The Cost of High-Masking AuDHD: Navigating Burnout After Success

In this episode, I sit down with therapist, entrepreneur, retreat host, and fellow neurodivergent human Patrick Casale to talk about something we don’t sugarcoat enough: autistic burnout, ADHD burnout, addiction, masking, and what happens when a “successful” life becomes unsustainable.

Patrick has built an incredible career—international retreats, multiple podcasts, coaching programs, and a group practice—yet behind the scenes he’s been navigating 18+ months of deep autistic burnout. We unpack the tension between ADHD-driven dopamine chasing and autism’s need for sensory regulation, the grief that comes with saying no, and what it really means to honor your capacity. This one is raw, honest, and real.

Patrick Casale, MA, LCMHC, is an AuDHD TEDx speaker, therapist, podcaster, and entrepreneur. He’s the founder of All Things Private Practice LLC and Resilient Mind Counseling PLLC, a group practice in Asheville, NC. As a neurodivergent business coach, he leads international retreats and summits helping entrepreneurs navigate impostor syndrome, self-doubt, and perfectionism while embracing authenticity. He coined the phrase “Doubt Yourself. Do It Anyway.”™

He hosts the All Things Private Practice Podcast and co-hosts Divergent Conversations. Patrick lives in Asheville with his wife Ariel and their very neurotic (but lovable) Shih Tzu, Hudson. He loves travel, Lord of the Rings, Anthony Bourdain, red pandas, cold brew, and craft beer.

Episode Highlights:

[2:26] – Why hearing his own bio feels overwhelming in burnout

[3:29] – What 18 months of autistic burnout has really looked like

[6:12] – High masking, high achievement, and hidden shutdown

[9:41] – ADHD vs. autism burnout: dopamine chasing vs. sensory overload

[13:33] – Grieving the “dream job” that no longer works

[14:13] – The origin of “Doubt Yourself. Do It Anyway.”

[17:14] – Deconstructing hustle culture as a neurodivergent entrepreneur

[26:30] – ADHD diagnosis first, autism later: identity and missed signs

[29:55] – Burnout vs. nervous system overload

[35:25] – Special interests as a burnout barometer

[39:54] – ADHD, dopamine, and addiction

[45:26] – Practical regulation tools before burnout hits

Links & Resources

TEDx Talk: https://youtu.be/hyImqW69OY4?si=yeo1bjgn5rvcx0AM
Instagram: https://instagram.com/patrick.casale
Website: https://allthingspractice.com
All Things Private Practice Podcast: https://www.allthingspractice.com/all-things-private-practice-podcast
Divergent Conversations Podcast: https://divergentpod.com
 
 

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Transcript

Patrick Casale: 0:00

My friend often says that I look like I'm an exposed nerve ending walking through the world being shocked relentlessly and endlessly, which feels pretty accurate.

Brooke Schnittman: 0:08

Yeah, that's some vision. Have you noticed when your ADHD is burning you out compared to your autism?

Patrick Casale: 0:16

Yeah, I think for autistic side of my experience, it's like I'm hypersensitive, so I feel overwhelmed and overloaded quite regularly. The difficulty is that ADHD feels restless and under stimulated a lot of the time, and that's what leads to saying yes to new opportunities, creating new projects, following the energy and the dopamine when I have it, following that interest based nervous system and autism often feels it's like waving the white flag, like desperately trying to say, like, please stop like, just slow things down. Like, take things off the calendar, stop saying yes to things. You know, I said that publicly for years, but that's kind of the headspace I was in and trying to figure out the balance. And despite the boundaries that I would put into place, it just continued to happen and happen again and again, and ultimately, just led me to the place that I'm at now where I don't really have a choice but to turn almost everything down that comes my way and say no to everything in my life.

Brooke Schnittman: 1:11

Welcome to successful with ADHD. I'm Brooke Schmidt, let's get started. Welcome today. I have a TEDx, speaker, author, therapist, podcast, host, business coach, group, practice owner retreat host, Patrick Cassell, I'm sure you guys have heard of him. He's an ADHD to E mental health therapist. He leads international retreats, summits and coaching programs, helping entrepreneurs work through imposter syndrome, self doubt and perfectionism while embracing their authenticity. He's coined the phrase doubt yourself, do it anyway, looking forward to digging into that a little bit more. And he is the founder of all things private practice and the host of all things private practice podcast, and the co host of divergent conversations podcast. Patrick also owns a group therapy practice in Asheville, North Carolina, and with experience in both the clinical mental health world and the small business worlds. He's helped 1000s of mental health professionals around the world start and grow their business while staying aligned to their values and dreams. And when he has personal time, he lives in Nashville, North Carolina with his wife, Ariel, and they're very neurotic but lovable. Shih Tzu Hudson, he loves to travel. Lord of the Rings. Anthony Bourdain, red pandas, great, cold brew, coffee and craft beer. Did I get that? All right,

Patrick Casale: 2:26

you did. I'm not used to people reading the whole thing, so I give you credit for that. It always makes me cringe. And then when I'm thinking about why I'm in such a heavy state of like, autistic burnout at the moment, it's like just listening to that entire thing,

Brooke Schnittman: 2:44

major imposter syndrome, right?

