New Autism Theory: "The boy whose brain could unlock autism"

The article "The boy whose brain could unlock autism" from https://medium.com/ is beautiful. It is beautifully written. It is hosted on a beautifully designed site. And most importantly, the non-judgmental theory of autism presented is beautiful.  This theory is also pretty brilliant.

The article presents a theory that reconceptualizes autism as an "intense world syndrome."  This theory suggests that autism is not best thought of as a disorder characterized by a lack of empathy or intelligence, but by the existence of an overload of emotion plus a great capacity to learn.  Further, intense world syndrome suggests that people with autism experience sensations differently.  What an awe-inspiring idea.

There are so many different issues to discuss now!

Let's start with empathy.  Just because it may appear that people with autism lack empathy, doesn't mean this interpretation is correct.  It could be that a person's mind with autism is so overloaded that focusing on someone else is next to impossible.  Over time, this could result in lacking empathy for others.  Further, if people with autism are constantly bombarded with not only intense emotions (e.g. anxiety), but aversive sensory experiences as well (e.g. the act of brushing your teeth produces the internal sensations that nails on a chalkboard would typically evoke), certain consequences can be expected.  We know that spikes in anxiety result in increased calcium release and the encoding of memories.  This process could result in really rigid thinking.  Not to mention, one's focus is really narrowed in those moments.  So if there is constant anxiety, the brain is in a state of rapid-fire learning...on one hand.  On the other hand, it may be difficult to focus on anything but a particular target.  This combination of increased anxiety and rapid fire learning may carve out some pretty "strange" observable behavior patterns over time.  For instance, perhaps a hyper focus on learning calendar dates could result.  Also, the manner of brain processing could leave very little left over for attention on others, hence our current/previous perception of lack of empathy in people on the spectrum.

Speaking of the "spectrum," as a field we are very comfortable examining autism on this spectrum.  But it seems to me that there is still the perception of a dichotomous cutoff whereby some people have autism and others don't.  Right now, once a diagnosis of autism is made, then you are examined on the spectrum as compared to others with this diagnosis.  But what if we viewed every single person as representing a different degree of autism on a full spectrum?  What if the spectrum was thought to encompass all humans?  Well, I think that'd do us a huge service when conceptualizing cases.

Eating disorders, OCD, and self-injury are all jumping into my mind as relevant to this new theory of autism.

Let's take eating disorders for starters.  I'm too invested in writing this blog post right now to look it up, but I remember learning at this year's International Conference on Eating Disorders in Montreal that autism and eating disorders are related.  This was an internal hypothesis of mine for ages.  When I saw the data, I literally scribbled "I knew it!!!" in my notes.  [P.S. Even though I'm not going to look up the exact presentation I saw, here's a Medical News Today article on the relationship between eating disorders and autism from August 2013.]

Similar to what this new theory of autism posits, people with eating disorders are also in a state of anxiety, which results in rigid thoughts (e.g. "fat is bad"), compulsive behaviors (e.g. calorie counting), and a self-centered focus.  There's also usually an increased level of intelligence in people with eating disorders... or perhaps it's better conceptualized as "fast learners."   Sounds a bit like high-functioning autism, huh?  

Unlike autism though, many times people with eating disorders report desperately wanting the approval of others.  So, even if the behavior is seemingly self-centered (e.g. wanting to look good), I maintain that the function of the behavior is not completely egocentric.  But reconciling this seemingly self-centered focus and a desire to please others is usually not easy for family members of people with eating disorders.  The idea is difficult to grasp that intense anxiety about other's approval ironically results in a "self-centered" disorder. In short, I think it could be really useful to use intense world syndrome concepts in fostering understanding about eating disorders. 

Here are a few last notes before I move on with my Sunday: I think eating disorders relate to autism in the same way OCD is related to autism.  In fact, I conceptualize eating disorders as a specific subtype of OCD.  It appears to me that the process is the same in both disorders, but the content of the worry differs.  And as such, slightly different treatments are needed... but not too different.  I'll publish more on what I've written about this in the future.

And lastly, there is the example of how self-injury may relate to autism.  I've blogged here before about my hypothesis on self-injury's relation to sensory integration issues.  To read, click this link.  The idea that intense emotions can create perceptual disturbances (auditory hallucinations such as hearing voices) is not new in psychology.  But the idea that intense emotions can also lead to sensory disturbances remains an area where we need work.  Taking that a step further, exploring exactly how emotions are moderated with sensory acts like self-injury (or even doing things like soothing oneself with lavender hand lotion) is worth researching.

We need to know the following: is there a dose response relationship between intense anxiety/emotion and 1) sensory disturbances, 2) learning, 3) rigid thinking, 4) compulsive/repetitive behaviors, and 5) a self-centered focus?  If not, is there some relationship?  What mediates/moderates that relationship?

