Autistic Meltdown, Panic Attack or Something Else?
Image with a young Black woman wearing a red sweater, holding her hands up to her face with small white flowers peeking through her closed fingers. She has a medium length afro hairstyle and is framed by a dark gray, almost black background. Only her nose and lips can be seen behind her held up hands.
Most people have heard of a panic attack and have a pretty solid idea of what that is. Fewer people know of what an autistic meltdown may look like. Fewer people still have any knowledge of physiological responses that can mimic either one of those two states.
In the post below, I will dive a bit into each of these concepts with the hopes that it can help you distinguish what may be going on for you and your body in situations where the body is experiencing something difficult to name.
Autistic meltdown
An autistic meltdown can be imagined as a complete system overload.
Picture a computer that has so many programs running, its functioning begins to slow gradually, and then all at once, coming to a crashing halt. There is a brief moment of hope that it will all work itself out before everything crumbles at once.
A meltdown is a bit like that. Some autistic people describe it as a desire to crawl out of their skin, become invisible, or just make it stop - “it” being whatever is causing the extreme overstimulation and overwhelm in that moment. Many folks feel meltdowns with their entire bodies, describing their cheeks getting red and hot, their muscles tensing and their vision going blurry (Phung et al, 2022). It can also be understood as a “natural reaction when an individual’s coping mechanisms are exceeded” (Autism Society).
While meltdowns themselves exist on a spectrum, they have defining qualities that can be pinpointed, named and tended to.
These are:
onset: gradual
while at times it may feel like it comes out of nowhere - mostly due to many autistics experiencing alexithymia or difficulty with identifying emotions - in reality meltdowns build slowly over time. The more we attune to our internal states, the more nuanced our perception can become in picking up on the clues that our system is at capacity. This can look like noticing when we experience irritation, lose focus, isolate or seek prompt solitude, or when words become hard and cognitive processes are less accessible.
intensity: severe
the intensity dial of overwhelm gradually yet steadily increases; more and more stimulation leads to less ability to take it in. That can look like lights starting to feel too bright and perhaps a light headache forming to boot, sounds begin to feel sharper and more invasive, the feeling of being perceived by others intensifies and the urge to hide in a safe space becomes a growing need.
duration: until the stimuli are removed
while every meltdown is different, it can still be defined as a physiological response to extreme levels of stimuli. The meltdown will continue until the stimulus is removed. In this way the duration of the meltdown is directly dependent on the individual’s (or their loved ones) ability to find a way to reduce sensory input and/or a safe place to process/scream/cry/kick/stare at a wall, etc.
For a more in depth resource on what autistic meltdowns are, what are some potential triggers, and how to help folks who are actively melting down, check out this great blog from Reframing Autism.
Panic attack
A panic attack is described by many people as "feeling like I am about to die”.
Panic attacks manifest as a sensation of intense fear without an apparent trigger or cause.
Folks experiencing a panic attack will typically feel very short on breath and begin hyperventilating, there will be an accompanying sensation of a rapid heart rate, body temperature rising, and a profound inability to feel any sense of control over one’s own body or physical responses.
Other physical manifestations of a panic attack may very well mimic symptoms of an autistic meltdown - face becoming hot, weakness or dizziness, sweating, disorientation (NIH, 2025).
So what are some markers that are unique to a panic attack? Let’s look at the same criteria again:
onset: sudden
panic attacks feel like lightning on a clear summer day - no one sees them coming. The rapid onset of symptoms is a large part of what can make panic attacks feel so scary and uncontrollable. Panic attacks “occur suddenly and abruptly — you may feel only slightly anxious or even calm before it starts.” (Harvard Health, 2024)
intensity: severe
panic attacks similar to autistic meltdowns trigger our autonomic nervous system’s fight or flight response, signaling to our brain and body that we are in danger and need to address said danger immediately. Not having a clear trigger or reason for these sensations adds to the feeling of a mismatch between the environment and one’s response to it.
duration: a few minutes to an hour
panic attacks typically leave as quickly and suddenly as they came. There is a sensation of the body needing to recover after the massive adrenaline dumps that it just experienced, but the duration of a panic attack is not directly influenced by or tied to an outside, identifiable stimulus.
Physiological reasons
POTS, EDS, MCAS & Dysautonomia
To complicate matters further, there are a number of physiological conditions that can mimic symptoms of a panic attack or an autistic meltdown. Meaning that if you are autistic, identifying what is happening with your body at any given moment can be a challenging task, to say the least.
While there may be a multitude of symptoms attributed to a physiological condition that mimic above-mentioned states, I will only list a few to limit the scope of this blog.
The onset, intensity and duration of physiological responses associated with these conditions vary wildly from human to human, so instead we can highlight where confusion may occur for people experiencing overlaps in symptoms.
symptom mimics
conditions associated with orthostatic intolerance such as Post Orthostatic Tachycardia Syndrome (POTS), dysautonomia and vasovagal syncope may present “symptoms including sensation of warmth, nausea, lightheadedness, dizziness, fatigue, abdominal pain, and visual blur.” (Lambert & Lambert, 2014)
Ehlers-Danlos Syndrome (EDS), POTS and dysautonomia frequently present with symptoms of heart palpitations and dizziness. With these conditions, symptoms “are usually relieved by sitting or lying and may be exacerbated by stimuli in daily life that cause vasodilatation, such as food ingestion, exertion, and heat.” (Mathias et al, 2021).
Mast Cell Activation Syndrome (MCAS) can cause flushing - a rapid flow of blood to a certain area making it appear red and feel hot to the touch, as well as anaphylactic-like symptoms that obstruct or limit one’s ability to fully breathe.
Defining difference: presence of an emotional response
With physiological reasons for body state changes, there is a marked absence of an emotional response.
If we look back at the panic attack category, we will see the intense fear as a huge factor that identifies what is happening as a panic attack. Similarly, an autistic meltdown will have an emotional flavor to it as well, mostly as an outlet for the intense overwhelm - irritation, frustration, anger, rage, sadness, etc.
Folks who have POTS, EDS or a number of other conditions listed above will typically experience the physical manifestations mentioned - palpitations, heat, flushes, lightheadedness, muscle tension, heart racing, etc. - but there will be a notable absence of an emotional response.
Many people will think to themselves “What is going on with me? Is this anxiety? But I wasn’t anxious before and can’t think why I would be anxious now.” This is typically a clue that what may be going on in the body has to do with the body’s biology and neurology, rather than it being an emotional or mental health experience.
When it comes to the body, many times by exploring issues in more detail leaves us with more questions than answers. Diving into the differences between body states is a nuanced and complex matter that one blog post will never be able to adequately cover.
However I hope that in presenting you with snapshots of some of these conditions, you are better equipped to investigate these issues in depth with a trusted provider - be it a therapist, nutritionist or a primary care doctor - as well as begin your own exploration of what your body may be needing from you at various points in time.