Updated: May 1
In this article, you will read the good news that the individual with autism may process stress through physical expressions that look like seizures. Why is this good news? -- Because identifying a stress-related spell can lead to meaningful improvement that seizures treatments will not achieve.
WHEN A SEIZURE ISN'T A SEIZURE
The amazing thing about the body is that it can (and will) process emotions and stress through physical systems. The connection between stress and some physical symptoms is well-known (e.g., headache, stomach pain, muscle tension). What may be less commonplace is the knowledge that memory loss, staring spells, or seizure-like episodes may also be physical expressions rooted in emotional suffering.
How do we know when a "seizure" is an expression of stress? The most unmistakable sign is when an episode occurs during an EEG exam. If the EEG fails to detect electrical changes in the brain during the spell, it is clearly "non-epileptic" (non-epileptic seizures, NES).
CONSCIOUS VERSUS UNCONSCIOUS
When this occurs, some mistakenly suggest the individual is "faking" the symptoms to "manipulate" others. But this is not what the latest and most comprehensive research confirms. In the case of a somatoform condition (or a functional neurologic condition like non-epileptic seizures), the physical expression of symptoms is authentic and distressing to the individual. There is no conscious awareness of the emotional underpinnings and no attempt to manipulate others.
It is as if the body says to the brain, "It's tough to feel overwhelmed, isn't it? I'll take the hit for you if you want?" So, the body takes on the emotions to give the mind some relief. Unfortunately, this often leads to indirect stress by creating concerning or upsetting physical symptoms.
In fact, most people who present with somatoform symptoms have no conscious awareness of stress at the time of their medical problem. That's how good the body is at absorbing these feelings.
Want to read more about somatoform conditions and current research? Try the book Understanding and Managing Somatoform Disorders.
OVERLAP WITH AUTISM
Somatoform (of functional) expressions of stress occur more often in certain groups of people than others. For example, those with a history of trauma seem particularly vulnerable to these expressions. Those on the autism spectrum represent another group at risk for physical episodes related to difficult emotions.
A. McWilliams and his team published an article in November 2019 (Seizure, volume 73) confirming that individuals with autism were significantly more represented (about 17%) in the non-epileptic seizure group than would be expected in a general population group (1-2%).
They noted, "It is beneficial to diagnose ASD early as its presence is likely to require a modified approach to assessment and treatment of non-epileptic seizures."
WHY THE INTERSECTION WITH THE AUTISM POPULATION?
There are many reasons that ASD may create a risk for somatoform expressions of stress. One reason may be that the ASD individual often experiences less resilience for daily life than the neurotypical individual. Feeling overwhelmed regularly may create a mind in chronic distress and in need of relief. Secondly, the autistic individual may struggle to identify his emotions, communicate them to others, and find ways to cope effectively with emotional experiences. Perhaps this difficulty also leads to the physical processing of emotions. Thirdly, individuals with autism are at risk for trauma, which in itself is a risk for somatoform conditions.
HOW TO HELP?
I was so excited to read the article cited above because it confirmed much of what I see happening in my clinic. The correct identification of the root of any physical symptom is essential to finding effective relief.
1. This is how my stress feels
Many of my clients express significant empowerment when they realize how stress feels to them. Because so many are unable to identify the emotional aspects of their stress experiences, the recognition of a physical spell as rooted in emotion becomes a critical "ah-hah" moment.
2. Effective Interventions
After identifying what stress feels like to them, autistic individuals can seek calming strategies while avoiding a search for medical interventions that are unlikely to help.
After the identification phase (e.g., "This is what my stress looks like"), the individual can better understand what triggered the emotional reaction. One person may say, "Oh, the noise and crowd on the bus may have been what was overwhelming to me." Another may note, "When I made a mistake in front of my family, I was so upset that I just went blank."
While some may find counseling for a history of trauma to be key, many on the spectrum will also want to focus on sensory strategies. Effective approaches may include muscle pressure (e.g., weighted blanket, curling up in a hammock), joint pressure (e.g., weight lifting, rock climbing), and sometimes vestibular inputs (e.g., jumping off a diving board, running). Avoiding sensory overload is also part of an effective sensory strategy to reduce episodes of a physical stress response.
Somatoform expressions of stress, such as non-epileptic seizures, are common and treatable (both within and outside the spectrum). Correct identification is key to avoiding unnecessary costs and ineffective treatments.