Season 3, episode 6 is here: Dr. Kim Sage, a Therapist Finding Her Place on the Autism Spectrum.
Dr. Kim Sage is a licensed clinical psychologist in southern California. Dr. Sage joins me to discuss her discovery that she may be autistic, the problem of autism underdiagnosis, and the close connection between autism and personality disorders (especially narcissistic personality disorder) within families.
Dr. Sage also talks about her early autistic traits, friendship challenges, autistic traits’ impacts on romantic relationships, and more.
Watch this episode on YouTube.
Check out Dr. Sage’s website: Dr. Kim Sage
And her social media:
Transcript
Kristen Hovet: 1:06
Today I’m speaking with Dr. Kim Sage, a licensed clinical psychologist based in Southern California, but before I share our conversation, I’d like to thank Colette for your generous one-time show of support to the Other Autism podcast.
Colette used the Buy Me a Coffee link to send in a one-time donation. If you find this podcast valuable, useful, and or informative and would like to do the same, please check out the link in the show notes that says Buy Me a Coffee. Please say hello to my guest for today, Dr. Kim Sage. Hi there.
Dr. Kim Sage: 1:46
Hi, my name is Kim Sage. I’m a licensed clinical psychologist in Southern California. I really do specialize in, I was kind of thinking this through. It’s really people that have had and are still living with, in some way, a complicated childhood. And that can really run the spectrum from your classic this is trauma to that constant little relational traumas that are being repeated down their adult life in different ways. That’s kind of how, I didn’t really start that way, but you get a collection of people. It tends to be those types of individuals.
Kristen Hovet: 2:19
I initially found you when a listener reached out to let me know that they were watching one of your videos on YouTube and you had mentioned an article I wrote about autistic traits, I think, as they commonly present in late-diagnosed individuals. In your video, you were documenting your thought process in how you were applying these traits to yourself and having what appeared to be a series of epiphanies about this. You also mentioned that many of your own clients in your therapy practice likely also relate and therefore could potentially be autistic as well. That was a few months ago now. What has your thought process been since then?
My Process of Discovering I Might Be Autistic
Dr. Kim Sage: 2:58
It’s interesting. It’s continued to evolve, though I am still very much in the inquiry, does this really fit? How could it not fit? Kind of stage. I found that the more I research high masking, the more I’m like, oh my gosh, it starts to explain so many things and yet then I start to research what does it look like? And I’m sure we’ll get to that, getting a diagnosis or not, and whether that’s helpful or not and how that’s helpful or not, depending upon where your challenges are and where you might need accommodations or things like that.
I feel like I’m there but I’m not fully ready to, I’m saying it and not saying it. I feel like that I’m on the spectrum, but then looking at my kids and their dad and family and all these things are emerging. And then I would say with clients, a lot of my clients, unless they find me on social media, they don’t necessarily watch me on social media that I know of. So there’s a lot of clients I have, they probably have never seen any of my TikToks and never seen on YouTube where I’ve talked about even this for myself, and so it’s this weird place, other people that are finding me that way, it’s a shortcut. So in terms of saying to them, oh, I think you’re on the spectrum. That’s not happening unless they’re raising it with me at this point. It’s not something that I feel like, okay, because they’re obviously very high masked if that’s happening, but it’s really made me start to go, hmm, I wonder if this explains things. So I feel like we’re going to have to get to it, but I still think it’s a very delicate topic for a lot of people.
Kristen Hovet: 4:24
Definitely, and how did you first come across it?
Dr. Kim Sage: 4:28
Honestly, your article was one of the first places and I made that my entire video about your article because I was like, oh my gosh, I relate to every single one of these, right down to the autoimmune disease, which I know there are links with your articles about the research. And so then that just sort of prompted, I had been hearing a lot on TikTok about neuro tribes and unmasking autism. So all of that had been going on for a while and I started to feel like I was making a lot of content on the CPTSD and people would say in the comments, okay, well, how is this different from autism? And I would sort of give back the answer that is what the DSM says, for the most part trying to, until this kind of conversation sort of started to blow up, really I think for me on TikTok, and then I started going, wait a minute, like there are things I may be missing that I don’t understand. And then I read your article, I read neuro tribes and unmasking autism. I was like, oh my God, I feel like it’s unethical to not be doing a deep dive on autism right now as a clinician, let alone just as a society to understand each other.
