Recently, I was laid off from work. This is a stressful event for anyone who experiences it, no doubt. And I was stressed. My experience of this stress and reaction to it, though, were complicated by the fact that I have mental health struggles. Many mental health struggles, multiple diagnoses. Or, as the mental health professional world would put it, comorbid disorders.

Complications of Comorbidity

I have PTSD from a traumatic childhood. I am on the autistic spectrum. I struggle with anxiety and depression. My executive function randomly falls into disarray. I have a hormone imbalance that plays havoc with my head and body. And these are just the major issues I have identified.

When the layoff happened, it wasn’t just the stress of the experience I was dealing with, it was a multitude of warring factors dysregulating my ability to function and deal with the situation. Many of us who have mental health struggles are rather complex in this way. Even if we have only been given a single diagnosis, we have so many other things going on as well.

You may be thinking, stress is stress is stress. What does it matter where it was coming from? That’s the thing, though, it does matter! If you want to make sound decisions, if you want to move forward, if you want to free yourself from damaging cycles, it matters very much.

True growth and healing require insight. If you want to make changes to yourself, if you want to make your life better, if you want functioning to be just a little bit easier to do, you need to know what to change. Equally important, you need to know what is driving the behavior, emotion, thought, or dysregulation so you even know how to change it.

The actions I need to take to process my trauma are quite different from the actions I need to take to regulate the rigid behaviors I struggle with because of my autism. How I handle my anxiety, is not how I address my depression. And, if there is an underlying issue, such as a hormone imbalance, that is physiologically wreaking havoc, then my attempts to change will be difficult or near impossible because I am fighting a losing battle with my body.

The Importance of Growth

I know there are many “experts” out there that promote a tough mind, pushing forward and never looking back, and just forcing yourself to be healthy. And if that works for you, great! But that philosophy has not helped me. It is akin to never actually cleaning, but only shoving everything into a closet. Maybe, if you’re lucky, that closet is big enough to hold a lifetime of chaos, the lock on the door is strong enough to keep it all in, and the smell of rot emanating from it will not affect you too greatly. But, if you’re like me, that door barely shuts, the smell is overwhelming, and more importantly, I’d rather actually clean my house then just live my life pretending that I had.

This is why, when a high-stress event occurs, whether that event is created by reality or by my inner wiring, I use it as a flashlight to illuminate the tapestry that is my mental health. I search for the loose threads so that I can reweave them into the fabric. I do not believe myself to broken. But I do believe in growing. I believe in wanting to be as strong, as capable, as healthy, and as happy as I can possibly be. It takes effort, but it is effort well spent.

All of this is easier said than done, though. Luckily for me, I have been practicing this skill of self-examination and reweaving for over 25 years. This is not to say that insight comes easy and change requires no struggle. It just means I have some idea of what I’m doing, how to do it, and what to expect. If you are new to this or maybe just struggling with a particular hurdle, I want to share some details of exactly what I did during this situation in hopes it will help you better use the light of stress to illuminate your frays so that you can make your tapestry of mental health stronger.

Awareness

The very first thing I had to do was become aware. Because I know that I have a lot going on with my mental health, any time I go through a typically stressful experience, I check in with myself just a little bit more. (Listen to our Mental Health Check-In episode for details). Unfortunately, as sometimes happen, I was so caught off guard that initially I did not do much checking in.

My stress response kicked in, and I let my adrenal glands lead the way. Checking in seemed irrelevant because what was needed was real-world action, not self-reflection. The fault with this idea, though, is that it allowed my many issues to run rampant, making it impossible for me to really take needed actions.

Don’t get me wrong, adrenal glands and the stress response are great for short-term situations. It’s part of what keeps you alive. But this was much more than a short-term situation. It was something that required planning, thought, rational choices, and a lot of high-level executive functioning. All things the stress response tends to shut down.

My stress response, though, ended up being the indicator that something needed to change. I had bouts of frenzied activity of job searchers, organization, and mental scheming. These oscillated with times when I felt frozen, unable to move. I would just sit on the couch, binge-watching Netflix unable to think or get anything done.

Our stress response typically has 3 main reaction modes: fight, flight, and freeze. I was switching back and forth between freeze and fight. Once I saw what was going on, I realized self-reflection was exactly what I needed if I wanted to make sound decisions that would not negatively affect my future.

Tracking Symptoms

Because things felt off with me even before the layoff, I decided to start with symptom tracking. I used a scrap of paper to write down brief notes on what I felt each day. For me, this included things like extreme anxiety, mood swings, feelings of depression, and energy levels. I also put a number by each symptom, ranking how intense it was (1 low intensity to 10 high intensity).

I didn’t just stop with psychological things, though. I also looked at my hunger levels, what I was eating, how much I was sleeping, headaches and their intensity, as well as tracking my menstrual cycle. I wasn’t fully sure what was going on, so I cast my net wide.

