What Causes Anxiety and Depression in Neurodivergent People?
An UPDATE TO AN OLD POST ABOUT THE CAUSEs OF ANXIETY & DEPRESSION THAT CONSIDERS THE EXPERIENCE OF NEURODIVERGENT PEOPLE.
About six months ago, I wrote a post about Emotion-Focused Therapy’s (EFT) perspective on anxiety and depression. However, for almost as long, I have felt the need to write a follow-up that addresses the neurodivergent experience.
The essential points of my original post were:
1. Rather than viewing anxiety and depression as chemical imbalances, EFT sees them as “secondary emotions” rooted in unprocessed pain and unmet needs. For example, when the grief process over the loss of a loved one is not supported, that unexpressed grief (i.e., the “primary emotion”) could then become chronic depression (i.e., the “secondary emotion”).
2. Therefore, a time-honoured EFT approach to therapy focuses on identifying primary emotions, transforming the negative self-beliefs keeping them buried and unprocessed, and developing emotional regulation (Greenberg, 2019). So, that depressed individual in the previous example could discover that their difficult emotions are not “a burden to others” like they previously believed. They could then develop the ability to feel and express sadness on a regular basis, breaking out of the pattern of numbing that fed their depression.
I still believe this perspective on chronic anxiety and depression is a valuable one that applies to many people, including some neurodivergent individuals. However, it lacks a great deal of nuance when you consider the specific experiences of individuals with ADHD, autism, and other forms of neurodivergence. That is what I will attempt to address now.
Research reveals a more complicated picture
Systematic research has established the fact that individuals with autism and ADHD are at a disproportionately high risk of developing anxiety and depression (Hollocks et al, 2019; Ogrodnik et al, 2023) So, are neurodivergent people more likely to suppress primary emotions and the develop secondary emotions, as per traditional EFT theory? Based on a brief, non-comprehensive review of the research on anxiety, depression, and neurodivergence, I would say that this assumption is simplistic at best. In fact, it might be markedly unhelpful, because it could indicate a course of therapy that may be irrelevant for certain neurodivergent people.
Let’s explore what (some) of the research shows us.
Genetic and neurobiological factors
There is evidence to suggest that genetic and neurobiological (i.e., the way the brain is naturally “wired”) factors make neurodivergent people more susceptible to mood disorders. For example, researchers have uncovered a “genetic liability” for people with ADHD to develop depression (Riglin et al, 2020) .
In another example, the “intense world theory” proposes that parts of autistic brains are naturally extra-sensitive and over-active compared to neurotypical brains (Markham & Markham, 2010). This can cause stronger reactions to sensory stimulus, emotions, and experiences, as well as intense memory and attention. According to the theory, autistic people can react so strongly to experiences—especially emotional or traumatic ones—that they start to focus only on certain things and avoid others.
Uncertainty stress
For many autistic people, uncertainty is a major trigger for anxiety (Ashburner et al., 2013). The research of Carleton (2016) describes “intolerance of uncertainty” as a strong preference for predictability. If you have “intolerance of uncertainty”, then grappling with circumstances that are unexpected or hard to understand is going to be quite stressful.
Social stress
If we take another look at the research of Hollocks et al. (2019) we see that social anxiety appears to be the most common anxiety disorder for autistic people (29%). In fact, research by Quenneville et al (2022) show the same pattern for people with ADHD; “social phobia” is the most common anxiety disorder in this group.
I do not think it is a tremendous leap to infer that the well-documented social differences between neurodivergent and neurotypical people might account for this. If the “rules” of behaviour and communication are inherently hard to understand, you are probably more likely to fall into patterns of people-pleasing or avoidance. If you have consistently behaved in ways that lead people to reject, ridicule, or criticize you, you are probably going to “over-think” your social interactions. If this describes your experience, there may not be any “primary emotions” hidden under your anxiety. You might simply find socializing to be frightening—and for such good reasons.
Remember, the research I have just cited does not represent all the work that has been done to understand the relationships between anxiety, depression, and neurodivergence. Far from it! I have included a small sample of evidence-based perspectives that hopefully show how complex the issue of neurodivergence and mood disorders actually is.
Why is this nuance important?
Now, does having a higher genetic, neurobiological, or socially-driven likelihood of developing anxiety or depression mean that the EFT model does not apply to you? Of course not. For example, you could certainly have a brain that is “extra-sensitive” and cope with that sensitivity with numbing behaviours (e.g., drinking excessive alcohol) that ultimately make you feel more depressed. That is entirely possible. But, in my estimation at least, it can be helpful to recognize that for you the world might simply be a more difficult place.
Here is the bottom line: not all anxiety and depression are entirely the result of “improper emotional processing”, which could be implied by EFT theory. You might process long-suppressed grief or anger and still find that you live in an “intense world”. You might identify a primary emotion that you have never allowed yourself to feel and still find socializing quite stressful. You might learn emotional regulation skills and still struggle to accept what cannot be controlled or predicted. You might let go of negative self-concepts and still find that your temperament leans towards worrying or melancholy.
In some cases, taking control of your sensory environment is the best step you could take. Or perhaps you might let go of your rigid expectations for how you should live or relate to people. Sometimes, no amount of “processing” and “regulating” is going to do what these practical adjustments might do for you.