Kristen Hovet: 5:30
I really appreciate that stance because I’ve seen a lot of the opposite. I think, especially people who’ve been in the industry for a while and they’ve been working with so many clients over the years, they don’t want to have to go back and fix the perceptions or even the way they approach therapy. So that’s awesome that you’re doing this.
Dr. Kim Sage: 5:52
Yeah. I will say that that once I started making a few videos, I started seeing clinicians making these very rigid videos, like this is what autism is, just repeating the DSM. I was like no, you think this is the one video you need? I’m like, no actually, why don’t you go read all the books and then we’ll have this conversation. I feel like it’s still a big issue for our community, but I’m hoping that’s changing.
Kristen Hovet: 6:17
In your personal life, have you told people close to you about this potential identification as autistic? If so, what have their responses been?
Dr. Kim Sage: 6:26
It’s interesting. I haven’t really shared much, except with my kids, to be honest, because my kids are all 16 to 24. They’re older and so initially it’s like, hmm, and I want to keep their lives private, but they’re like, huh, that makes sense, or they’re like, hmm, I don’t know about that. So it’s been this interesting thing where I feel like I’ve been most open with it, honestly, randomly, on social media, with strangers on TikTok. They’re not strangers, people that I connect with there. So that’s been interesting.
And I started following a lot of autistic creators because I kept hearing you need to understand things outside of textbooks and things like that. You need to understand the lived experience, and so that’s something else I started doing and so I feel like, with those creators, I just feel this connection. I’m also a very private person. I have a small, I mean, friendships have been an issue, so there aren’t a lot for me to tell if that makes sense.
Kristen Hovet: 7:19
Definitely. As the community of therapists, counselors, and psychologists is becoming more aware of late-diagnosed autism, often synonymous with level-one autism, there’s been a kind of collective reckoning or coming to terms with the high number of people who’ve been in some form of therapy for years, who’ve gone undiagnosed, incorrectly diagnosed, or partially diagnosed. So how big of a problem would you say this actually is?
The Problem of Undiagnosed Autistic Adults
Dr. Kim Sage: 7:46
I mean, honestly, at this point where I’m still on my inquiry, I’ve been reading and educating myself, I think it’s a massive problem. I think that people have been met with therapists who are or aren’t educated, not intentionally. I mean, even in my programs not that long ago, I just didn’t know, you know, [we were taught] that stereotyped version [of autism and autistic people], and so I think it’s a problem unless people are willing to learn and educate themselves.
And then, as I was saying earlier, I think the challenge is how do you say to a client, for example, who has no knowledge of any of this, right, they don’t go on social media, they’re not on TikTok, they’re not reading your articles, and I’m thinking, okay, this person is high masking. To try to tell that person you’re maybe autistic, that’s big. I think therapists are afraid of that. Like I’m afraid of that! It’s a little scary. I’m not going to withhold that because I think that’s important for treatment, but it has to be in the right place or time. And I think that many of us are probably scared to face, what does that really look like? And then, what do I need to do to shift my awareness and training and education to be a good support for this person to help them?
Kristen Hovet: 8:46
That makes sense, and I’m hoping at some point there’s some kind of guide or training for people in this predicament, basically for therapists and counselors, because right now I think everyone’s kind of not sure what to do about that.
I know you specialize in working with clients who have trauma as a result of growing up with parents with personality disorders such as NPD, as I mentioned before. So a lot of us working in autism self-advocacy have noted an overlap in families between narcissism and autism and other personality disorders, and of course, autism is not a personality disorder. I just want to make that very clear. So have you noticed this overlap as well and, if so, why do you think this is?
The Overlap Between Autism and Personality Disorders and Complex Trauma
Dr. Kim Sage: 9:30
Well, I mean, that’s interesting because when I first heard someone make the association between autism and narcissism, my mind was just kind of blown. It made a lot of sense, especially in my personal life, also with people who have been described as arrogant, certain things that you look at like, or stereotypical autistic traits that may have been misperceived and misinterpreted. I think it’s a massive problem. I also think it’s a problem that we demonize narcissism so much and we say, oh, but it can come from trauma or autism or whatever’s going on. But then other disorders, we don’t allow the space, there’s just not a really good dialogue about it. It’s like, how do we address all that? I think that’s a shortcut [to say], oh, they’re narcissistic. Maybe they’re not, maybe there’s something else going on. And so I think it changes everything, to be honest, just to think about neurotypes in terms of how our brains work and without necessarily labeling. But I also think sometimes labeling gives us a sense of like, oh, that explains it, it’s not my fault, my brain’s like this — whether it’s borderline or narcissism or whatever. So I do think it’s a large problem to address and the overlap is significant.