Patrick Casale: 2:48

No, not me. Not really about that anymore. Just like listening to all the things I've done is a good way for me to realize why I have burnt myself out the way that I have.

Brooke Schnittman: 3:00

Yeah, yeah. We know that burnout definitely has higher rates with ADHD people. So I'm just curious, can you share with me a little bit more, since you've just touched on that, what burnout looks like for you? I don't

Patrick Casale: 3:17

know if you want to have a real depressing podcast episode, but we can. We can deep dive for sure.

Brooke Schnittman: 3:21

I want a real podcast episode with whatever, you know, whatever feels good for you. Yep.

Patrick Casale: 3:29

So I've been talking about burnout for a while now, because I've been in that that place for a very long time, probably 18 months. Feels maybe like it's accurate, but it could be longer. Wow, I noticed myself going into major autistic burnout back in the summer of 2024 and it was kind of a couple of years of doing all the things that you listed in my bio, and it caught up to me hard, especially doing the retreats and the summits and traveling in and out of the country every other month for about four and a half years of my career. And I just kept telling myself, like, you've got to get to this Italy summit that you've got planned in September. Once that's over, you'll have time to rest and recover, and the rest of the year is yours. And I was going to go to New Zealand and do like, a two week Lord of the Rings tour, and I was really pumped for that. And then, if you all are familiar with Asheville, North Carolina, you know that we got hit pretty hard by Hurricane Helene at the end of October, and the rest was history. And I really never recovered. I never got that, that landing spot to, like, recover gracefully into 2025 before I ramped back up again with all of the things that I was planning to do. And I had already gone into 2025 promising my therapist that I would only host and commit to events and speaking engagements in odd numbered months. And I said in the even number. Months I will just sensory, soothe, regulate, not put anything on my calendar. I probably lasted all of a month or two, never really panned out. Ended up getting a TEDx in February. Made that concession, made more concessions, put podcasts in all the empty spots and all the even numbered months that I needed to record. And I just noticed, like, energetically, I was always like, robbing Peter to pay Paul, so to speak. I was always operating from empty, getting sick constantly, still to this day, ending up in the hospital multiple times and never really fully being able to recover, to the point where I've had to basically shut my entire world down, more or less, in terms of everything that I do professionally, getting ready to go to New Zealand for two retreats and be there for a month. And I publicly announced on my podcast and my socials a few months ago that these would be my last, at least, for the foreseeable future. And I think there's a lot of grief in burnout and acknowledging disability and limitation and capacity, and the world definitely gets a lot smaller once you start realizing that.

Brooke Schnittman: 6:12

Well, thank you for being so vulnerable about sharing your burnout 18 months. That's a long burnout, like shutdown. So neurotypical people can think of burnout as, oh, you know, I just needed a night dress, and I'm good to go the next day, right? But you don't think of burnout as a year and a half. How do you have a thriving business, right? I guess I would call this high masking, right? A successful business, a wife, you're doing all these podcasts. How do you handle all of that in burnout? I don't Okay.

Patrick Casale: 6:54

My world is really small. I think a lot of people, if you're just like looking at accomplishments on social media or elsewhere, my life can probably seem really glamorous and extraordinary based on all the travel that I've done and all of the things that I've had created in the last four or five years, and it's taken such a toll that the in between is typically Me, like lying on my couch in the dark, re watching special interest shows and movies on repeat, taking everything off of my calendar for the most part, minus a few things here and there. And truly like just becoming super reclusive to the point where I feel like I have to protect my very limited energy at any means necessary, like, it's just that's my job now is trying to figure out, how can I protect the capacity that I have? How can I not over commit? How can I not let ADHD run the show, so to speak, for me,

Brooke Schnittman: 7:55

for you, are you able to identify the signs of when you are starting to burn out,

Patrick Casale: 8:01

yeah, for sure. I mean, it's harder when you're in it. You know, ultimately, I have been in it for so long that it is almost like, can you identify the signs that you're coming out of it? And that is the hard part right now, of despite closing my world down significantly compared to the last four or five years being in a space where, like, I just still feel as bad as I do, and I think that's kind of demoralizing.

Brooke Schnittman: 8:29

Sometimes sorry to hear that. Can you think of a time where you didn't feel burned out?

Patrick Casale: 8:35

Yeah, probably when I was masking and I didn't really know what autistic burnout was or why I got so overwhelmed in social spaces and in certain sensory environments, and I masked and dissociated and relied heavily on alcohol and was in like deep flow states, and it felt like everything was just moving in the right direction. Felt really aligned. Ultimately, I discovered I was autistic back in the fall of 2021 and since that time, it has definitely felt like every single experience and trait that I've I have has been exacerbated and intensified times a million. So it just feels my friend often says that I look like I'm an exposed nerve ending walking through the world being shocked relentlessly and endlessly, which feels pretty accurate.

