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The DSM-5 Has No Language for an Autistic Person at Peace – The Medical Model Only Shows You Our Worst Days

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I Was Playing Life on Hard Mode, But My ‘Health Bar’ Starts From Full Now: For 30 Years, I Didn’t Know What Calm Felt Like in My Own Body – I Didn’t Get ‘Less Autistic’, I Got Regulated


I am Autistic and ADHD, and we live in a world that is, by design, dysregulating for people like me. As a result, I spent most of my life very dysregulated. Because of this, until very recently, I didn’t know what it felt like to be calm and regulated in my own body.

When I was dysregulated, my Autistic and ADHD traits were much more easily recognizable to those around me, because (in my opinion) our medical definitions of Autism, ADHD, and many other forms of Neurodivergence largely describe what it looks like when Neurodivergent people are struggling or dysregulated, and tend to ignore us when we’re doing well, have our needs met, and are properly supported.

In fact, if one only follows the medical language, in many, possibly most cases, one must be struggling to even be identified as Autistic, ADHD, or other differences described within our medical textbooks.

Because I am Autistic, and Autism is one of my Neurotypes that I know the most about (since I’ve had this diagnosis the longest), I am going to use my personal experience as an Autistic person as an example for this piece.

I will go through the diagnostic criteria for an Autism diagnosis, explaining how my outward (and inward) presentation of ‘Autism‘ has changed over the years as I’ve managed to build more understanding of my needs and create a life that supports myself.

While every single Autistic person is unique, and some of us may always struggle, in my case, many of my struggles were due to not understanding my own mind and its needs, and trying to fit myself into systems, structures, and social groups that didn’t meet my needs (that expected me to conform to the world around me – a world that often treated my needs and differences as problems to solve rather than support).

For most of my life, I found myself in a state of chronic hyper-vigilance, always on edge, wondering who or what would bring the next assault.

As a result, I lived tip-toeing on the edge of what some refer to as my ‘window of tolerance‘, where the slightest change could tip me over into overload (meltdowns, shutdowns, as well as emotional and sensory distress).

I like to describe my experience using a video game ‘health bar’ metaphor.

The non-autistic people around me, especially those with more proximity to neuro-normativity, live in an environment that is tailored to charge up their ‘health bars’, or to take less life force away from them.

A video game character with cat ears and a health bar above them that is mostly full. To their side is a gold plaque that says ‘level up’.

My ‘health bar’, on the other hand, was constantly taking hits that dealt huge chunks of damage.

At the same time, because I didn’t know what I could do to regenerate my life-force, and kept trying to regenerate myself with the wrong things (mimicking the people around me who had very different needs than I did, due to not understanding my own Neurodivergent mind and its needs), I was unable to recharge myself. This led me to start each day with much less ‘health‘ in my bar than the people around me.

While my peers, who had fuller ‘health bars’, could take 10-20 ‘hits‘ of damage a day, in my depleted state, and my bar so low, it was like starting out the game of life each morning, only able to take on a few hits of damage before dropping past my window of tolerance, sending me into ‘game over‘ (various types of overload that are commonly associated with ‘Autism‘ in our medical models).

Within the last few years, since redesigning my life and finally gaining an understanding of my needs, triggers, and the types of support that actually help me recharge and shield myself, a lot has changed.

I am no longer starting each day with a ‘health bar’ blinking a warning that I’m close to being tipped into ‘game over‘.

I am now starting with my ‘health bar’ on ‘full‘ each day (or much closer to it). This change means many of my Autistic and other Neurodivergent traits are much less visible to the people around me. . . at least if they are going by the narrow, deficit-based medical models of Autism and Neurodivergence (which fail to give us clear pictures of what Autistic success and regulation look like).

Content warning: This article will include some medical and pathological language to describe Neurodivergent people and our experiences.


Criterion A: Social communication & social interaction (all 3 required)

A1. Social-emotional reciprocity

In the diagnostic manual, it says that Autistic people:

For most of my life, all of the points above could have been considered ‘true‘ for me (though I push back on the concept that there is anything ‘abnormal‘ about the ways Autistic people socialize and engage, and reject the use of non-autistic people as the baseline that we use to define what is ‘normal‘ and socially acceptable).

Once I was regulated & had my needs met, things changed:

As I started to feel more confident, and learned how to connect with people who ‘get me‘ and how to avoid those who don’t (and to care less about when people don’t like me) I started to be more confident initiating social contact with the right people, at the right time, in settings that feel safe (quiet, predictable, no performance pressure).

I have learned that I have a depth that is ‘too much‘ for some people who prefer shallow, surface-level conversations and are uncomfortable with how deep I am and how passionate I can be.

I have also learned that, while I have to focus more to get timing right in conversations, I actually can have a back-and-forth conversation much more easily when I am not overwhelmed, with people who are patient with me, who allow me to take the processing time I need, especially if the topic is meaningful to me.

When I was overwhelmed most of the time, it was much more difficult for me to express empathy and compassion for the people around me, because I wasn’t picking up on things and didn’t have the capacity to care for others (when my own needs weren’t being met).

