Vesuvius

I thought I was having severe panic attacks. Turns out there was more to the story.

Photo by Alain Bonnardeaux on Unsplash

Note: This post has been in draft for a while. I was procrastinating HARD, even though I find the topic fascinating, and have had the research done for a minute. I realized that I have a lot of deep, deep shame around this topic. Will there ever come a time when my ADHD symptoms and the way they manifested themselves don’t fill me with shame? I am hopeful. I suppose this is my way of trying to do that. Writing my way out of shame, secrecy, and sickness.

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I have suffered from panic attacks since I was 12 years old. A panic attack is one of the most unpleasant experiences a person can go through that is (usually) not life threatening. The symptoms of a panic attack are well known: racing heart, hyperventilating, a feeling of impending doom, lightheadedness, trembling, dry mouth, nausea. The first time it happened to me, I seriously thought I was going to die. I have probably had hundreds of panic attacks in my lifetime. I was diagnosed with Generalized Anxiety Disorder when I was 16.

Since starting medication for my ADHD, up until very recently, I did not have a single panic attack. I also am not experiencing the daily baseline level of anxiety I once had. In fact, I am rarely anxious at all now. When I do feel anxiety now, its usually for a good reason, and it usually passes. It is one of the best outcomes of medication. Being anxious all the time for no reason is like being in jail, except you are being chased by an angry rat at the same time.

I was talking to a friend of mine - who also has ADHD - and told her that it was so strange I didn’t have anxiety all the time anymore. She didn’t seem surprised.

“That’s because you don’t have an anxiety disorder”, she said, “You have ADHD”.

I am still thinking about that.

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Once every so often, I would have what I called a “severe anxiety attack”. These were different from my normal panic attacks. These attacks seemed to come out of absolutely nowhere, and were severe enough that my husband actually debated on taking me to the hospital a couple of times. When these happen, I lose my fucking mind, for lack of a better term. I cry hysterically and cannot stop, I fly into rages (not violent ones, mostly directed at myself), I say crazy things, and I can’t think. No matter how much logic is thrown my way in those moments, my brain simply freezes. It’s like I’m stuck in a loop, and every negative emotion I can possibly feel is being felt all at once, in their most intense form.

It sucks.

As an adult, these mostly have happened at times of high stress or overwhelm. I treated it the same as I would any other panic attack - either let it run its course, or I would take my anxiety medication. I have a prescription for a very low dose of Xanax, and I only take it when I absolutely have to. Break glass in case of emergency. Fortunately, these only happened to me maybe a few times a year, but left me shaken and anxious for days afterward. Not to mention the shame, especially if someone saw it happen. The word “humiliation” doesn’t cover it.

I had these kinds of attacks when I was a child/teenager, too. I would go into what I called a “blind rage” and would lash out, sometimes physically. It often involved some kind of conflict in my home. I have not laid hands on another person in a violent way since becoming an adult, and I know that response was in part due to learned behavior, since emotional abuse and occasional physical violence occurred in my family. As an adult, I learned to turn that rage inward, as lashing out at people is not terrific for interpersonal relationships and cool things like having friends.

These “attacks” also affect my memory. I often have very little memory of how it started, or what occurred when it was happening, sober or not. It’s not a blackout, per se. I’ll remember some of it, but in this almost dream-like way. I know that I experience depersonalization and dissociation. It’s difficult to explain. They also are more likely to occur if I have used any substances, like alcohol or pot, but not always.

This has only happened to me once since I was diagnosed, during the holiday season. I was so ashamed, confused, and discouraged. I blamed it on the medication shortage, which may have had something to do with it. Once I calmed down, I started googling ADHD and panic attacks. I came across a discussion on Reddit about ADHD and meltdowns.

A light bulb went off.

I realized that these were not “severe anxiety attacks”.

These were meltdowns.

Yes, they are different.

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What is an ADHD Meltdown?