This new idea of conceptualizing autism as "intense world syndrome" clicked a few pieces into place of an enormous puzzle that I have been kicking around in my brain for years.  I very much look forward to learning from research on this theory in the coming years. 

Dysregulation of the Anxiety System & Bipolar

As per usual, I'm trying to focus on work now, but get completely derailed with a thought I feel the need (compulsively) to blog about.

I saw that someone somewhere on a remote part of the globe was reading a post I wrote a while ago postulating that fear was the first emotion to appear on the evolutionary scene. I decided to revisit it. Here's the link: http://taradeliberto.blogspot.com/2011/03/first-emotion-fear.html

While rereading the post, I had the thought that bipolar disorder may result from a dysregulation of the anxiety system. Long story short, in depression, we see that prolonged anxiety can lead to chronic sadness (via chronic exposure to cortisol and what I conceptualize as over-use of the hypothalamus-pituitary-adrenal axis). We can also see that exhilaration and anxiety are quite similar emotions. Combining these two thoughts, perhaps bipolar disorder could arise out of the dysregulation of a primary anxiety system - sometimes leading to chronic sadness and other times leading to chronic exhilaration.

Interestingly, bipolar is pretty hereditary, but like most psychiatric disorders, it is thought to be prompted by none other than stress, perhaps indicating that it stems directly from some a dysregulation of the anxiety system.

I realize that this is being done already, but the fact that stress / anxiety can trigger the onset of disorders might be a signal to look at how anxiety relates to the course of the illness (with the consideration that anxiety could be the ultimate primary emotion). In this case, while stress may trigger bipolar disorder, lack of ability to regulate anxiety may maintain the behavior. While research in which I am involved examines reward sensitivity in bipolar, I'm wondering if a layer beneath reward sensitivity is anxiety sensitivity, being that we're conceptualizing anxiety as the ultimate primary emotion in this post.

I also realize that to say anxiety dysregulation may prompt bipolar disorder because stress prompts the onset utilizes circular reasoning. But circular reasoning notwithstanding (lol), I still think this is interesting to consider anxiety sensitivity as it relates to two separate constructs of bipolar - both onset and course of the illness.

Ok, back to work.

Thoughts on Secret Fears of the Super Rich

by Tara Deliberto

I came across this article "Secret Fears of the Super Rich," and thought it was pretty interesting. I posted a link to it in an online forum, and one of the readers responded with this Ayn Rand quote: "Only the man who does not need it, is fit to inherit wealth, the man who would make his fortune no matter where he started."

Here are my brief thoughts on this marvelous quote from a psychological perspective:

Being in my line of work, I'm acutely aware of the fact that people need to build their own sense of mastery. Without mastery, feelings of helpless set in and a general lack of motivation is fostered. Translated into clinical terms, people become depressed and anxious. So perhaps if an individual is given everything, their sense of mastery can be diminished because they have not had to take opportunities to succeed on their own.

There are several possible reasons why these opportunities are not taken. For one, when the bar is set so high by a family member who built a fortune, it may be too frightening to even approach success. It is seems safer not to attempt anything at all and live a comfortable life. But is it better for one's own well being to never have tried?

While fear of failure might drive this behavior, the possibility also exists that it is that once wealth is attained or inherited, there may simply be no perceived need to achieve. Perhaps if the same person who inherits wealth and chooses not to engage in tasks to build mastery is put under real pressure, he or she might very successfully build resources. But without ever needing to, attempts are not made to earn one's own living.

In short, I'm conceptualizing two paths, the first would be an anxiety-avoidance path while the second is a contentment/maintenance path.

Whether or not they want to, people who inherit money may benefit from continually engaging in mercenary tasks where failure is possible along with adopting an accepting attitude that they may never achieve at the level of their family members. The idea is that when any amount of success is achieved, their own sense of mastery may increases, motivation can ignite, and life many feel more purposeful.

I think this idea fits nicely w/ Ayn Rand's - one needs to be motivated to achieve for their own sense of self-worth. Sometimes having an inheritance can take away one's own sense of importance while increasing entitlement. While importance and entitlement are often linked, perhaps they are very different constructs. While a person may not view themselves as being meaningfully able to contribute to the world (importance), they may think they deserve everything (entitlement).

Does A Therapist Judges You?

Today I received a question from a man in Mumbai asking if I went into being a psychologist so I could be in a position to judge people. He expressed the sentiment that everyone must understand that we are in no place to judge others and that he prefers a live at let live philosophy.

Here's my response:

Thanks for the post. Since many people share your opinion, I think this question is particularly important to address.

I can understand that without an introduction to the type of treatment I practice, one may assume therapists just want to judge people. In fact, it is just the opposite! People come into my office with a series of judgments about themselves that we work together to debunk. I've seen people who have made wonderful contributions to society but seem to think that they are completely worthless. My job is simply to neutralize judgments. We help people to stop harshly judging themselves so that they can function better and suffer less.

