Illustration of a person peeking out from behind a blanket held in front of them

Exposure Anxiety

Exposure anxiety (EA) is a condition identified by Donna Williams in which the child or adult feels acutely self-conscious; it leads to a persistent and overwhelming fear of interaction.

Exposure anxiety in autism | Network Autism

Header image: “Exposure Anxiety” by Marissa Paternoster

EA can be quite crippling as it causes the person to feel acutely self-conscious and leads to a persistent and overwhelming fear of interaction. And that makes any attention from other people feel potentially threatening so that the child feels ‘exposed’ each time someone looks at him, talks to him or even compliments him.

Autism and Exposure Anxiety. Don’t look at me! – Autism Daily Newscast

Exposure Anxiety is about feeling your own existence too close up, too in your own face.

Exposure Anxiety – The Invisible Cage

Exposure Anxiety: a definition

Exposure Anxiety is the internal parent watching its vulnerable and exposed baby being stolen by the world outside or given away by ‘the self’; being robbed of control by what are felt as ‘outside forces’. Exposure Anxiety is a self-parenting survival mechanism, an intense often tic-like involuntary self-protection mechanism that jumps in to defend against sensed ‘invasion’. When it becomes chronic, it is self-perpetuating – like a boulder hurtling down a hill, gaining momentum. Chronic, uncontrolled, acute Exposure Anxiety is about addiction to your own adrenaline. We all experience stress and some of us are more driven, more passionate, more fixated and intense, more independent, more controlling, more dominant or passive, more jumpy or aloof, naturally. In most cases where Exposure Anxiety goes hand in hand with the metabolic, digestive and immune system disorders that co-occur in the largest percentage of people on the autistic spectrum. The chronic stress of Exposure Anxiety exacerbates physiological problems which then affect information processing as well as throw neurotransmitter balance into a state of chaos, forming a self-perpetuating loop. The person with Exposure Anxiety who lives and works with those who do not understand the condition are bound to find the self-in-relation-to-other, directly-confrontational approach of the environment seems to make Exposure Anxiety worse.

Exposure Anxiety – The Invisible Cage
A woman holds an open bird cage as birds fly away
Bird Cage by Heike Blakley

Exposure Anxiety has two faces and is the heaven and the hell, the lure of sanctuary and the suffocation of the prison.

Exposure Anxiety is a mechanism that craves the extreme and retaliates against any sense of impending invasion. It is like taking a feeling of severe shyness and multiplying it by fifty, yet its presentation is extremely confusing to onlookers. People with severe Exposure Anxiety can be frozen, or they can be manic and high. They can be prone to despair and depression, driven and creative, or unable to connect. They can be obsessive or fiercely indifferent, compulsively helpful or aloof. They can be passive or controlling; bombastic or phobic; deeply empathic or compulsively violent; open and honest or secretive and intensely private. Exposure Anxiety is likely one of a range of conditions relating to what has been coined ‘Reward Deficiency Syndrome’, essentially relating to reward feedback and impulse control mechanisms in the brain.

Exposure Anxiety makes it difficult to dare ‘expressive volume’ in a directly-confrontational (self-in-relation-to-other) world

If I could draw you a picture of acute chronic Exposure Anxiety, I’d draw you a rainbow unseen within heavy stone walls. There’d be places in the stone where the cement had crumbled, been chipped away and some of the colour had come streaming out like a ray of light into the world. I’d draw you a picture of someone inside a prison, an invisible prison with replica selves on the outside, each a contortion, a distortion of the one you can’t see who can’t get out. I’d draw you a picture of someone avoidant with a social person waiting inside for the keys and a way out. I’d show you the compulsive, with a face manic in the midst of a diversion to distract you, to control you, from getting in. I’d draw you a face with a plastic smile, perfect movements, a learned handshake and a gut full of despair and loneliness in a world that applauds the ‘appear’ at the expense of ‘self’; suicide without a corpse.

Exposure Anxiety – The Invisible Cage

I was fine chattering away to myself, singing or making sound patterns, in order to close out the impact of the invasiveness of others, and being told to shut up only heightened the desire to surround myself with the sound of my own voice. If I was expected to reply, however, this was the complete antithesis. Hearing myself speak in my own voice in acknowledged connection to the world was excruciatingly personal and felt like fingernails down a blackboard.

Exposure Anxiety – The Invisible Cage

It wasn’t that the volume was too loud so much as that in the grip of an adrenaline rush everything was sensorily too much. The intense ‘pain’ was that the personal, individual, me-ness in it was unbearable. I was allergic to the experience of my own existence and the experience of hearing my own voice speaking from connected expression as me could, at times, be far worse than the terrible feeling you get hearing your own voice on an audio tape or answerphone.

Exposure Anxiety – The Invisible Cage

Exposure Anxiety makes information-processing problems much worse. It is very hard to connect and let information affect you, even to process or synthesize it when you are compulsively, phobically geared to protect yourself from such ‘impact’.