It turns out I can show empathy and care for the people around me. However, the ways I express this care may differ from how other people do.

I don’t always know what to say, but I can connect with people in my own way.

A2. Nonverbal communication

In the diagnostic manual, it says that Autistic people:

Once I was properly regulated & finally had my needs met:

I realized that I was faking eye contact even when it was uncomfortable for me.

Growing up, I had learned to hide my internal feelings (due to fear they wouldn’t be understood or would get me in trouble/cause me to be bullied).

Once I started to feel safer around other people, I became more regulated and felt I could express my feelings, thoughts, and emotions more authentically.

These days, my face displays genuine emotions more frequently (because I am not fawning/masking or shutting down and dissociating as much).

As I started to snap out of survival mode, I also started studying human body language and facial expressions because, while I had learned a lot about animal body language and expressions growing up, I hadn’t realized I needed to pick up ‘unspoken communications‘ from the humans around me.

Being well-regulated in a calm, sensory-friendly environment is a big part of this for me, because being dysregulated, by a space with lots of background noise (which can cause sensory overload), or being emotionally or physically stressed, can make processing and attention more difficult for me. However, when my mind and the environment are right (assuming I am not being rushed), I am learning to read people more easily (especially people I know well).

Something else I have noticed is that, for me, I often find Autistic people (who aren’t camouflaging their Autistic traits) easier to read.

Autistic body language and communication are often more direct. We may also use more ‘big‘ movements that are less subtle than the social cues of non-autistic people (like different types of hand flaps that can express a multitude of emotions, jumping up and down when happy, or rocking when stressed or focused). The manual calls that “abnormal“ body language; however, if people know what to look for, these movements can be an essential part of authentic Autistic non-verbal communication.

A3. Difficulty developing and maintaining relationships

In the diagnostic manual, it says that Autistic people:

Recently, I’ve learned that, in my current state, many of these things are false for me.

Growing up, I tried to make friends but struggled because I was trying to connect with people who expected me to be something I wasn’t (non-autistic).

Also, because I didn’t understand how to read the facial expressions and body language of the people around me for most of my life, it left me venerable to being abused, because I didn’t pick up on it when people were pretending to be nice to me because they wanted something from me (often to bully me or trick me into doing things that would get me in trouble for their amusement).

When I was younger, I wasn’t nice to people I didn’t like, so whenever people were ‘nice‘ to me, I assumed they must like me.

It never occurred to me that people who hated me would pretend to be nice.

I wanted to have relationships with other people, but people (especially kids my age) were hard to get along with.

Eventually, I decided it was too difficult, and people weren’t worth the stress, so I stuck to friendships with animals or people who would seek me out, or who my guardians paired me up with, because it was easier than reaching out and being rejected by my peers.

Now that I am older and have worked past my social anxiety, I’ve started to want and welcome relationships with other people again.

The relationships I seek out these days are often with other openly Neurodivergent people, and in small groups with clear rules.

I’ve also learned that I can adjust my behavior more easily when my ‘health bar‘ is full, and when the expectations of a group I am participating in are explicitly laid out and explained rather than based on hidden social rules.

For example, there is a small social group I attend once a month, where we each go around the circle and take turns speaking. A timer is set, and we can speak until it goes off.

The rules of this group are clear. We do not interrupt, we do not try to fix anything or offer feedback unless it is explicitly asked for, we just witness and hold space for the person sharing.

In this way, I can easily handle engaging and sharing, because the expectations are clearly explained and agreed upon by all participants before we begin.

When I am regulated and feel safe, I can be a loyal, honest, and deeply caring friend. I just don’t fit the neuro-normative script for friendship (small talk, frequent casual hangouts).

I also need more downtime between engaging with others, and I thrive when I have lots of time on my own to process things and unwind.

I don’t have many friends, but the ones I do have I would trust with my life. For me, it is a matter of quality over quantity.

The rest of this post is available on Substack and Patreon.


This post was written with the assistance of Focused Space (a sponsor of the Neurodivergent Rebel blog).

What is Focused Space?

Focused Space is an ADHD-focused, Neurodiversity affirming, goal‑setting, and online co‑working / body‑doubling platform designed to help people prioritize, stay motivated, and bust through procrastination (and it is something I believe in and personally use every day).

More info:

Screenshot showing various features in the Focused Space Community app.

I get requests (that I mostly ignore) to do brand partnerships all the time, because I don’t want to partner with products unless I actually find them useful and high-quality. I also want to work with brands whose owners and processes align with my personal standards and ethics.

That’s why I’m excited to announce that the Neurodivergent Rebel Blog is officially partnering with Focused Space, and our community members can now get access to Focused Space at a special rate of 20% off forever when you use the code “NEURODIVERGENTREBEL” at checkout via the button below or at get.focused.space/neurodivergentrebel:

Now when you Get Focused Space via the link above you’re getting discounted access to a great tool as while supporting the work I do here at the NeuroDivergent Rebel Blog.

Also, if you ever join a 7am CST wakeup call, or pop into an un-hosted Quiet Owl session on a week day, you might bump into me.

Not sure if Focused Space is for you?

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