Brooke Schnittman: 9:24

Yeah, that's some vision. I have ADHD too, but I do notice major differences between ADHD burnout and ADHD burnout. Have you noticed when your ADHD is burning you out compared to your autism?

Patrick Casale: 9:41

Yeah, I think for autistic side of my you know, my experience, it's like I'm hypersensitive, so I feel overwhelmed and overloaded quite regularly. And the difficulty for me is that ADHD feels restless and under stimulated a lot of the time. And that's what leads to like. Like saying yes to new opportunities, creating new projects, following the energy and the dopamine when I have it, following that interest based nervous system and autism often feels it's like waving the white flag, like desperately trying to say, like, please stop. Like, just slow things down. Like, take things off the calendar, stop saying yes to things. You know, I said that publicly for years. That's kind of the headspace I was in and trying to figure out the balance, and despite the boundaries that I would set up or put into place, it just continued to happen and happened again and again, and ultimately, just led me to the place that I'm at now, where I don't really have a choice but to basically turn almost everything down that comes my way and say no to everything in my life.

Brooke Schnittman: 10:44

Yeah, I can see that it's like you're visibly upset about this, almost, you know, anxious, depressed about how you have to say no to everything, and how you push yourself past burnout and how long you've been in this I would imagine you at this point just are so overloaded emotionally, physically that just the sheer word yes is too much

Patrick Casale: 11:19

For you, yeah, for sure, I am also a PDA or so struggling with demands that pile up, wanting to resist them at every turn, no matter what. And have felt like that since I was a kid. I remember like fantasizing about retiring when I was like five years old, and I think it was not from lack of like, desire to work, but more so like, the subconscious realization of the demands of existing are quite hard, that it was always like this fantasy to disappear into this, like, I don't know, Irish countryside cabin surrounded by animals, no internet, no access to people, Endless sensory soothing, and that has always been like a dream or a fantasy of mine.

Brooke Schnittman: 12:04

Is that why you do retreats? I

Patrick Casale: 12:08

think that's why I started was for like, community and connection. I just wanted to build things that I didn't always have access to, and I wanted to I've always been a good connector and community builder, and I'm really good at helping people feel like they can be their authentic selves and be vulnerable and work through the hard things. And I wanted to help people do that in really cool places, and I kept thinking, like very early on, when this caught on and became a big part of my career. For the last five years that I had created a dream job that I can't actively participate in, I remember having that like, Aha moment at a retreat that I was hosting January of 23 in New Orleans, and having to, like, go outside and like, scream at the top of my lungs because I was about to, like, have Such a major meltdown from feeling so overwhelmed, sensory wise, it was just really challenging. And I just remember thinking to myself, like, damn, I have created this dream job scenario that people would kill for. This is like a bucket list experience. These last five years been the 20 countries hosted 22 events. Like I've met a lot of cool people along the way, and it just takes such a toll that it's no longer worth it to me, regardless of, could I sell these out forever? Maybe, but like, is it worth it? And the answer has been a resounding no for a long time.

Brooke Schnittman: 13:33

I'm so sorry, and I appreciate your authenticity with this, because I I can see how hard this is for someone who wants community and connection, I can see you value community and connection over finances, but to be in such a state of burnout that you can't actively participate in having the ethical right responsibility to say, No, I'm going to take care of myself so then I can take care of you. Yep. Now you coined the phrase doubt yourself. Do it anyway, so I'm just curious how that relates to what's going on in your life currently.

Patrick Casale: 14:13

Yeah, I think someone who's always experienced a lot of self doubt and imposter syndrome and perfectionism and when the world shut down in 2020 and everyone was sheltering in place, and it was really wonderful for a lot of us who have more sensitive nervous systems and struggle in traditional workplace environments. And I remember feeling like, Man, I really like to pursue some of these entrepreneurial goals that I have. I was in private practice at the time, and it's kind of getting bored of it, if I'm being honest, and you get it, absorbing too much energy in therapy sessions and always feeling very overwhelmed and dysregulated from from my day. And I started actively working on building a private practice coaching business. Yeah, and I was good at it, like I would meet with therapists around town for lunch or for coffee or for free, and everyone would say, You should do this for a living. And my immediate response was like, but there's someone in this city that has a massive audience. Why would anyone hire me if they can hire her? And one day my grad school mentor was like, because you have such different personalities, and you are going to attract and repel based on how you show up. And I took that to heart, started that business, and that took off. And then every step along that way, from like that consulting business and the coaching programs and the courses and the podcast that I started, and the retreats, I've experienced such an overwhelming flood of like self doubt and impulse imposter syndrome, but it used to debilitate me and paralyze me and dictate how I move forward. And then started to just embrace it as I continued working through it and showing up and talking about it publicly and sharing it on stage when speaking at events and helping normalize that feeling and realizing like it always exists for me, but it doesn't necessarily control how I move forward anymore. It just I noticed that it exists, and I like pay attention to it, and I think that we should have some level of self doubt in things that we do if we really care about the outcomes, and have started to really use fear as a gas pedal and not a break, and just really paying more attention to if I'm feeling scared or afraid of doing something, then I'm probably on the right path.