Exposure Anxiety – The Invisible Cage

I was a social kid: social with the dirt, the trees, the grass, the birds in the aviary, the rolls of carpet at the hardware store, the tinkling of pins, the books of wallpaper samples and the smell and lickable surface of patent leather. I felt the world deeply and passionately. I was cheerful in my own world and I had a fascination with anything that was not directly-confrontational and which would allow me to ‘simply be’. People too often failed the criteria. They were looking for concepts such as ‘together’, ‘with’ and ‘us’. They were not worlds unto themselves within the world, as I was. They needed to be taken account of, to interact in a directly-confrontational way that they called ‘normality’.

Exposure Anxiety – The Invisible Cage

Carers want to feel they are making a difference. They are told that positive reinforcement will help make that difference. But with Exposure Anxiety, the more you expect, want or promote something, the more the self-protection response says, ‘Don’t do that again, that triggers the external world into invasive attempts to connect’. You know when praise works because it really does work. You know when it doesn’t when your job as carer becomes harder and harder. So what can you do if your ability to praise or give attention makes you feel more and more impotent to help?

Exposure Anxiety – The Invisible Cage

Jasper was afraid to show his own voice because the self-exposure of hearing it in his own ears resulted in him having feelings. Even daring to think about saying or doing something with intention from his own interest or want would result in such an intense feeling of exposure and vulnerability that he often could not even dare think about expressing himself.

An Inside Out Approach: An Innovative Look at the ‘Mechanics’ of ‘Autism’ and its Developmental ‘Cousins’

Exposure anxiety is something all people have at some level if pushed far enough. In some people, it takes a lot for this instinctual response to fire. In others it is triggered much too easily, making conscious awareness experienced as painful regardless of the emotion attached to it. The conditions of agoraphobia, exam anxiety, fear of public speaking, ‘intense shyness’ and compulsive hypersensitivity found in ‘autism’ is this state at its worst and for some, the only answer may be to indulge almost constantly in attempts to hypnotise oneself out of conscious awareness.

Exposure anxiety is not intentional and nor are its often reactive, avoidant or defensive and distancing results. It is an uncomfortable state for everyone, especially the person with this condition. It can make life itself feel like an infliction, a place of pins.

The result of exposure anxiety is an intense rawness that is easily mistaken for ‘pain’ and because the expression and interaction of others are often the cause of its provocation, intentionally or unintentionally, the result is the same; they cause the pain.

Exposure anxiety is a suffocating and entrapping experience. If one can struggle for awareness with this condition, one is generally stuck with that awareness for a very very long time before any control over the ability to fight for its expression develops to a level where one can control the intense impulse to divert, avoid and deny expression enough to get expression through in any consistent and real way. This, more than anything else, forces intense self-awareness, if only at the preconscious, though triggerable, level.

An Inside Out Approach: An Innovative Look at the ‘Mechanics’ of ‘Autism’ and its Developmental ‘Cousins’

Sometimes the world may be found to have too much impact, to be too directly confrontational. Watch the avoidance behaviours of some children dren around the age of three when approached or gazed at too directly or too personally before you have made his or her acquaintance and you may see a sort of ‘exposure anxiety’ or ‘emotional hypersensitivity’.

Autism and Sensing: The Unlost Instinct

Emotional hypersensitivity or exposure anxiety can be a natural stage for most children and the support of their environment together with their own repertoire of deflective and avoidance strategies probably protects them in getting through this and no long-term harm is done to their development. Sometimes, a child going through this may not have the resources to cope. If the capacity to perceive or interpret is impaired, then even in a supportive environment, reassuring tones of voice, words, gestures or facial expressions may not be able to be consistently or cohesively interpreted with meaning. Expression may convey nothing, or worse, be sensed as clashing with the actual feeling of tension, annoyance or anxiety that is sensed as happening. Here the support that environment offers may be intangible, tangible, incomprehensible, imperceivable, confusing and even disturbing. The result may be that as conscious awareness dawns, such a child may be left too rawly exposed and, in effect, be unable to feel supported no matter how present that displayed support may be.

Autism and Sensing: The Unlost Instinct
Bet you think that you're better off dead
Someone told you it's all in your head
Too afraid of being inconsistent
Wanna leave the house but you think you'll miss it

In the comfort of your home
You're a star but no one knows
Too afraid of being optimistic
You could have it all but you just won't risk it

I don't wanna show up I don't wanna show up
I don't wanna show up for this
I don't wanna give up I don't wanna give up
I don't wanna give up on this
I was never enough
You were never enough
We were never enough for this
I will never live up I will never live up
I will never live up to this
Never saw it coming and I'm guessing it was luck
It was just as easy as showing up

--Show Up by Sundressed
Cat laying underneath a step stool looking out through holes in the side
“I was a little scared, but still curious.”

Or, “I am not the droid you’re looking for!”

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