Kristen Hovet: 10:36
Yeah, I’ve been trying to find articles, research about it because I’ve seen articles on the overlap between schizophrenia and autism existing in the same family or in the same individual, same with bipolar disorder. So I’m wondering if personality disorders fit in there as well, if there’s a genetic component, because it seems like every single person I’ve spoken with who’s autistic, and especially late-diagnosed, has a parent or a grandparent that’s more toxically narcissistic or even covert narcissism, and some of them have autistic traits, some of them don’t.
So it’s just teasing apart these different traits and how they all fit together and how that fits with [the fact that] so many of us autistic folks have trauma and that actually made it very challenging to get our diagnosis because we, for the longest time, thought, oh, I’m highly sensitive, plus PTSD. I know for me that definitely delayed a diagnosis or even looking in this direction at all.
Dr. Kim Sage: 11:44
Yeah, that’s something I learned a lot, too, which is that overlap. My initial inquiry was, how do I separate complex trauma from autism, from high-masking autism? And the more I’ve gotten into it then, and I’ve obviously listened to a lot of other people, that it’s almost impossible to separate in many regards or some things you can tease out, but because it seems to be inherently part of the autistic experience to experience trauma, especially relational trauma at a minimum I would say, because I think of the PTSD and then relational trauma tend to go together. Most people have both. And I also noticed that within family systems, like things like borderline, and the research had shown like you’re more likely with everything, you know, the more closely related you are to have these certain disorders. And so how much of that is genetics, how much is environment, I think it gets really confusing, like you’re saying. It’s like how do you start to tease those things out?
Kristen Hovet: 12:32
And what would you say, you mentioned the overlap or we were talking about PTSD and autism. So what are some of the differences or things that can basically indicate that a person’s not autistic, but they maybe do have PTSD or complex PTSD?
Dr. Kim Sage: 12:49
As I’ve continued, and I want to keep saying, I’m still trying to fully understand, but when I start to look at, like myself, for example, all the things I am now identifying with as potentially autism, as autism, to be honest, I thought were only all complex trauma, they could be explained by complex trauma. And then when I started to dive into it, I’m like, well, that doesn’t really make sense, like a lifetime of sensory issues. Okay, yes, theoretically you had the same mother and she had the same struggles. And so it’s like, it feels like the degree, the intensity of certain things, like sensory responses, social dynamics, like that makes sense from a certain perspective with complex trauma, but not to the degree that it feels like with autism. You know it could, if you had trauma around certain social environments or interactions, and so I feel like it’s in itself, it’s kind of a spectrum of degrees and so I don’t think you could absolutely say, you know, it feels like at this point it’s hard to say, well, that’s this and that’s that. It feels like the collection of, when you start to look at autism, you have these pieces of repetitive behavior and social dynamics or difficulties, and you know dysregulation and all of that. That, when it starts to really cluster, it feels like that feels more autistic than if you just pick out a few pieces that are complex trauma, if that makes sense.
Kristen Hovet: 13:57
Definitely, and I’ve had the same kind of thoughts about that. It’s like I’ve met people with complex trauma and they have no issues with socializing. Or maybe they did right initially after their trauma but then they didn’t at all after. So there’s things like that that always stood out to me and I was like, PTSD doesn’t explain this at all when you get down to it on the details. I guess, to switch gears now, and talk about you and growing up, what traits did you have as a child that you now know to be related to autism?
Traits I Now Think Indicated I’m Autistic
Dr. Kim Sage: 14:31
I think the first thing, I’m laughing because my daughter, I just shared this on another video, she had said to me one day in the car, she’s like, oh my God, everything bothers you and I was kind of horrified, like in the moment. But then, because we were like getting drive-through food and I was upset because the food wasn’t hot, which sounds, that doesn’t make me autistic, but I mean, I’m deeply bothered by it in a way that’s embarrassing, that I shouldn’t be.
As a child, it was extreme sensitivity to clothing, to textures, to fabrics, to noise, to sound, to light, like I would say my sensory issues were at first I was like, okay, is this a sensory processing disorder? What is this? Because that part has always been not being able to be comfortable, feeling like I was different, like an alien, like what am I doing? Why does everyone seem to get what’s happening here? I’m faking it and then I’m getting misperceived as being a bitch or not open, like what is happening with my face right now or whatever. So those things I think were huge.