It was surprisingly difficult to find a succinct definition of a meltdown. Most of the information I found focuses on meltdowns in neurodivergent children, mostly with Autism Spectrum Disorder. The same mechanisms apply, but there isn’t a ton of information focusing on adult ADHD meltdowns. There doesn’t seem to be a huge difference between a meltdown in someone who has ASD, ADHD, or AuADHD (diagnosed with both autism and ADHD), so I’m going to use the term “neurodivergent meltdown” to describe it.

Simply put: being overstimulated/overwhelmed can lead to a meltdown in neurodivergent people, which is directly related to emotional dysregulation, which is a part of our brain’s executive functioning. Overstimulation and overwhelm can lead to a shutdown or a meltdown.

A shutdown happens when we are overstimulated or overwhelmed, which can result in ADHD paralysis, appearing withdrawn, or avoidant behavior. Shutdowns are discussed at length in most of the ADHD materials I have read.

A meltdown is also be the result of overstimulation or overwhelm, but rather than a shutdown, the symptoms of a meltdown are more external, and can be extreme.

Some of the symptoms of a meltdown include:

• Crying or sobbing, which becomes difficult to control or stop

• Verbal explosions, including shouting, cursing, or screaming

• “Stimming” - or self-stimulating, which is a soothing behavior. This can include repetitive behaviors such as repeating a word/phrase over and over, rocking, humming, or muscle tensing

• Self-harming behaviors

• Violent behaviors towards others, like kicking, punching, or biting

• Inability to calm down or think logically

Meltdowns - especially in children - are conflated with tantrums. While a tantrum can look similar, a tantrum is usually goal-based, and is used to get something when other methods of communication have failed. A meltdown does not have a goal and is not intended to manipulate/control a situation or others - it is usually to try and bring the brain back to some kind of stasis.

What causes a meltdown?

People with ADHD/ASD are susceptible to sensory overload, and when you are already overloaded, further stimulation and overwhelm leads to what I can only describe as your brain “short circuiting”.

I found a helpful summary:

Sensory overload can lead to disorientation, distraction, confusion, anxiety, and rage reactions that are difficult to control.  In its most mild form- when the system is just bogged down by too many commands at once-  it looks like run-of-the-mill distraction and difficulty focusing. 

But when the commands and sensory inputs just keep coming, then we enter meltdown mode.  Then it’s not just how well our brains function, now all of those inputs start to feel like an assault on our nervous system, and we enter fight/flight/freeze mode- shutting down rational thinking with the sole intention of getting out of the situation.

There is also the ADHD Volcano Model, which is an infographic I had seen before, but never connected to my own experience. The meltdown itself is the outcome of everything going on under the surface, much like a volcanic eruption. This is not unlike the ADHD Iceberg I mentioned in a previous post.

The similarity between a panic attack and a neurodivergent meltdown is that they both involve the amygdala, which is a part of our limbic system - the portion of the brain that processes emotions and threats. The amygdala is the brain’s “alarm system”. When it senses danger, it triggers the “fight, flight or freeze” reaction - a very common phenomenon in both anxiety disorders and PTSD. When the amygdala becomes activated, it temporarily disables your prefrontal cortex, which is the part of the brain responsible for thinking. However, a meltdown means it takes much longer for the ability to think clearly to return. Your brain is literally “flooded” with stimuli, and it feels like having all of the thoughts at once. It can also amplify the effects of drugs and alcohol, which both also affect the prefrontal cortex, meaning what was once a pleasant buzz turns into a really bad time really fast.

Meltdowns tend to last longer than panic attacks, involve a lot more disorientation, and take longer to recover from. Interestingly, unlike a panic attack, a neurodivergent person can actually stave off a meltdown until they get themselves somewhere safe. When I think about it, this makes total sense. This has almost never happened to me in public or around someone I don’t know very well. This isn’t something I do consciously. I’m not like “ok, you’re about to melt down, wait until you are in a safe place!”. My brain does that all on its own.