Brooke Schnittman: 16:33

I'm curious. You mentioned before you knew were autistic and you were masking and you're drinking and you're dissociating, you weren't burning out. But then when you were more aware, you started to burn out. And I'm curious, what is the answer? Then, in your opinion, usually, awareness is the first step right to making progress. Obviously, progress is not linear. So what is that next step then do you think to not burning out?

Patrick Casale: 17:14

It's rearranging your life in a way that truly works for you, deconstructing your own internalized ableism around capacity and limitation and ability and productivity, and we live in a capitalist hustle culture hellscape. So it's hard to shut that down when you're an entrepreneur and a business owner, but I am definitely privileged enough to not have to rely on all of the sources of income that I've created over the last five or six years. So it means really feeling like you have to start to align yourself with the things that really matter to you, that bring you joy, that are energizing, opposed to the things that you should tell yourself you should be doing or that you are just good at, but they don't light you up and always giving yourself that permission to kind of pivot and adapt as an entrepreneur, because I think that's an important piece. The finish line is certainly not the starting point, and I've made lots of pivots in my career over the last eight or nine years based on energy flow and circumstance and medical stuff and life and new areas of interest. And instead of shaming myself for that, just letting myself follow that intuitively, and also just giving myself permission to step away from things that no longer serve me, instead of forcing myself to try to fit into that box,

Brooke Schnittman: 18:39

right, right, I think it's you know, beautiful. What you said. Stop shaming yourself. Stop forcing yourself to fit into a box. Stop trying to make things work when they're not working. Right? It's almost like higher slow fire, fast mentality, right? Don't force yourself to do things that no longer serve you or energize you, but there also comes with a lot of metacognition and recognition and quiet reflection to know before it burns you out right, that it is time to pivot and stop, or else it does become part of our identity and ego to just keep going. So when were you able to start making those shifts?

Patrick Casale: 19:26

Was probably maybe like two and a half years ago when I started realizing like coaching programs no longer serve me. I don't find them to be interesting. I don't enjoy one on one coaching anymore. Never really had so when I started doing retreats. They started in Ireland back in 2022 and every year after I left that location, I would talk to the owner and say, I want to book the same dates for next year. I didn't even need to think about it. Just run it back and give her a deposit. Start planning it. Duplicate the sales page. Sell it out. And then this year, well, last year in 2025 I just knew it was my last event there. I didn't even think to ask to book for 2026 this March would actually be me, my sixth year of doing it there. I just knew that it was over for me. That was a aha moment for me as well. And then just realizing, like, I'm not going to put any more of these events into my calendar. New Zealand had already been planned. I mean, it's been planned for almost two and a half years now, and I wasn't going to bail on on the people who are coming all the way around the world, but I just knew I wasn't going to add anything after that. I still had all these commitments from the last couple of years, plugged into my calendar and unmovable, and just trying to figure out ways to work through those. And that meant really rearranging the rest of my life and removing a lot of the other obligations and demands, because the only thing I had energy for was to like, rest in my home for a month, go do an event, come home for a month, do it over, rinse and repeat, and that just was taking longer and longer and longer to recover from, right?

Brooke Schnittman: 21:08

So it was just extending the burnout longer because you're continuing to push yourself. How does this show up in your marriage? I mean, I'm sure you have a very loving relationship, where you both understand each other, but you're shutting down the rest of the world, I would imagine it impacts your relationship.

Patrick Casale: 21:32

Yeah, not really. My wife is such a has such an active life, socially and interest wise, and we've always kind of lived very different lives as it was, so it's really been really nice, because I can feel like I don't have the pressure to push through and go do something that I don't have the capacity for. And she will go to one of her like, multiple book clubs that she's in, or she'll go to hip hop dance on certain days of the week, or she'll be in a play that she's acting in, or, like, doing other things. And I, for me, I'm, like, very content not leaving the house very often, so it actually works out really well.

Brooke Schnittman: 22:14

So I gather she's not autistic. No,

Patrick Casale: 22:17

she's ADHD, but she's she's not autistic, but I think that it's been helpful for her, for our marriage and our partnership, and just my me in general, she's always been really supportive and accommodating in terms of how I need to show up and how I can't show up, and it's really taken a lot of that, like shame and pressure away from Well, if I can't commit to going to her families on the holidays, because I love them, but there's also 50 of them in one small, little house, and it's overwhelming just having those conversations now, it's almost like a given, opposed to having to, like, figure out ways to make it work. So it's actually worked out really well.

Brooke Schnittman: 22:59

And did those conversations start when you realized you had autism? Or were they taking place before 2021

Patrick Casale: 23:09

they were definitely taking place before that, but in a different way, and I didn't have an understanding as to why I didn't want to go do certain things, like I didn't want to go to loud gatherings, and I didn't want to participate in certain like family events that society kind of tells us we're supposed to participate in, weddings, holidays, big birthday parties, etc, have always felt really overwhelming to me. And I think, you know, we've been married now for 12 years, but she at first, I assume, and imagine that she felt like that it was personal, like you just don't like my family, you don't like my friends, sure, and we definitely got into conflict around that. But thankfully, our communication has always been really good, and have been able to work through a lot of those things in terms of like understanding neurotypes and neurologies and just different support needs that we both have, and I think we complement each other really well in that way.

