Episode 126 (Season 4): Am I Still Me? Post-Diagnosis Identity Spiral

Show Notes

Discovering you're Autistic or ADHD as an adult can turn your whole sense of self upside down. Navigating the emotional aftermath—wondering, "Am I still me?"—often brings up more questions than answers, and can feel both destabilizing and deeply transformative.

In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, discuss the post-diagnosis identity spiral that so many neurodivergent people encounter. They break down the emotional complexities of life after self-discovery or diagnosis, exploring questions of authenticity, the role of masking, the impact of imposter syndrome, and how claiming a neurodivergent identity can shift relationships, careers, and even self-advocacy.

Top 3 reasons to listen to the entire episode:

1. Unpack how coming to terms with an Autism or ADHD diagnosis can impact your sense of self, relationships, career, and community—plus, get insight into navigating the uncertainty and self-doubt that often arise after discovery.
2. Learn why it’s common to experience imposter syndrome, emotional overwhelm, and a desire to "map" every experience to a diagnosis—and how to find reassurance and clarity in the midst of this complexity.
3. Hear Patrick and Megan Anna’s honest reflections on their own journeys, including how health events, career changes, and intersecting identities complicate (and enrich) the process of integrating a new neurodivergent identity.

If you’re asking yourself who you are after discovering you’re neurodivergent—or supporting someone through this kind of identity spiral—this episode offers validation, practical insights, and the reminder that you’re not alone on this journey.

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Transcript

PATRICK CASALE: Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.

MEGAN NEFF: And I'm Dr. Neff.

PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health. And there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening.

MEGAN NEFF: Welcome back to Divergent Conversations. So, we've been having a… Oh my gosh.

PATRICK CASALE: You got this.

MEGAN NEFF: Social ligament's hard. We've been talking the last few episodes about some of the emotional experiences post-discovery, post-identification, post-diagnosis. And what we want to dive into today is the kind of post-diagnosis identity spiral and the question of… And I love this question when I've seen it of like, am I still me? And partly because it's, well, I think there's a lot to unpack in that. But yeah, do you resonate with this question of, like, did you have that question of, am I still me as part of your…

PATRICK CASALE: 100%. Yeah, as someone who has masked very highly throughout most of his life, I think when you start to unmask, you start to question your sense of self completely in all aspects of like, because I think masking separates you from your true sense of self so much that, like, when all is said and done, you're left kind of sorting through, almost like an archeologist. So, like, am I still me? We've talked about this. Like, do we still enjoy the same things? Like, do I have hobbies that I like? Do I actually like these friends that I have? Like, you start to question everything.

MEGAN NEFF: Yeah, yeah. Okay, I almost want to have, like, different buckets, because there's so much about identity that gets kicked up. So, that would be one bucket would be the masking of like, if we've been masking, then, you know, what we find pleasurable, or our desires, like, we've not necessarily thought about those, or we're pretty disconnected. So, there's the coming to know, like, more authentic self, but then that doesn't necessarily match the life we've built. And so, that's a huge bit of identity.

I think another bucket I would add is, well, if there's a name for this, that I've thought it's me, does it take it away? So, for example, okay, that's an autistic trait. If it's an autistic trait, does that make it less of a personality thing?

So, for example, like with special interests, if it's like, so much of my identity was around my relationships to special interests, but now we call that a trait, right? So, I see that happen for people, too, where, now that we have a name for an experience, it's an autistic trait. It's like, well, does that take away from my identity?

PATRICK CASALE: Yeah. And I think you even start to ask yourself, is this really a special interest of mine? Like, am I really that interested in this thing that has shaped so much of my formative years or my identity? Now I'm looking at it as if, like, do I actually like Lord of the Rings? I don't know. You know?

MEGAN NEFF: Yeah, yeah.

PATRICK CASALE: [CROSSTALK 00:04:26].