And then I was a very shy child, extremely shy. I’d have to rehearse [what I was going to say] even in my twenties, which seems funny now, but no one makes phone calls anymore. I’m 55 now, so I’ve learned a lot of skills and probably have been masking for so long. But so much anxiety about everything, which I also was thinking, okay, this is all attachment, and I was like, yes, and.
And then a lot of some stimming behaviors that I didn’t realize were stimming. When I started researching I was like, oh, I definitely do this.
Kristen Hovet: 15:56
What was school, like for you?
Dr. Kim Sage: 15:58
You know, I think I did relatively well in school. It’s because of my generation, you know, I mean it’s not true for everybody, but our parents were generally not involved at all, so you’re just on your own figuring it out. And so I think school was one place, not so much socially but academically, I could handle as long as I was working at it.
I’m a huge procrastinator. I mean, all my kids are like this, too. It’s bad, that anxiety. We put everything off and then you power through it at the end and you do well enough so that you’re not really motivated to plan ahead again. So, like that constant dynamic.
I really enjoy learning. Like I just started a French class and I was like, oh, I’m back in a classroom, you know, which is like, I enjoy that part.
Kristen Hovet: 16:37
Do you wish you’d been identified as autistic in early childhood? Why or why not?
Dr. Kim Sage: 16:43
I have to say, knowing the way that autism has been stereotyped, like through the lens of today, I probably wouldn’t want to be diagnosed because of what I’m still witnessing and watching in the world. I hope that changes. I wish that someone could have seen me in all of the difficulties that I had, and so I guess that would have meant yes, right. I mean the collection of why is everything so hard for you? Why do you cry so much? Why are you so emotional? Why does everything bother you? Because that gets internalized. It’s like what, alongside childhood trauma, what is wrong with me? Why am I like this? And it’s frustrating to other people that don’t understand it. It’s like you’re just being difficult, you’re just high maintenance. It’s like, no, I’m not, but I can’t help it, you know. So yes, I guess, if that makes sense, like yes and no, I would have wanted to be identified.
Kristen Hovet: 17:27
What were friendships like when you were younger?
Dr. Kim Sage: 17:30
I didn’t realize this until the last, honestly, several years, but I think I’ve always struggled with friendships. Choosing certain very strong personalities, I think, and then it being too strong for me later and lacking good communication skills, and then my feelings getting hurt a lot and then not saying why it was going on and then ending friendships.
And then, frankly, like I’ve always loved — I’m an only child — I love to be alone and I’ve been raising four kids, so I don’t feel very socially driven. Like I want that, but it’s like, oh, but I could be home, eating sushi and watching Netflix by myself. I’ll just do that! I would say they’ve been more of a struggle than I would have wanted to admit and still, it’s still something I have to work on.
Kristen Hovet: 18:12
I know, for me, I would just kind of focus on one person, one friendship.
Dr. Kim Sage:
Yeah.
Kristen Hovet
Out of all of the autistic traits that we read about, what are some that you identify with most or resonate with most?
My Top Autistic Traits
Dr. Kim Sage: 18:27
I think the two biggest ones for me are, well, definitely routines. I definitely realized I have my life set up a certain way and it’s difficult for me. I can manage it, like when I’m traveling or something, it’s difficult.
But I would say that, outside of that, the sensory issues and the social dynamics are the two things that really started to drive me to think, okay, being highly sensitive, all of those types of things, and how that manifests in my daily functioning and relationships with myself and everybody else.
Kristen Hovet: 18:59
I was wondering if you ever came across Elaine Aron’s work on highly sensitive person? A lot of us have a story of, like, that’s what we identified with first, well before autism.
The Highly Sensitive Person (HSP) Trait Is Code for Autism
Dr. Kim Sage: 19:11
Absolutely. That’s part of what I found in your article is that that whole conversation around HSP is really just code for autism, [and] became a conversation I witnessed on TikTok. And then being in this world I had always, when I heard about Elaine’s work, oh, that makes sense. I’m a highly sensitive person. It’s HSP with CPTSD. You start doing all these things like we’re separating things out. And now, I mean, I have to say, when I look at the criteria, to me it feels like this is autism and I know there was later people she based her work on. I guess it was her nephews or grandnephews who were later diagnosed? There’s some pushback on that side sometimes, it feels like, I think because people don’t want to make the leap towards, to say the word autism, but absolutely every single HSP [says], oh, I’m an HSP long before [I realized I was autistic].