Brooke Schnittman: 24:13

So that came naturally to you, or was that work?

Patrick Casale: 24:18

It really came naturally honestly, like I've been in and out of therapy my entire life, so I've always been really good at communicating and just sharing what I need, and vice versa. And then the autism discovery really didn't shock her. She was she was not surprised. So I think it's just been a lot of learning and unlearning in terms of, like, what we both need to feel supported and understood. She's my biggest cheerleader and supporter, like, I couldn't have done any of the things in my bio without her, and really have appreciated all of the support she's given me. And I think she's also very supportive now of me stepping back from everything. It and trying to find a way to, like, live again. And she's, she's definitely encouraging me to do everything and anything that I can to get to that place.

Unknown: 25:12

Yeah, when did you know you had ADHD?

Patrick Casale: 25:15

I got diagnosed ADHD maybe four or five years before my autism discovery is probably when I was like, 28 or 29 I'm 39 now. I was working in a community mental health like 24 hour walk in behavioral urgent care. And it was stressful. It was intense. Freaking loved it honestly. I remember talking to our psychiatrist on staff, just in, like, a friendly conversation one day about, like, Man, I'm really struggling with feeling satisfied with where I'm at in life. And I'm always thinking about like, I want to move to the next place, or I want to do the next thing, or I want to quit this job, or I want to create this new idea. And he was like, you probably have ADHD, and you should probably go get tested. And I was like, really? He's like, Yeah, man, go do that. So I ended up doing an assessment evaluation with a psychologist in town, and I remember in the first like 10 minutes, she was like, Are you autistic? And I was like, No. Why would you ask me that? And she was like, Oh, it's just your affect. And I said, I think it's just like Complex PTSD. She was like, Okay. And end up getting diagnosed ADHD never thought much about any of the rest of it. And yeah, she was, she was certainly right. I was just not ready to hear it.

Brooke Schnittman: 26:30

I see so not ready to hear it. Do you think that is the reason why most ADHD ers get diagnosed with ADHD first?

Patrick Casale: 26:41

Maybe to some degree, I think that there is a little bit more understanding about ADHD, especially in male presenting people. I think there's a very big stereotype, obviously, of like ADHD, young, white, unruly boys that are running around classrooms and doing a, b and c. And that's obviously completely inaccurate. I mean, there's a there's a portion of that, right, that's true, but, like, obviously not the case for a lot of us. And so I think that when I was diagnosed ADHD, I didn't think much of it. I was just kind of like, okay, yeah, sure, that makes sense. I never even, like, did any deep diving on what that meant for me what I needed to do to support myself. So the autistic thing felt much more like identity work and focusing on like acknowledging how autism impacts every single segment of life. And it's interesting because, you know, I co host the divergent conversations podcast with Dr Megan Neff, and she's ADHD as well, and we've had this conversation on there many times, like we both defer and default to speaking about the autistic experience significantly more than the ADHD experience, and we've never been able to truly figure out why. But I think that there's just this, like, missing identity piece for a lot of the autistic people I know who kind of went through most of their lives just trying to figure out what the hell is going on. Like, why do I feel the way that I feel? And the ADHD answer did not unlock that for me. I just had more questions after that, and I just felt like I still couldn't figure out the why. And I think for a lot of us who are maybe higher masking Autistics, there's a lot of, like, deep existential questioning, and that has been a pretty consistent experience for me my entire life, of just like, trying to figure out the ins and outs of, like, why I am the way I am, why I experience the life that I do, why life is the way that it is in general. So it just didn't make a ton of sense to me at the time. But yeah, it didn't answer the questions that I wanted it to.

Brooke Schnittman: 28:49

Okay, so being an existential thinker and, you know, trying to figure out the why behind everything, do you feel like you have your autism piece figured out?

Patrick Casale: 29:01

Yep, for sure, it's taken a long time, you know, going on, five years of just learning and unlearning and always learning more about the autistic experience in general, trying to learn from a lot of different voices, especially those who are not represented well. And it's just so fascinating to see how these experiences impact people so differently. But yeah, I feel, I feel. I feel as autistic as I can be at this point.

Brooke Schnittman: 29:32

Okay, so we know that neurodivergent individuals get overloaded with their nervous system, especially autistic individuals. Can you differentiate for people, what burnout compared to my nervous system is overloaded actually looks like for people? Yeah.

