(Hold out for Love–Francesca Battistelli)
Alternatively titled: the post in which you find out more than you ever wanted to know…
I have been in counseling for the past three years. This has allowed me to have a lot better perspective on who I am and as I am getting ready to call the end on this story in my life, I’d like to put together some thoughts on some things. As a disclaimer, any motives assigned to other people cannot be guaranteed accuracy; I only know what I have been told, and inferred the rest based on actions. That being said, I am not trying to display anyone inaccurately or in a negative light. For me to really process things I have to put pieces together, and if I am not given the full puzzle I do my best to fill in the gaps. I tend to see people idealistically and excuse any negative actions, and I do not want to hurt even people whom I do not like, but sometimes my words can come across that way…
So yeah, between the parts of my records I have seen and from my experience there have been a few different labels that have been placed on me over the years.
Year 1: I started the year with the general label of stress possibly stemming from transitioning to a completely new environment. From there the label shifted to social anxiety, and though my worksheets continued to be about social anxiety and I was never informed about the shift in perspective, the label changed to autism towards the end of the year. I brought up OCD at one point when my friend told me to, but I wasn’t myself fully convinced yet, and never really got a chance to explore that since I said “my friend said to bring up OCD” and when the counselor asked why I said I don’t know and the conversation ended at that.
Year 2: All year the label on my records stayed pretty much the same: anxiety and rusty social skills. There was a definite discussion about OCD, and I don’t think my counselor nor I would doubt that OCD was a label that belonged on me. At one point towards the end of the year she asked me if I’d ever thought about autism and I was a bit taken aback and wasn’t sure what the right answer to that question was, and gave an answer that was intentionally ambiguous as to my position on the topic to see where she was going with it. She then told me that although certain things might fit that she was confident that my issues stemmed from my anxiety rather than from autism. She agreed that there were definite pieces that could fit but that they made more sense in the context of anxiety. I had not seriously thought about autism at that point, so I didn’t question it–I already was sold on the idea that I had a problem with anxiety, so no need to rock the boat when she also agreed that anxiety was my problem.
Year 3: I have not read the notes about me from this year, but there is no doubt in my mind that at some point OCD will have been mentioned. Additionally, very early on my counselor brought up autism with me and when I questioned it she seemed pretty sure of it so I went through the criteria, and like my previous counselor had said, there were pieces that fit. Looking back now though, I am wondering if perhaps she was already not such a fan of me. My counselor the year before had told me that she had pressured me to follow her because she didn’t think Michelle would have time for me or wouldn’t want to work with me, and perhaps she was right and Michelle was already planning how to get rid of me. I suppose once she got me to buy in enough to the autism thing it wasn’t so hard to use it against me to say that I do not have a firm grasp on reality.
Here is the DSM criteria for autism and for social anxiety in order to decide where I think I fit…and perhaps I need to stop believing people unquestioningly. From experience I know that people’s word is not worth much, but I still somehow naively believe that everyone has golden motives and am probably a bit too quick to forgive and give more chances…I suppose in other words I am Minnesota Nice to an extreme.
Autism Spectrum Disorder 299.00 (F84.0)
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
hmm, reduced sharing of interests and failure to initiate social interactions…yes, that does describe me, but if you were afraid of talking to people and what their reaction might be, wouldn’t you, too, share less frequently and be a bit slower to initiate social interactions? The more comfortable I have gotten communicating, the less that this has applied to me. Additionally, while at first I needed help for every situation separately, my growing ability to communicate has allowed me to generalize and social skills I learn in one context help me to communicate in a completely separate context.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Once again, if you were scared of having too much attention on yourself, and were focused on blending in and staying unnoticed most of the time, wouldn’t you avoid using overly expressive nonverbal communication styles likely to draw attention towards yourself? Wouldn’t you naturally avoid eye contact to avoid being invited into a conversation and having to determine what to say? If you were terrified and constantly trying to figure out what is expected of you, don’t you think your facial expression and body language may be somewhat paralyzed and incongruent with the words coming out your mouth? Finally, if you have spent much of your life avoiding social contact and focused on what you need to do to get through it, don’t you think you might not be as quick to catch on to other people’s communication?
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
I would argue that it is also rather difficult to form friendships with your peers when you are terrified of communicating with them and it adds an extra level of challenge when growing up you were developmentally more similar to students in the grade above you, and one more level of challenge when you were bullied mainly by students in your own grade, not to mention an incident in high school called moving to a new church where the students your own age where a bit clique-y but the older girls quickly welcomed you in…just sayin’…As for difficulty in understanding relationships, I think that goes straight back to the problem that if you have less experience with relationship due to either being excluded or self-exclusion due to fear then it is going to be something you understand a bit less.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Yes, I will mimic things I have heard people say. That is called modeling. Being scared of and avoiding communication means that I have not had a lot of opportunities to learn proper ways to communicate, so just like a toddler learning to communicate for the first time by imitating phrases he or she sees older children or adults using to obtain desired results, I will borrow phrases I read or hear people say that seem to have the desired results. Yes, at first it may cause very scripted conversations, but as I get more comfortable with the situation, the words become my own and flow as such.