Many neurodivergent people also suffer from panic attacks and anxiety disorders, so there is a lot of overlap in symptoms. And let’s not forget to invite trauma to the party! Trauma reactions and responses can cause or worsen a meltdown, and some of those symptoms overlap too. My C-PTSD means there are situations where I am inherently going to be more overwhelmed and prone to melting down. Christmas is one of them. I just discovered that Christmas lights - the mere sight of them - is a trauma trigger. Did I mention I hate the holidays?

Strategies for Preventing/Coping with Meltdowns

One way to prevent a meltdown is to avoid a situation that has caused them in the past. For example, let’s say you look back and noticed that you tend to have meltdowns after a rock concert. Maybe they’re fun in the moment, but all that loud noise and the crowds overwhelm your system. As much as you enjoy a rock concert, you may decide that you’re better off not going to them anymore, especially if you are stressed out in the first place. Or maybe you decide to stay for an hour, take a break and self-assess, and decide whether to stay or not.

But what about situations you can’t avoid? Work parties. Family gatherings. Crowded subway stations. Life keeps happening. The world isn’t designed for neurodivergent people, and you don’t necessarily want to disclose your diagnosis in certain situations. You can’t just go live in a cave - as tempting as it sounds.

I spoke to my psychiatrist about this - which was a hard session because there’s so much shame involved - and she was wonderful and told me that I’m doing great, which I really needed to hear. We discussed coping going forward and that now that I am aware, I can implement strategies to at least know what situations might trigger this reaction.

I read a LOT these past couple of months, so here are some strategies I plan to implement going forward:

• Identifying my ADHD Triggers - I feel like I am starting to have a better understanding of these, but I think I need to be more organized and actually write them down. I process a lot through physically writing things. Time to start a new journal just for ADHD stuff…

• Name It - The other day there was loud construction going on outside my apartment, and it was making me start to lose it. I actually said “I FEEL LIKE I AM GOING TO HAVE A MELTDOWN” and left the house and went to the coffee shop. It took a while, but I did finally calm down. I think verbalizing it helped me take action and take care of myself. We can add “persistent, repetitive loud noise” to that trigger list…

• Co-regulating with a Partner - My husband and I are both keen to come up with strategies in case this happens to me again (it probably will) that benefit the both of us. Co-regulation is a mirroring tool where the other person models calm to help slow the nervous system of their partner (this can be a friend or family member too). I’m going to read more about this.

• Box breathing - I think in that state I would have a really difficult time doing this, but I know when I am feeling just normal anxiety it does help. Yoga and meditation have helped me downregulate my nervous system at night.

• Accept that setbacks are part of the recovery process - I was really pissed when this meltdown happened. I felt like eight months of progress got wiped out in a single day, and I was furious at myself for not seeing it coming and not taking better care of myself. It also brought up the unpleasant memories of when it had happened before, which almost sent me into a shame spiral. I had to really work on extending compassion to myself. I am beginning to understand that not only do I have ADHD, I am in recovery from going so long without a diagnosis.

  Undiagnosed ADHD is trauma in and of itself!

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If you experience meltdowns, I am sending a big hug and lots of compassion your way. No one wants this to happen. No one wants anyone to see them like this. No one is doing this on purpose. Talk to people you trust. Be good to yourself. It’s not your fault.

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RESOURCES:

Neurodivergent Meltdowns in Adults - My Soul Balm

Adults Have Meltdowns Too - Psychology Today

Panic Disorder: When Fear Overwhelms - National Institute of Health

Dissociation and Dissociative Disorders - Better Health Channel

ADHD Symptoms - ADHD Aware

Sensory Overload in ADHD - ADDept

The overwhelm-shutdown: why ADHD leaves us stuck - InFlow

Taming Emotional Triggers with an ADHD Brain - Dr. Sharon Saline

Co-Regulation - Complex Trauma Resources

ADHD Meltdowns: What Causes Them and How to Minimize Their Impact - Frida

Understanding Meltdowns: The ADHD Volcano Model - CHADD

Do you have resources to share on this subject? Please link in the comments, or share your own experiences with meltdowns if you’d like!