Patrick Casale: 29:55

So burnout, you're you're often going to see a compounding cost. Combination of experiences, you're seeing a diminished ability to cope with the stressors in your life for a prolonged period of time, and then you're going to also see heightened sensory struggles, or you're going to see heightened mental health, co occurring symptomology, like depression, OCD, quite common to exacerbate in burnout, you're going to see an increase in suicidality. In burnout, you are going to see a kind of distancing from special interest joy and the things that are really exciting to you. In burnout, you're probably also going to start seeing more reclusiveness and more distancing in social situations and capacity and motivation, and when we're talking about nervous system and sensory regulation, and when trying to pay attention to when our systems are overloaded, we can certainly see those outside of burnout, like we can see that if I was to go into the grocery store, it's a good example, like, I would experience sensory overload pretty quickly. And telltale signs for me are like, if I remove myself from said sensory input or environment, can I regulate enough to get back to a place of feeling grounded and connected, and the answer is typically Yes. When I'm in burnout, the answer is yes, but it takes a lot more effort and energy, so that means I have to be significantly more aware about my sensory triggers in general. So it just depends also for those of us who are more hyper sensitive versus hypo sensitive, those of us who might experience alexithymia in the mix, or we struggle to identify our emotions and bodies internal cues. That gets real complicated really quickly, too.

Brooke Schnittman: 31:50

Oh yeah. I was just talking about alexithymia in my group where I train coaches, and we know that 20 to 44% of ADHD ers have alexithymia. I know the rates are high for autism as well. And then on top of that, you have trauma and our age. We didn't really talk about our feelings to begin with when we grew up. So it's compounded.

Patrick Casale: 32:12

Yeah, people always ask like, how did you not know these things about yourself as a child? And I'm not just talking about myself, but a lot of people who discovered autism or ADHD later in life, and what you just mentioned is exactly it right, like it could have been. There's a Lexi thymia in the mix, ADHD in the mix, autism in the mix, complex PTSD in the mix, like so many different things that overlap and look very similarly, and that's where you end up with a lot of misdiagnosis of like bipolar disorder, personality disorders, generalized anxiety disorders, major depression, and the stuff just gets missed to go

Brooke Schnittman: 32:51

along with what you just said. Do you notice that that bipolar diagnosis comes more often with ADHD over ADHD, and I don't want to make any claims, but I've been noticing that in my clients as well.

Patrick Casale: 33:05

Yeah, yeah, I notice a lot more of it. And again, I don't want to proclaim that either, but I do think I acknowledge that, and I think I understand why, like, when you're having a combination of impulsivity and restlessness and dysregulated mood symptoms, and maybe you end up in hyper focus or monotrophic flow, and all of a sudden you look euphoric and borderline manic. It makes a lot of sense why these things get missed. I got misdiagnosed as bipolar two in college and early adulthood. I also had an active gambling addiction, so I I don't fault my psychiatrist for saying that he thought it was bipolar too, and didn't think that it was ADHD or autism. But then when mood stabilization meds don't work, and like all the things that you might do to support your bipolar disorder don't work, it starts to make you question, is this yet another misdiagnosis to add to the list? And of course, it was when

Brooke Schnittman: 33:59

you were talking about refraining from social situations, not doing things that you enjoy, all the signs of burnout. To me, everything that you describe is depression.

Patrick Casale: 34:12

Well, yes, but there is a high prevalence of depression in burnout. So like, if you already have some sort of depression, cyclothymia, major depression, disorder, whichever, and you're in burnout, it's just going to exacerbate those depressive symptoms, where, if you are in a more regulated place, it might be a lot more easy to kind of manage and navigate those and they may not be as pervasive. I know for me, when I'm not in burnout, I love feeling like I can be social and connect with friends. I think a big telltale sign for me in burnout is like, if certain special interests no longer bring me joy, then it's meaning like I feel like I don't have access to that in my world. And that feels like major burnout for me, and it's not. Because I'm sad, or it's not because I'm just worn down or exhausted. And if that's the telltale sign for me, that's something I always try to pay attention to. The Lord of the Rings is a huge special interest of mine. There's some other ones that come to mind, but like, if I am just, like, not able to access that world or those those feelings, then I know that I'm in a place that's that's not good mentally or emotionally.

Brooke Schnittman: 35:25

Thank you. I'm curious, how do you check in with yourself, though, to know that, like, you're no longer interested in your special interests, or is it more of a reactive thing, like, oh, for the last few days, I have not talked, I've not looked I've not thought about Lord of the Rings, and I've been withdrawing from society. You know, I want to sleep blah, blah, blah,

Patrick Casale: 35:52

yeah, I think it's a bit of both. So like, if I'm not actively seeking it out, then that's a telltale sign. But if I am coming across it, if I turn the movies on, if I try to watch something that I that generally brings me joy, and I'm just not able to access the connection to it. That's also a sign as well. And what will end up happening in those states is like, I just loop on like things that I don't have to pay attention to and dissociate from. And that's typically My pattern is like dissociation. I always experience way more shut down than meltdown, so just noticing when those periods increase and intensify as well, that's a good sign for me. And if I start to melt down easier, that's a really good sign for me, because that means that I've really lost access to regulation and that it feels like the littlest things will start to create meltdown, when in most of my life, I don't really ever experience meltdown.

Brooke Schnittman: 36:49

Yeah, you've experienced burnout before the 18 months, even though you used to dissociate, I'm assuming, yeah, how have you overcome that in the past?