MEGAN NEFF: But like, for me, it was like being a really zealous Christian, right? Not current context. It's like that was so core to my identity. Because it's like being a really passionate Christian becomes pretty integral to someone's identity in the evangelical context. But then, if it's like, especially, I think this would make more sense if someone was still in that context. If someone is like, "Oh, I'm this passionate about my religion." Or, "I'm this passionate about, you know, a social justice issue because of my autism." Does it take away from the passion? I think becomes the question for some people.

PATRICK CASALE: Absolutely. One thing I see people experience too, this isn't exactly in the identity space or post-discovery, but you've just maybe went through the evaluation testing process. You start to have massive impostor syndrome. What if I am not autistic, ADHD? What if all of this time that I've spent during my entire existence trying to figure this out chalks up to, nope, otherwise specified, or some mental health experience that they're going to explain to me.

MEGAN NEFF: Yeah, so, like, maybe we call that the diagnostic bucket. And also, with that, the am I autistic enough? Or am I ADHD enough? Or am I taking away from someone else by putting on this identity? So, that becomes part of it as well.

PATRICK CASALE: It's impostor syndrome-ish, you know? It's like, I don't want to take up too much space. I don't want to say the wrong thing. I don't want to, like, take away from other people who are struggling. Like, maybe I'm not autistic enough, all the things that start coming, yeah.

MEGAN NEFF: Yeah, yeah. So, like, yeah, do I really kind of have the right to take on this identity? Which, I think, whenever we're integrating a new identity, I think it makes so much sense that we would have a lot of that impostor syndrome around that experience of what does it mean to take this identity on, to integrate it? Yeah. What will people think?

PATRICK CASALE: Yep, all of that comes to mind. Other buckets that start to exist post-discovery?

MEGAN NEFF: I would say, like, maybe we could call it the intersectional bucket, and we've kind of alluded to this in the wardrobe episodes, but it's just the idea that I think whenever you start queering any one identity, like, and so I would say, putting on an autism or ADHD identity and integrating that, that's kind of an act of queering, that all other identities often get put on the table. So, the identity bucket, in the sense of other identities, might get explored in new ways. Or maybe we call it the queering bucket of just you start exploring different ideas from.

It's almost like once you get free of the social constructs of like, this is what society expects me to be. And like, you start asking, who the hell am I actually? Once you start doing that in one part of your life, then you start doing it in all of them.

PATRICK CASALE: Absolutely.

MEGAN NEFF: And so, yeah, the queering bucket I would say.

PATRICK CASALE: Queering bucket, for sure. I would say there becomes, like, almost a accommodations bucket, because you become so much more aware of the accommodations that you need in your life. So, you're like, sometimes shamefully asking for things that bring up vulnerability, or they might have a certain reaction from a family member, or a friend, or a loved one who's like, "Well, you never needed this before."

MEGAN NEFF: Yeah. So, like, accommodations vulnerability, like getting more in touch with our needs.

PATRICK CASALE: Yeah.

MEGAN NEFF: Yeah, yeah. That's a huge one, especially if part of our identity before that was maybe being, like, hyper-achieving or hyper-independent.

PATRICK CASALE: Yep.

MEGAN NEFF: That bucket is hard because it directly threatens, perhaps, something that we were using to feel secure in our identity. And it kind of undermines that, like, if that was the way we were coping, is by overcompensating, then that would feel like a threat to the way we were identifying.

PATRICK CASALE: Absolutely. And I think that it brings up some ableism, too, from potential people in your life who are like, you've done A, B, and C, and now, all of a sudden, you can't go out in public, you can't socialize in a certain way. You need, you know, A, B, and C, in order to be comfortable at my house. I mean, it starts to really create these dynamics, if people are not receptive, where the friendship/relationship bucket gets created, where you're like, who am I placing in this bucket, who I feel like is affirming and understanding, or at least curious enough to learn?

MEGAN NEFF: Yeah, yeah. That was exactly where my brain was already going, because, of course, my brain has a visual of these buckets with labels. And I was like, "Oh, the next one is the relationship bucket."