Kristen Hovet: 19:58
I was wondering if you could describe your perfect day starting from the moment you wake up. The reason I’m asking this is because hearing about everyday life and preferences of autistic individuals is helpful, I think, for both autistic and non-autistic people. Both are able to see similarities and differences between themselves and the person answering the question.
My Perfect Day
Dr. Kim Sage: 20:19
I mean, honestly, it’s usually a day where I wake up, ideally without my cat waking me up, so I wake up alone without interference in some way, which is very rare because I wake up pretty early, like five o’clock usually most mornings. I wake up and then I have my coffee and spend my time just usually with low lighting and candles, which is my routine every day, and I would probably eventually take a walk by myself at the beach, have a great dinner for myself, watch a movie. Like a lot of it, to me, it’s really solitary time.
I’d love being with my kids if that worked out, but they’re all scattered and older, so at this point there’s just a lot of peace. And I initially had thought that the reason why I enjoyed that was because of my CPTSD and living in hypervigilance, that being around other people is stressful, like my nervous system is… so I do think that that’s part of it. I also just enjoy doing my own thing, and so my nervous system feels regulated alone. I don’t have to be or present or do anything and be on, you know, and so I think, for me, a day that allows me to pursue the things that I enjoy in a kind of peaceful, quiet way is probably a really good day.
Kristen Hovet: 21:26
We talked about friendships, but I was wondering also if you’re comfortable talking about relationships, so romantic relationships, and how have these traits kind of impacted relationships?
How My Autistic Traits Impact Romantic Relationships
Dr. Kim Sage: 21:38
I mean, this is more of in retrospect because, at this point, I’m not in a relationship. But I would say that this new awareness has made me understand my partner, my partner choice, the things that I struggled with that I, you know, like I was just making a video about this the other day, where I think I was very rigid and controlling about things in a way that I needed to feel safe as a result of my childhood. And when I was doing it I thought like, oh, I’m just being the parent that I wanted, that I wished I’d had. But I do think that there’s been, like my whole life, an attempt to control, not just from trauma but my nervous system, like the way my brain works. And so I think, you know, I realized it recently, like that might not have been easy to be with me in that dynamic where I was so affected by the temperature in the room or whatever it was, like the way the mattress was, like things that other people, like, why do you care about this? Like I can’t not care about this! And so I think, in that regard, it’s just made me have increased awareness about the way those partners have shown up and the way that I’ve shown up.
Kristen Hovet: 22:38
That makes sense and I think, when we’re going through those sensory issues and we don’t know what’s causing it, I think that it even adds to the frustration and kind of builds into, I think, a worse meltdown in some ways. Because now that I know [I’m autistic], I can de-escalate myself a lot easier.
The other thing I thought of when we were talking is, I did an episode on narcissism and so not only do we have this in our families, it seems, a lot of us also end up in relationships with narcissists or people with very high narcissistic traits, whether or not we have this in our families. So I don’t really have like a strong question formulated, but I guess if you could speak on that connection or maybe what is it about autistic people that is attractive to narcissists and vice versa?
Why Are Autistic People Attracted to Narcissists and Vice Versa?
Dr. Kim Sage: 23:31
One of the things I have come to learn is that it’s very common for people who, I believe, are raised by parents who struggle with borderline, for example, for those people to actually be attracted to narcissists themselves. So let’s say, if I have borderline, I’m more attracted to narcissists.
What I realize is that the same thing I feel like has applied as a child of both parents, I think, with my parents — and I’ve questioned whether they’re on the spectrum or not, too, which is a different conversation — but with their severe emotional and relational dysregulation, I think for something like covert narcissists, unless they have rage issues, like a parent who struggles with emotional and relational dysregulation — initially they feel confident and containing and maybe there’s a little arrogance there, but it feels like, oh, this [narcissistic] person has it figured out.
I think there’s a draw to that. [The narcissist is] like, I’m going to take over, I’m going to take care of you, which I think, from a child trauma perspective, is what we want. We all long for that. And then, if I think about autism, if I thought about my dysregulation and just everything being so hard and not having safe parents, oh yeah, it’s great to have someone feel like they’re going to finally be there for me and take care of it.