This is how I came to realize that everything got so much worse as I neared my period. I had symptoms throughout the entire month, but as my period grew closer everything escalated into a crescendo of shitiness. Debilitating migraines, anxiety so high I was chewing the skin off my lips and picking at my scalp, depressive feelings deep enough that I could accomplish nothing. If I wanted to ease up these symptoms, I was going to have to do something.

Taking Action

Nearly all disorders in the Diagnostics Statistics Manual (the book used in the U.S. to diagnose mental disorders) include this caveat in their list of symptoms: “. . .is not attributable to physiological effects of a substance or another medical condition.” Essentially, whatever is going on is not because the person is taking a medication or drug or has a physiological illness that could be causing the symptoms.

A lot of mental health issues and symptoms can be created by drugs, meds, and medical conditions. And if you don’t address the underlying physical problem, things aren’t going to get better. For example, if you have an underactive thyroid, no amount of therapy is going to fill you with energy, help you lose weight, or make your depression go fully into remission. This is because your body has set my hormones at such a level as to make all of that impossible. Until you address and repair the hormone imbalance, you will not be able to experience the long-lasting, deep changes you need to feel healthy again.

Knowing this, I focused on my body first. I did a lot of research on hormones, which included websites, books, and even talking to people. I improved my diet. I found a way to pay for the help of a medical professional, something I had been putting off for a long time. All of these changes lead to the discovery of a few supplements that eased the symptoms enough so I could function and create long-term plans to make significant changes that will hopefully (time is yet to tell) get my system back into balance.

Check-in Again

Since these plans were long-term, I knew I would not see changes overnight. I also knew myself well enough to know that it is extremely rare that there is ever one thing that is going on. And even rarer that addressing only one thing will actually help me grow, change, or heal.

Now that my symptoms had eased up a bit with my diet changes and supplements, I checked back in with myself. This meant sitting with the discomfort. Up until this time, my symptoms had been so extreme the only coping skill I really had was escape. I was running away from the discomfort with distraction, sleep, projects, and Netflix. It was now time to stop running.

When I felt spikes of discomfort, depression, anxiety, or outright panic, I allowed these emotions to be without attacking them or trying to change them. This is a skill I have honed with vipassana meditation practices. Others learn this skill through mindfulness, therapy, or radical acceptance coping skills. The ability to be in pain or discomfort, acknowledge it, but not react to it. This skill allows you to examine what is happening in the moment. To tentatively explore all the parts of it.

Express It

Exploration is typically not enough for me, though. I need a way to organize all the data I gathered, to make sense of it so I can analyze it and explore it. For some people, this step may not be necessary. They have the ability to hold and understand intuitive knowledge. This is not something I can do; it slips away like water cupped in my hands.

I need to translate this data into something I can understand. Some people use artistic expression, creative outlets, or even writing. I talk, talk, and talk some more. I talked with my boyfriend. I talked with my sister. I took long walks and talked to myself. I used my words as a way to feel out what felt right to me. Each sentence and bit of feedback narrowed my focus a little more until I was able to hone in on what I was experiencing. And my experiences indicated that there was more going on.

Know Thy Disorders

The first thing I realized was my autistic nature was butting heads with reality yet again. I dislike change. I love routine. Even when I’m in a rut, I find it hard to get out because the rut is familiar and comfortable and known. These are all part of what I term my autistic nature. Or as the DSM would put it: “insistence on sameness, inflexible adherence to routines.”

What it came down to was this: a life without set boundaries is a gaping void that I shy away from. Change was forced on me suddenly without my permission. It scared me. This change further required me to go boldly into a future that I could not picture because there were no boundaries to define it. I had to create new boundaries. I had to make a choice about what I was going to do next. How was I supposed to make the “right” choice, when all of the options were lost in a haze of unknown?

Furthermore, this choice was very limited. It would probably mean no longer working from home. This meant people, this meant sensory overload, this meant a return to the insanity of wasting precious time to prepare for, travel to and from, and wind down from a job I didn’t even want in the first place. How was I supposed to make the “right” choice, when all the options sucked?

I was able to understand what was going on and from whence it sprang because I am familiar with my disorders. If you have disorders or mental health struggles, I encourage you to thoroughly research each diagnosis and even anything that just brushes up against what you experience. Read the “official” research. The kind of stuff that is in the DSM or on PubMed or Google Scholar. Don’t stop there, though. Also, read the blogs and articles and watch the videos made by people in you community, who experience what you do.

The very fact of knowing that part of what was going on was the basic fact that I am autistic in a neurotypical world, helped to ease my experiences of distress. I wasn’t over-reacting, being broken, or any other shameful idea. This was simply part of the struggle. Knowing this also allowed me to address my fears and rigidity in a way that would soothe the troubled soul of the autistic person I am.

Understand Trauma

After I began doing the things I needed to do to address that aspect of my stress, I checked back in. Again, knowing myself, I know that I am rather like an infomercial: “but wait, there’s more!” And sure enough, there was more. Underneath the autism was a bigger fear. A life and death fear. A fear that felt like being 3-years-old again. And that is how I knew another piece of what was happening was my PTSD.