Patrick Casale: 37:02

That's a good question, and that makes me start to think, like, Did I ever really overcome it? Because, like, I've been someone who's been a high achiever who's created a lot and has moved from one thing to the next thing to the next thing, and hasn't often sat with how I've been experiencing something for a long period of time, I've always experienced an enormous amount of restlessness and intellectual like, under stimulation is really hard for me. So when I'm in burnout and I'm like, physically depleted, my brain is still like, yeah, man, we got to do Yeah, that's hard. So I don't really have a great answer for that, because I don't really remember the last time I felt good where I wasn't just packing my schedule with things and just moving from like one thing to the next without, like, truly thinking about how I was feeling about it. Would you

Brooke Schnittman: 37:50

say that that piece, besides being a high achiever, is a symptom of your ADHD?

Patrick Casale: 37:56

I think so. Yeah, I think that restlessness and that, like that just intellectual under stimulation is a challenging place to be, because my body can be done exhausted, like run into the ground, and my brain will just be going and going and yeah, that's that's been a really hard challenge I've experienced my entire life. I have yet to figure out a way to figure that out. Like, I'll figure out if that starts happening, I can, like, satiate it a little bit with, like, reading a book, listening to a podcast, doing something that doesn't make my body have to be active, but it still doesn't, like, truly do it for me, if I'm being honest.

Brooke Schnittman: 38:39

Yeah, it is so hard to listen to your hierarchy of needs when you're burned out. I feel like the only way I personally have overcome burnout, and I'm not autistic, but some of my clients are is with accountability, yep, because we are our own worst enemy when it comes to being perfectionist, being people pleasers, being high achievers, having that ADHD piece where we constantly are thinking and have that overactive dmn that without someone checking in and being accountable to ourselves and being reflective, we are going to think about the next thing, because after shutdown is underwhelm, right? And after underwhelm, you're looking for that new, exciting idea. Yeah, it is so uncomfortable.

Patrick Casale: 39:33

That's what my ADHD tries to resist at any point in time. It's just

Brooke Schnittman: 39:37

any point, right? We get to boredom because we're in shutdown because of the burnout, and then we hate it, so we're like cats in water, like, get me out. Get me out. Get me out. I need that exciting new idea. Give me the dopamine.

Patrick Casale: 39:54

Exactly, yep, and I think that's why, you know, there's such a high prevalency of addiction to. Mm hmm, and that dopamine seeking, and just the bursts that you get from addictive behavior, like I had a gambling addiction for probably eight to 10 years of my life. And it makes so much sense to me when I look back at it through like a lens of being an ADHD human, of like, why gambling was so easy to hook me in, because it is that like constant activation and that constant dopamine hit, and it's almost like, exactly like pulling a slot machine lever over and over and over again with much more catastrophic and destructive results. Yep.

Brooke Schnittman: 40:34

And then your baseline gets higher and higher and higher or lower and lower and lower, and you need more and more and more. What do you define addiction to be real, true addiction?

Patrick Casale: 40:45

So I always think about like the differences between dependency and addiction, and when I think about physical or psychological dependency, like physical dependency is like, my body is dependent on, let's just say, alcohol to feel regulated or to calm the nervous system, or psychologically, my body, my brain, needs alcohol to be social. I know that to be true. Or, let's say that's an example of dependency. I think when addiction is happening, it's we no longer have control. Like in dependency, there's still rational thinking that goes on, there's still the ability to distance, there's still the ability to figure out coping skills and implement them. And in addiction, your brain is just completely turned in a different switch where it is all consuming, 24 hours a day, seven days a week, is the only thing you are thinking about is, how do I get that high? How do I get that whatever that I'm looking for, and for me, with gambling, it was literally all day, every day, when I'm at work, I'm thinking about, how can I get enough money to pay the gambling debt or go to the casino when I'm out socializing? How can I incorporate gambling into socializing when I am like at home? How do I prevent myself from going to the casino, or going to play poker, or like, and then you start making all these concessions with yourself, about, like, if I do this, then you do this, and all these rules, which are fascinating, but like, it's a complete and utter loss of control. And I used to think that was the worst part about being an active addiction, was that you knew how destructive whatever it was, was was for you, for me, gambling. I knew how bad it was for me. People would tell me like, can't you see how much you're destroying yourself, and you know this, but you cannot stop it. And I think that is the place mentally that is so freaking hard to explain to people, because if you look at it as like a failing of character or morality or like control issue. You just can't control it. There's so much shame wrapped up into that too.

Brooke Schnittman: 42:48

I appreciate that. Do you feel like your gambling addiction has transferred over to work?

Patrick Casale: 42:55

I've always been kind of like a workaholic, honestly, like even back in junior high, high school, I was always like an entrepreneur. I was always trying to create new things. So I don't really think so. I think that sometimes the gambling addiction, some of the components, transfer over into content creation and social media management, in terms of time spent and the energy that it consumes. Sometimes, for me, which makes a lot of sense, there's a lot of similarities there. And there's a lot of like, you know, you're scrolling through, you're seeing thing after thing after thing, or you're posting and you're getting reaction, or you're getting dopamine one way or another from connection or commentary or and your brain is just like going all the time. So I think there's a there's similarity there, but I haven't gambled since June of 2012 so it's been

Brooke Schnittman: 43:46

Wow, congratulations. Thank

Patrick Casale: 43:49

you. Yeah, certainly never something I thought I could do.