Now it flips, it doesn’t end up staying that way, whether it’s the [narcissist’s] love bombing stage or all of that, and so that’s definitely been something that I have tried to reconcile. And why did I choose someone like that to create a family with, honestly. It’s because of that, in large part, and also maybe there’s autism in there, too. So, who knows, you know?
Kristen Hovet: 24:58
Definitely, and I think to the narcissist, as well, I don’t want to say we’re easy targets, but it’s almost like we’re good at perspective-taking, which is sort of contrary to the traditional, you know, autistic criteria, almost to a fault. I know for myself I can take someone’s perspective too much and not remember that I also have a perspective in this and have to remember myself.
Dr. Kim Sage: 25:23
I think that’s actually really true. I think that also this concept about being naïve with autism. I thought all of these were trauma-related, like, oh, I take good perspective because I wasn’t listened to. And that may be the case, but it also may be that we’re so invested in hearing all the sides or being in that regard. So I think that, and then being naïve, like just trusting people, like I just said. Like I [never] think, oh, they’re going to screw me over. [Neither am I] like, oh, I see the good. But I really just took things at face value, even as a parent. My kids are, like, mom, why didn’t you check on that? I’m like, I don’t know, because I believed you! And I think I’m a relatively smart person, but I just I don’t know. I think there’s something about that that also may be part of it. I don’t know.
Kristen Hovet: 26:10
For sure. The other thing is high empathy. For those of us with really high empathy, I think that makes it even more dangerous in some ways, unless we have blatantly been trained, like this is what a narcissist looks like, and most of us haven’t been.
So I think that’s another future goal is to create some kind of training for, you know, adult autistics going into relationships. But just trying to think, like, if you have high empathy and someone’s coming at you and they’re trying to blame shift and doing things like that, I feel like we take the person’s perspective and like, yeah, yeah, maybe I am doing that, right. So that’s another element, possibly.
Dr. Kim Sage: 26:52
Yeah, I agree.
Kristen Hovet: 26:53
And how has it been working in a caring profession, having to work one-on-one, face-to-face, with people who have sometimes very, very traumatic experiences, and they’re sharing this with you?
Neurodivergent in a Caring Profession
Dr. Kim Sage: 27:05
Outside of the very early years where I was working with a population that had been the victim of sexual assault within families, like a lot of abuse in families sexually, that work was, it felt so intense and so difficult. I had to really work at the barrier of self-protection while also letting myself be present and connect. When I started working, and this is not to minimize, because everybody at every level has issues, but when I started working in Newport Beach with a high-functioning population, whatever that looks like — I don’t mean in terms of autism — but just like a highly successful population, there were lots of issues there, too, but it wasn’t that same level. Like, you know, people of course have sexual trauma and assault also, but not to the same degree and the lack of resources and support.
I’ve always been pretty good at being able to sit with people in their trauma, and I think this is true for most therapists because we’ve had a lot of trauma. Like I always say, I would never want a therapist who’s never had anything happen in their life. No, thank you. I wouldn’t want somebody who’s, like, it’s all about them and their trauma, either, of course, that wouldn’t be appropriate.
But there’s something about, I think, when you grow up in a chaotic environment, that you have built up a tolerance and if you have high empathy, it’s like I can be with you in this, and this doesn’t have to permeate my boundary. I mean, some sessions are hard and you have to manage that and work at it. Everyone always is, like, how do you do that? It’s like, how can you not do this job? It’s incredible. People let you into their most sacred parts of their lives and it’s an honor. I don’t know, I don’t take it on. Like I said, it might be dependent upon, though, also, what kind of work I’m doing and who I’m working with.
Kristen Hovet: 28:37
I guess in terms of also having to mask, because we’re definitely high maskers being late-identified, because there’s also masking within your profession and masking with clients and things like that. So have you experienced burnout in your profession or would you say that you have enough kind of more protective elements in your life that have reduced the risk of that?
Dr. Kim Sage: 29:01
I’m pretty mindful of keeping my caseload in a place where I feel like I can manage it. That has meant not taking on all the clients I could take on because I know that I couldn’t handle that. It has meant sometimes when I haven’t taken enough vacation and I can feel it, it’s like okay, because I do tend to work a lot, it’s time for you to do that.
So I balance it. I don’t think I do it perfectly. I think that my personal life has been probably more challenging raising four kids alone, and so when all of that would mix with work, that would be even more difficult. But I’m starting to realize, I think the way that burnout has presented has been in my body, in my physical health, in neglecting my physical health and having autoimmune disease and not dealing with that. That’s where I think a lot of my trauma and my burnout, because I’m such an achiever, like I’ll just push through things. But you know, as you get older, too, your body’s like, sorry, we’re not, that doesn’t, you can’t do that anymore without feeling it. So that’s something I’m still in the middle of trying to work on right now.
