, but a customized treatment plan is necessary. Insomnia is a common comorbidity of fear, anxiety, and PTSD.  Proper sleeping habits, a good diet, and exercise are valuable therapeutic adjuncts.  Other valuable interventions include cognitive therapy, exposure therapy, relaxation training, and psychopharmacological agents. 

References

Casanova MF. Fear, emotion, and socialization in autism. Cortical chauvinism, 2013