Self-Gaslighting in PMDD, Autism, and Chronic Illness
I’m so lazy.
I just recently took a lot of time recovering; I can’t take more time to rest now.
I can’t possibly have this many things wrong with me; I must be making it all up.
These are the kinds of things I say to myself when my body is asking me to slow down.
Recently, I went to see a doctor because I thought my symptoms matched a particular diagnosis. The possibility had been in the back of my mind for a while. Then, without me ever mentioning it, two different health care professionals suggested my symptoms seemed to fit that same condition.
At the appointment, I rattled off my symptoms and explained why I thought the diagnosis might fit. Then, practically in the same breath, I started giving all the reasons I was probably wrong and didn’t actually have it.
This is a life-long problem for me. I am very good at erasing my own reality.
When my body needs rest, my brain demands proof
I live with PMDD (premenstrual dysphoric disorder), dysautonomia, and symptomatic hypermobility. I am also a late-diagnosed Autistic person and I have been exploring whether mast cell activation syndrome (MCAS) could help explain some of my other symptoms.
Brain fog is my baseline. Naps have become a regular part of daily life. And yet, I’m constantly convincing myself that I am not doing enough or not trying hard enough.
If I try to rest, I find myself getting up to grab a pile of laundry so that ‘at least I can be productive while I rest.’
PMDD and Autistic burnout affect how I experience memory, decision-making, attention, and my ability to access information that I know is in there somewhere. When that happens, I feel like I cannot trust myself. I feel incompetent. I feel like I’m dropping balls left and right.
But something predictable happens when I actually listen to my body. Eventually, once I am rested and recovered, I start moving through life more normally again. I put the dish in the dishwasher instead of next to the sink. I run the errand on the way home. Things that had felt impossible begin to happen without so much force.
And I am reminded: I am not lazy. I was pushed too far and needed restorative time.
Complex conditions make self-doubt even sneakier
The more complicated my health picture has become, the easier it has been to tell myself that surely I must be exaggerating. How could PMDD, dysautonomia, hypermobility, possible MCAS, and Autism all be part of one person’s life?
Some research suggests Autistic people may be more likely to experience PMDD, although prevalence estimates vary and the evidence is not settled.1 Dysautonomia/POTS, hypermobility syndromes, and MCAS are also frequently discussed together as an interlinked clinical picture.2 Researchers are continuing to examine possible relationships between mast-cell activity and Autism, but that work is still emerging.3,4
Knowing this does not diagnose me. It does something different: it makes the existence of multiple overlapping conditions feel less inherently absurd.
Sometimes the voice of doubt is not entirely ours
Often, the things we tell ourselves are echoes of doubts and dismissals we have heard from other people.
Why do you always have so many things wrong with you?
Why do you love going to so many different doctors?
What is wrong with you?
You are so sensitive.
I can’t handle hearing about yet another health problem from you.
I have also had health professionals tell me, fairly, that they could only help me with the toolbox they had. Others have told me I was doing better than I thought, or that there was not much else they could offer.
As a registered dietitian and international board certified lactation consultant, I know how to read research, evaluate sources, and value evidence-based practice. I do not want to jump to conclusions. If I hear hoofbeats, I think of horses first, not zebras. I respect Occam’s razor.
And still, I have walked away from appointments feeling silly for having brought up my concerns at all.
Over time, that can create a dangerous internal conclusion: There is a problem, but perhaps the problem is simply me.
How mindfulness helps me interrupt the pattern
Mindfulness has not solved my health problems. What it has helped me to do is catch myself while I am arguing with my own experience.
When I am having a hard day and feel compelled to stick with the schedule anyway, I am more able to notice: Oh. Maybe my body is telling me I need to rest today.
When I start feeling better and guilt tells me to jump back into everything immediately, I am more able to notice: Actually, I think I am still recovering. What is one baby step I can take instead?
Three mindfulness habits have helped me most:
Practicing presence and observing my thoughts and feelings. This helps me catch the self-doubt while it is happening, rather than automatically believing it.
Self-compassion. Talking to myself the way I would talk to a friend gives me a much kinder lens through which to interpret my capacity.
Loving-kindness meditation. Offering well wishes to other people helps me remember that I am not uniquely failing at being a person. We are all struggling in our own ways–trying to survive and hoping to thrive.
Knowledge and other people’s stories help, too
I also find it easier to trust myself when I understand the conditions I am navigating and when I hear stories that sound like mine.
Other people’s experiences are not diagnostic criteria. But sometimes another person’s story gives you language for something you have been unable to name. Sometimes it is the first thing that makes you think: Maybe I am not imagining this after all.
If this resonated with you, I would love to hear what self-doubt sounds like in your own head–and what helps you come back to yourself.
Trust your instincts and be well!
Diane
A note about this article
This article reflects my personal lived experience and is for educational purposes only. It is not medical advice or a substitute for individualized care.
References
Groenman, Annabeth. “Menstruation and menopause in autistic people.” National Autistic Society, April 27, 2022. Discusses research on PMDD and menopause in autistic people and notes that findings on PMDD prevalence are mixed. https://www.autism.org.uk/learn/knowledge-hub/professional-practice/menopause-menstruation
LDN Research Trust. “Understanding Stealth Syndromes – The Documentary.” Explores the frequently co-occurring/interlinked clinical picture of mast cell activation syndrome, dysautonomia/POTS, and hypermobility syndromes. https://ldnresearchtrust.org/stealth-syndromes
Priego-González, Laura, Paula Perez Pardo, and Frank Redegeld. “The role of mast cells in Autism Spectrum Disorder.” Neuroscience & Biobehavioral Reviews 176 (2025): 106263. https://doi.org/10.1016/j.neubiorev.2025.106263
Kovacheva, Eleonora, Maria Gevezova, Michael Maes, and Victoria Sarafian. “Mast Cells in Autism Spectrum Disorder—The Enigma to Be Solved?” International Journal of Molecular Sciences 25, no. 5 (2024): 2651. https://doi.org/10.3390/ijms25052651