It’s interesting I was a very sickly kid. So chronic ear infections, sick all of the time and always very tired. I even look back now in between high school I would take a lot of naps, I slept a lot and I didn’t really think much about that until I started hitting, I would say, as I got close to menopause, which I think is a whole other conversation around menopause and autism, which I don’t even know where the data is on that.
But I started really struggling with chronic fatigue and to the point where I would push to where literally, all weekend, I just couldn’t do anything. My kids would — I had majority of custody, but if they would be gone for the weekend, I would literally lay on the couch the whole weekend. I just was, like, I can’t. And then my daughter, unfortunately, has had a lot of serious illnesses and infections and has been hospitalized for over a month and we finally got her diagnosis with Sjogren’s disease several years ago. And then around that time I was getting diagnosed with, like it’s a connective tissue disorder, basically this combination of symptoms. So I started really seeing how often those symptoms were manifesting, with just exhaustion and fatigue and being emotional and not sleeping well and insomnia, and then, unfortunately, menopause just made all of those things worse. Because you don’t sleep, you don’t feel well unless you’re managing your treatment, and that’s a whole other thing.
Kristen Hovet: 31:20
Do you have a message for adults who are in the process of contemplating or getting an autism assessment?
Next Steps
Dr. Kim Sage: 31:25
This is a place where I don’t feel like I have the expertise to have an opinion, except for what I’ve been reading is that in some areas, having a diagnosis can be detrimental to like adoption, things like that, in other places, you know, and so I think it depends on your level of accommodation and need, and it seems like everybody, theoretically, needs accommodations with autism. I’ve grown up with just no help with anything in my generation. Like I think the idea of like, what, there could be help with that? It’s like, no, that’s not possible. So I think the idea of being identified and supported is incredibly important. I guess I worry about, right now, where we’re at in terms of the stereotypes, with people getting stigmatized, being denied access to things that they should not be denied access to. I don’t really feel like I’m educated enough to have a full opinion on that, to be honest.
So Many Autistic Therapists
Kristen Hovet: 32:15
One thing I’ve noticed is kind of an explosion of autistic therapists and they’re sort of going through this thought process of, like, do I disclose to my clients? I think we talked about that a little bit; they may be further [out] from their diagnosis and they still don’t put it on their website, they don’t disclose it, but I know it would be so helpful for autistic folks who are looking for therapists specifically who are neurodivergent. And I think autistic people love psychology, maybe because it sort of helps explain human nature.
Dr. Kim Sage: 32:51
I’ve seen so many therapists, too, on TikTok coming out and saying that they are, and on YouTube and stuff, and so I think we’re still wrestling and I’m obviously — and many of them are younger therapists — with our own internal stigma about autism, our own stuff we’re trying to deal with. I mean I think that’s what’s scary. It’s like I’m saying, how do you navigate that for yourself with a client you’ve been working with for like three years, and now you’ve learned all of this and do you go, hey, by the way, I think you’re autistic. Like obviously you don’t do that, but I mean, you know what I mean. It’s hard to reconcile. And yet I also think, like you’re saying, but what a beautiful bridge to say, hey, I’ve learned about this for myself and I’m seeing these qualities in you and maybe that helps explain these struggles you have and what supports you might need. So I think we’re still figuring that out, a lot of us.
Kristen Hovet: 33:36
Definitely. And what about the ADHD component? Because a lot of late-diagnosed folks are also finding that diagnosis, too, at the same time.
Dr. Kim Sage: 33:45
Yes, and I’ve been learning more about that. It seems like that’s extremely common for those with autism, like it’s a pretty significant overlap. Was it like 30 to 80 percent or something like that?
Kristen Hovet: 33:53
Yeah, something super high.
Dr. Kim Sage: 33:55
I don’t know, it’s pretty high! Which makes a lot of sense, I think, in some regards. The whole AuDHD, there’s like a whole subset of that going on. I don’t see how all these things aren’t connected and aren’t helpful to understand. I just think that we are, I keep saying, I think we’re at this beginning of where we need to be.
Kristen Hovet: 34:12
Definitely. A huge thank you to Dr. Sage for being my guest on The Other Autism podcast.
The Other Autism 