One of the things I have studied over the years is developmental psychology. How children think, act, feel, and respond to situations. If you know me, this may seem odd, because I don’t typically like children. But, turns out, I was once a child.

If you’ve read my blogs on trauma, listened to our episode on trauma, or have just done your research, you will know that traumatic memories are created, stored, and processed differently than typical memories. When something in life trips across one of your triggers, it is like being thrust back into the fire and ice of the initial trauma. It is as though that trauma preserved a tiny piece of who you were in that exact moment in amber. An amber that you get forced to revisit again and again when anything even mildly similar occurs.

Care for Your Inner Child

While the brain’s idea of immersing you in the past to allow you to access the skills you need to survive is nice, it is not in fact helpful. Because, I don’t know about you, but I honestly didn’t have many awesome psychological survival skills when I was 3-years-old, hiding in the back of a car, terrified of my mother. The nice thing about this amber effect, though, is that it does take you back to the age the trauma occurred, which can give you insight into how to process the trauma.

Reviewing my personal history and studying developmental psychology has helped me pinpoint how certain ages feel. Am I beyond words, full of the urge to scream out in hopes it will bring me the solace of physical contact and motion needed to soothe me? Then likely this is something that happened in my infancy. Am I scared and small, wishing someone would hold my hand, wanting my mommy to save me? Then likely this is something that happened when I was a young child.

Understanding child psychology means I can understand what those ages feel like and the kinds of thoughts I would be having. It also means I can understand what I need to do to soothe that younger version of myself. Something that has triggered me back to infancy will not be soothed with logic. It takes tactile sensations like rubbing, the closeness of a loved one, rocking, and soothing noises. But if I used these same techniques on teenage me, they would not only be ineffective but likely also piss me off.

What I realized in this situation was that I was terrified of making the “wrong” choice. I knew this fear was bigger than my autism because it felt like I was 3-years-old again. I felt like the world was on my shoulders, that there was no help to be found, that it was fully and totally my responsibility to make the right choice, to be a good girl. Because “if I wasn’t a good girl bad things would happen.” That was honestly as articulate as I was, which was part of how I knew that I was 3 again.

Process the Trauma

This discovery was extremely interesting to me. I have been out of that household since I was 19. I have been working on processing my triggers for nearly 2 decades. You would think, by now, I’d have found them all. Not so. This was a new realization for me. An epiphany.

This understanding didn’t just light up a tiny bit of my tapestry, it shone on and bounced across threads throughout my whole life. Why large decisions have always been so difficult. Why I feel paralyzed when making life choices. Why, more often than not, I simply choose impulsively or at random. These huge decisions make me feel like I am 3 again, and I make choices as though I was that age.

I don’t want a 3-year-old directing my life. This means processing this trauma. Working with it to first create knowledge of when it is even being triggered, and then creating space to accept and assimilate it into who I am now. All in the hopes that someday, I will not be triggered, but simply reminded of a time in my past. A time that I learned from and moved on from.

Seek Help

The issue of my layoff, which has been going on for two months now, revealed a lot. Most of which I am still actively working to sort out. Trying to make needed changes, trying to employ applicable coping strategies, trying to process past traumas. All of this on top of the original issue: soon, I will be without income. This is a lot to deal with.

All this enlightenment provided me a means to move forward and eased my stress in a lot of ways, but I still needed to take action long before I finished repairing these loose threads in my tapestry. Sadly, though, all of these issues on top of the stressful situation left me floundering, overwhelmed, not able to make a decision in the time frame necessary. So, I phoned a friend. Or, rather, my sister to be more exact.

This is another part of repairing the tapestry, seeking out an expert. Sometimes this is a professional. Other times, it is simply someone who has made her own mental health tapestry repairs and knows you well enough to assist you in yours. In this case, my sister helped me untangle myself from all of the threads for just a few moments. She helped me to step back and see the bigger picture. Not just the mental health tapestry, but the room in which I was working on it. She offered insight and much-needed advice to help me be strong enough to make the choices I needed to make.

Is everything all better now? No, I’ve only replaced half of my lost income. I’m still in the process of making needed changes to get my body back into regulation. I’m still processing trauma and working with my autistic nature. But I do feel like I can breathe again. I have hope that things will be ok. Most importantly, I once again know that I am capable of making them that way.

Stress is part of being alive. Even if you go to great lengths to eliminate useless, unneeded stress from your life, some types of stress will still happen. But you can learn to value (eventually) the stressful experiences you do go through because they help you understand yourself a little bit better. This understanding then gives you the power to reweave your tapestry, to rewrite your narrative, to grow toward your own light.

Pulling at the Threads: The Struggle to Heal When You Have Comorbid Disorders

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Pulling at the Threads: The Struggle to Heal When You Have Comorbid Disorders

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