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
I have difficulty letting go of control–which is why Betsy suggested that I ought to look into OCD. I am also the first to admit that I do not do change well, but I would also point out that I can handle change in many situations, namely change is made easier if I can look at it as an adventure, if I can be directly involved in the chaos, if it is my idea, or if it is explained to me in an understandable way in advance. It may not always be immediately obvious why I insist on certain things remaining unchanged, but there will be a reason…for smaller things, I would like to point out that humans are creatures of habit. If every morning for years you have parted your hair down the left side, chances are tomorrow you will not wake up and part your hair down the middle for no reason. If you needed to you could do it, but you wouldn’t just do it…finally, one more argument on this. A few years before I started college, I started attending a new church, and I am still dealing with that huge change. Additionally, without good communication skills, as I move back and forth between school and home I essentially am moving to completely new worlds each time. Multiple cross-country moves leaving behind everyone you know each time would cause anyone to want a sense of continuity to stabilize the craziness of all those moves…Okay I lied, one more argument: I do eat the same food a lot. In cafeteria situations that is a combination of picky eating and the fear that comes along with having to communicate what I want to people. When I am buying my own groceries it is a product of the simplicity of picking up most of my food in bulk before the semester starts, and the feeling that everyone is looking at me at the grocery store which makes me get the same things frequently so I do not need to go looking for things and therefore spend as little time as possible at the store.
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
I am not so sure this really applies to me. I have a variety of ever-changing interests. Perhaps I do spend too much time on the internet, but when you are extremely limited in your ability to communicate, getting to know people via the internet where it is not necessary to respond immediately or even at all can help meet innate social needs. I will also admit that I used to be fully immersed in being a swimmer, but that was my identity–just like my friend Alyssa talks about and structures her life around being an RA now, that is what I was doing with swimming then.
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
I do have a high pain tolerance, though I believe most of that is more due to getting used to it because it is very hard for me to express that I am in pain, and I also have a history of self-harm. Additionally, it may appear by my clothing choices that I do not notice temperature, but trust me, I do. Inside temperatures remain fairly consistent year round, so I prefer to inasmuch as possible wear clothes that are comfortable for me inside. This means t-shirts and sandals when yes I do realize it is cold outside. As long as I will not be outside an excessive amount of time, it feels better to me to deal with the coldness outside for a short time in order to be more comfortable inside. This also means that I do get used to the cold and it doesn’t feel as bad…and no one who really knows me would question that I have trouble with heat. Put me in a hot environment and you have the recipe for a crabby whiney sweaty girl.
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
As far as I know this does not apply to me overly well beyond the way it would apply to any child. I have had difficulty with communication since I was little, but I still remember fear when I was younger, though I think I did fit in better back when it was socially normal for parents to orchestrate most children’s relationships.
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
I would certainly agree that my fear of social situations has held me back from forming good relationships and from having experiences that would positively shape my communication skills, but occupationally I have not been overly limited. Yeah, I didn’t get interviewed for the RA position, but I am fairly certain that is the only job I have wanted and not gotten so far…unless the reason I have not been asked to be the lead tutor for anatomy is Michelle trash-talking me to Kim…but then that has less to do with symptoms that exterior circumstances.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
This is one I suppose I would have to agree with because as far as I am aware I do not have an intellectual disability. I have been teased a lot in college about having dyslexia, but as far as I know I am not actually dyslexic, though I did have a gen chem partner first year who was dyslexic…it wasn’t a big deal though.
SOCIAL ANXIETY CRITERIA
A. A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.
This is definitely true. I am afraid of communicating because I feel like I will do it wrong and bother people and I feel embarrassed.
B. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.
Any situation in which I must communicate scares me, and while I am not sure what I get would be classified as a panic attack, I do get flooded with anxiety. Obviously as I repeatedly put myself into situations and have success I am getting to a point where some previously feared situations are much more tolerable, but it takes a lot of work to get to that point, and it will be very scary at every exposure up to that point.
C. The person recognizes that this fear is unreasonable or excessive.
Umm, there is no doubt in my mind that most people do not go through life with the intense fear that I do. I am fairly certain that my level of fear is unproductive and over-the-top.
D. The feared situations are avoided or else are endured with intense anxiety and distress.
Yep. I used to mostly be an avoider, and I still do avoid a lot of things, but now I have gotten more into pushing myself into situations and dealing with the anxiety.
E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
Once again, it is undoubtedly true that my communication deficits get in the way. I have no doubt that my life would have a completely different course if I were more able to communicate…more friends…more ability to “hang out” and talk on the phone like a “normal” teenager…less reliance on other people to bridge the way for me. I HATE having this fear.
F. The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.
Once again, no doubt about it, I have been facing this for much more than the requisite 6 months.
G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.
I am not usually under the influence of any drugs. I occasionally ingest caffeine and even more seldomly take in ibuprofen/Tylenol, but unless someone has been hiding something from me, those drugs do not have any effect on fear and avoidance…I do not have any medical conditions beyond awful vision…I suppose that last clause about another mental disorder is where people could twist this into an autism story, but after going through these criteria, it seems to me that while I fit every criterion for social anxiety, I do not meet as many criteria for autism, and my fitting into the categories for social anxiety seems much more defined and less contrived. If I do decide to try out another counselor at some point, I am willing to listen to her viewpoint on the issue and take into consideration if she thinks I am autistic, but at the moment I have jumped off the autism bandwagon and have navigated back to the social anxiety trail. I guess I’ll have to see where this trail takes me, but at this point it feels more natural to place myself in the anxiety camp.
On a side note, sleep is such a good thing…after a couple nights of crashing while sobbing and then some sleepless nights while I was in too much pain to sleep (blistered arms), it felt so good to finally have healed enough both physically and emotionally to get some real sleep…I have never been a good sleeper, so I mean I am still waking up thirsty and such in the night, but getting some good sleep felt great!