Brooke Schnittman: 43:52

This is a broad claim, so I want to be careful on how I'm saying this. But do you think the most successful people who just work all the time likely struggle with addiction.

Patrick Casale: 44:09

I'm sure there's a very high percentage, because I think when you're in that state, when you're working all of the time, you probably and it's hard, there's nuance to this, because there's so many people in especially in neurodivergent spaces, who really get so much joy out of work and creation and community and being, you know, and offering some sort of virtual component like so for a lot of us, working is often a place where we might be A monotropic state of flow, or like really feeling connected to ourselves and creative. So it's hard to sometimes like delineate, but I do think that a lot of people who struggle with workaholism and more struggle with working all the time, probably have more dependency to substances or. Habits or processes than than not as a soothing mechanism or just a regulating mechanism or a way to just turn the brain off temporarily.

Brooke Schnittman: 45:09

Yeah, I know we're running up on time here, but do you have some quick tips for neurodivergent people, specifically, more for ADHD or autism, before you get to burnout, what are some things that you can do to regulate the nervous system?

Patrick Casale: 45:26

Yeah, one thing I always want to try to do is get to know your sensory system, because you might be hyper sensitive to some input, you might be hypo sensitive to some input, and it might depend on the environment and situation. So I want to get really clear on like, what are my sensory triggers? What are the sensory experiences that I try to like pursue more often than not? Those are things I want to know, because if we are noticing there are certain sensory triggers that create an enormous amount of meltdown or shutdown, and we can remove some of those from our lives, or at least go in with more awareness and understanding, it can really help us kind of keep that nervous system a little bit more regulated and more able to deal with some of the other stuff going on. So that's one thing I always want to talk about. I mean, two, figuring out your sleep rhythms, and I know how hard that is, because I am someone who does not sleep, but I think it's about letting go of like what sleep hygiene is, and trying to figure out what works best for you, because that may be very different than what you're being told by your doctors or your providers or even your loved ones. I know that I am someone who's going to stay up a lot of the night and I'm going to sleep in the early parts of the day. I don't nap like I'm it's just, it's hellacious. But I've learned to work with it. I think finding a good therapist who really understands the autistic or the ADHD experience, who really gets it, and preferably someone who is autistic or ADHD themselves, or a good coach if you can't find a good therapist. So, like, lived experience really matters, but lived experience with someone who really has done some of the work to also understand themselves and other experiences super helpful. Reducing demands to the best of your ability. I don't want to, like, take everything out unless you need a drastic reset, but trying to step back from your calendar and on a daily, weekly, monthly basis, and just thinking about like, what are the things that are feeling energizing? What are the things that are feeling draining? Are there things that I can get rid of, or are there things that I can double down on that might feel really good for me? So trying to do some of that in advance, and then having some creative outlet, like whether it's physically creative, whether it's artistic, like something that can make you feel like you are using that part of your brain, and if you're able to get into nature to regulate, that's always super helpful. I'm a big soccer player, so that has always been really regulating for me. I actually have an over 40 game tonight. Nice.

Brooke Schnittman: 48:01

My family is a bunch of football players as well. We don't say soccer. It's football here.

Patrick Casale: 48:09

That's the way it should be, yeah? For sure. Just like having a toolkit that is all encompassing and holistic, because we're not going to find one thing that just works all of the time. Yeah, so we need to have different tools and strategies to support all of the different domains of life, so that you can default to them when one thing isn't working or one thing's working really well, and just trying to have that, that flexibility in terms of the menu,

Brooke Schnittman: 48:40

yeah, love it. Thank you so much for joining us. I really resonate with your story, and I know that it kind of just went there, and I'm so happy it did. And thank you for being so honest and transparent and vulnerable on this podcast. If someone needs to find you, and wants to reach out. Where can they find you?

Patrick Casale: 49:04

Yep, thank you for having me. And I love talking about this stuff. So I'm probably the most active on my Instagram, which is just my name, Patrick dot casal, and then my sub stack, which is the ADHD journeys. I am trying to remove myself from other platforms, and I am also the host of the all things private practice podcast, which you just came on, and that has episodes out every single Saturday on all the platforms. And my website is all things practice.com, and if you reach out to me, please don't invite me to jump on a quick call, because I never will and just will never

Unknown: 49:42

do it. Yeah,

Brooke Schnittman: 49:43

exactly. Thank you again. You are very welcome. Thank you. Thanks for listening to this episode of successful with ADHD. I hope it helps you on your journey, and if you need any additional support for you or a loved one with ADHD, feel free. To reach out to us at coaching with brooke.com, and all social media platforms at coaching with Brooke. And remember, it's Brooke with an E. Thanks again for listening. See you next time you.