Burnout, Inertia, Meltdown, and Shutdown Can Shape Autistic Lives

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When I began working with autistic adults, there was only one book I could find on the topic. It held a very narrow perspective on what autistic adults needed. Over the last 10 years, autism advocates have utilized social media to have their voices heard, and their voices have shaped the research and literature about autism. One of the things that is frequently discussed on social media is BIMS periods (Phung et al., 2020). These are periods of autistic burnout, inertia, meltdown, and shutdown that shape many autistic people’s lives. Although autism self-advocates talk about BIMS periods often, the lack of clinical research is noted by many clinicians and often leaves many clinicians and autistic people at a loss for how to deal with BIMS (Welch, 2023).

In my practice, one of the things that causes the most distress in autistic adults' and teens' lives and leads to the most lost time at work and school are BIMS periods. So what are BIMS periods?

• Autistic burnout is a period of exhaustion experienced by autistic people when they have pushed themselves too hard. This differs from neurotypical burnout in many ways. It can be driven by sensory overstimulation or too much social interaction. Autistic adults who mask heavily and frequently (Phung et al., 2020) are more likely to experience this. What makes it different from typical burnout is that it is usually accompanied by a lack of functionality and increased sensory aversions. Cognitive impairment in this phase can be severe. For me, I often struggle with forming words and completing sentences. I can become nonverbal or less verbal.
• Autistic inertia is the inability of some autistic people to transition from one activity to another. Many autistic people describe this as feeling stuck. Neurotypicals sometimes see this as laziness, but it is very different from laziness. It is like being stuck on a train that can’t change tracks.
• Autistic meltdown is the most stereotypical autistic state that is often depicted in media as an autistic child having a “tantrum” at the grocery store or in a public place. This stereotype is dangerous because a meltdown is completely different from a tantrum. A tantrum is a period in which a child exhibits overwhelming behavior to get something they want, and the tantrum is easily stopped when the desired object or behavior is provided by an adult. A meltdown can't be stopped easily and has nothing to do with simply not getting what you want. An autistic meltdown occurs when you have pushed yourself past your ability to cope with sensory, emotional, or social stimuli. At this point, the autistic person becomes completely unable to regulate. Autistic adults report feeling like completely different people in this state. They describe a complete loss of control. The feelings associated with autistic meltdown are often so aversive that many autistic adults experience brief moments of suicidality because they would do anything to make the meltdown state stop. Meltdowns often occur after prolonged burnout has been ignored and after autistic people try to push through.
• Autistic shutdown was first observed in autistic children, and researchers described it as a state of catatonia in autistic children (Loos and Miller, 2004). These states were described as periods of being “dazed, sleepy, and nonresponsive.” The states could last for periods ranging from 10 minutes to two hours. This state is similar to meltdowns in that it occurs when periods of burnout and overwhelm have been ignored and the autistic person has been pushed past their capacity, but it outwardly seems like the opposite of a meltdown. As a meltdown can be loud and outward, a shutdown will look like a failure to respond to outward stimuli, a diminishing of all activity, a slowing of cognitive ability, and a feeling of being completely detached from reality.

BIMS states are the most destructive part of an autistic adult’s life. As a clinician, helping my clients cope with BIMS and working with their neurotypical employers and spouses to create coping strategies for BIMS is one of the largest parts of my job. The neurotypical world is not understanding of neurodivergence, and workplaces that aren’t supportive of neurodiversity often push autistic adults to the edges of their sensory and emotional capacity regularly. Relationships with neurotypical partners and friends who don’t try to understand and help their autistic partners can also push autistic people to the edge.

It has been found that autistic adults have quadruple the suicide rate of the normal population (South et al., 2021). This frightening statistic is contributed to by BIMS states. Autistic people’s brains do not function like neurotypical people's brains (Gandal et al., 2022). Autistic people have many strengths and can do remarkable things. We are amazing humans; however, we can’t do things the way neurotypicals can.

When I speak about autism, I often use the children’s book Stellaluna to describe what it feels like to be autistic. Stellaluna (Cannon, 1995) is the story of a baby fruit bat who accidentally falls into a bird's nest. The bat is raised by birds and spends its entire life feeling like a failure. Stellaluna can’t perch right and doesn’t eat the right food. She can’t do anything the way she should. One day, she leaves the nest and finds other fruit bats and realizes that she is different, not wrong. This is what it is like to be autistic. We are different, and pushing us to try to be birds when we are fruit bats pushes us into BIMS states.

As an autism advocate, what I fight for the most is the understanding, acceptance, and accommodation of BIMS state. I frequently help autistic adults who are normally high-performing in their jobs apply for short-term disability when they have entered a BIMS state. I advocate for autistic adults and teens to have disability accommodations at schools and work to prevent BIMS states and reduce their negative impact when they occur.

As we move forward in our advocacy, understanding BIMS states is critical. It is critical to know that a fruit bat that is forced to live in a bird’s world will need breaks and support, and, if they don’t get these things, the world will break them.