While many people are not in need of treatment, I'm afraid that many people are seriously troubled and on the fence abut whether or not they should end their own lives. With suicidal people, a live and let live philosophy wouldn't exactly work out. And just because someone is contemplating suicide, does not make them worthless and deserving to die, it just means they are suffering from what can feel like a tortured internal experience. They come to treatment of their own volition because there is a piece of them that wants to get better. Therapists don't force clients into treatment.

There have been many research studies on the type of therapy I do showing that the techniques are in fact useful in helping people build a life worth living. Therapy, when practiced well, is much more than a series of judgments - it is an effective way to retrain people's thoughts and behaviors.

The First and Ultimate Primary Emotion - Fear

A member of an online community to which I belong posed this very interesting question to me on a psychology thread: Could fear be the origin of the entire spectrum of human emotion?

My answer:
Very thought provoking question. Fear is certainly what we consider a primary human emotion (among other emotions, e.g. happiness, anger, and sadness). Thinking about fear as the first emotion to appear in living things evolutionarily though is interesting.

[When we talk about origins, there are two types: a single person's individual origins and evolutionary origins. Being that each person comes into the world with a complex nervous system, it doesn't make sense to think of fear as being each individual's ultimate primary emotion. Considering this question in an evolutionary sense is far more interesting.]

In an evolutionary sense, fear is - of course - vital. Fear as a threat detection and deflection system certainly seems to rank #1 in terms of importance.

In fact, earlier in the thread in which this blog post originated, I discussed Kandel's Nobel Peace Prize winning work on the "memory" of slugs. The response that sea slugs can "remember" to recoil after being pinched in the gill is certainly very interesting. While this borders on what may seem like a classical conditioning response, there could be the beginnings of fear like responses here. [In terms of fear and how it relates to memory, it may be interesting to note here that fear evokes a release of calcium in the brain that leads to highly ingrained encoding of information.]

Although Freud might have said that sex drive is more primary, I'm not so sure. Perhaps fear responses were actually first to develop evolutionarily and reproduction urges (which aren't really emotions anyhow) came about later. But sex, and it's relation to love, seem way more advanced than fear. As far as a sea slugs is concerned - it is a hermaphrodite so a drive to (at least) seek out sex probably isn't that developed.

Along with sex, maybe other positive emotions simply aren't as necessary from an evolutionary standpoint. In fact, maybe emotions from being comforted and soothed developed after fear as a way to reduce and control it. Paul Gilbert Ph.D. talks about the importance of the physiological Soothing and Contentment System - but soothing from what? My guess is anxiety / fear - which was on the scene first.

Along with positive feelings of being soothed, exhilaration or happiness might also be linked to fear. Just think about the last time you were on a rollercoaster. Since the feeling of fear seems more important than exhilaration, it may be the case that feeling exhilaration developed out of the fear system.

[Hm - just had a thought about bipolar disorder and the sadness and happiness responses being a result of a dysregulation of anxiety systems, one that leads to prolonged depression and the other that leads to constant exhilaration. Anyhow - back to the original question.]

After talking about some positive feelings and the link to anxiety, let's consider anger. We know that someone's "threat detection system" is activated when they're angry. In other words, they may feel anxiety, and anger is the motivator to act. Therefore, the argument could be made that anxiety is first and anger has developed secondarily in the more advanced fight or flight system. We now have two options in response to anxiety: fight (anger) or flee.

Ok, now let's shift from talking about fear arising first on the evolution scene, to fear underlying our everyday experiences now.

For fun, let's consider the link between fear and depression as a psychiatric disorder. When first reading this question, my mind immediately jumped to the link between these two things. Prolonged fear / stress releases enormous amounts of cortisol, which impairs the functioning of the brain (for the scientifically curious - along the Hypothalamic Pituitary Adrenal axis) and leads to depression. Therefore, prolonged fear / stress is experienced first, and we think this is one route to depression.

Now, I realize depression is a psychiatric disorder linked to sadness, but it is not sadness itself. Therefore, saying fear always prompts sadness would not be a logical inference per se. On the other hand, these symptoms may be intimately linked whereas fear sometimes comes first. For instance, one may experiencing horror at the loss of a loved one first, and then deep sorrow. Typically people don't go straight to sad. There is usually shock (perhaps an anxiety response) and then sadness kind of sinks in either seconds, minutes, hours, or days later.

Flipping back into evolutionary terms, it seems that sadness is quite an advanced emotion compared to fear. While I can imagine an insect having a developed reactionary response with the rudimentary beginnings of a fear system, I can't necessarily picture a sorrow system.

In short, I think the case can be made that fear (as it stems from stimulus / threat detection) may be the ultimate primary emotion.