Because relationships shift often post-discovery, and when we start talking about it, some people shut away. New people enter our lives, and our relationships have a big impact on our identity.

I guess also career. Many of us might shift careers as part of this process. And career is a huge part of our identity. Damn, like this is a huge process to go-

PATRICK CASALE: [CROSSTALK 00:09:57] workbook/graphics coming from Megan Anna at some point, even though I was told to hold you accountable to know more of those.

MEGAN NEFF: Because it'd be such a good visual workbook, is the thing.

PATRICK CASALE: That would be such a good visual workbook for the autistic burnout city, too. Like, God, we had so many good [CROSSTALK 00:10:16]-

MEGAN NEFF: Yeah.

PATRICK CASALE: …in that, that's serious.

MEGAN NEFF: Oh my gosh. Oh my gosh. That would be a cool collective. Like, if people who listened to the podcast wanted to draw pictures and a cool, like, collective experience to make like an autistic burnout city illustration guide, and then, a monotropic manor, and people could submit, and then it's like… Wait, that actually would be really cool. And it's just an illustration of the two books. Yeah. So, if anyone's listening and you, like, like doing art, and you want to send in your pictures of-

PATRICK CASALE: Yeah.

MEGAN NEFF: That'd be really cool.

PATRICK CASALE: This is an amazing idea and divergent thought process right now. But if you all want to send us any sort of pictures, or illustrations, or creations of Burnout City and Monotropic Manor, you can send them to our Instagram messages. Or you can email them to our Divergent Conversations podcast Gmail. So, that will be awesome. I'm looking forward to seeing those.

MEGAN NEFF: Yeah, that'd be really cool.

PATRICK CASALE: So, all these buckets are piling up. And it almost feels like the roof is leaking, and it's falling into all these different places, appropriately, though.

MEGAN NEFF: And at the same time, while the roof is leaking, you're asking, but am I actually autistic, or am I actually ADHD? So, you're having these buckets, but you're also like, but am I?

PATRICK CASALE: But I need more proof?

MEGAN NEFF: Yeah.

PATRICK CASALE: Yeah. I think that's a very real part of this journey in discovery, because for so many of us, right, like, if it happens later in life that you're starting to unpack this, you might have gone several decades, you know, upwards of 5, 6, 7, 8 decades of not knowing this. Or maybe it was gnawing at the back of your mind, but you really didn't have the language for it yet. So, there's just so much to unpack.

And I think it makes a lot of sense to constantly be questioning, like, but am I missing something? Is it something else that could be described or explained for this experience?

MEGAN NEFF: Well, that gets tricky, right? Because there often is other things in the mix. Like, it's so rare to meet someone who's autistic and nothing else, or ADHD and nothing else. And then, I would imagine, if you're combining autism and ADHD, it would make it even more rare for there to be nothing else in the mix, be it complex trauma, OCD, bipolar, or personality disorder. So, there probably is something else in the mix.

And then, there can be this kind of urge to, like, try and pinpoint every single experience we have to like, almost map it to a diagnosis. And on one hand, I see how that can be helpful. On another hand, sometimes I think that can get too, like, reductivistic with it, where we kind of start losing our humanity or our like, you know, maybe this is just the complexity of my experience, and it doesn't neatly map on to some diagnostic or identity label. And maybe that's okay. But I do find this almost like frantic urge at times.

And this is probably a lot of the autism of like, well, is this experience and attachment experience, or is it RSD, or is it complex trauma? And it's like, well, it's all of those things. Like, it's part of the complex soup.

PATRICK CASALE: Yep, the complex soup. Yes, yeah. I think that's a great point, and really common to try to pinpoint, and then, really common to be overwhelmed by the inability to pinpoint, because it becomes so complicated and so overwhelmed. And then, maybe you go and look at Dr. Neff's Misdiagnosis Monday graphics, and you're like, "Ah, a little bit of peace and reassurance." But the overlaps are challenging, and complicated, and very nuanced.

MEGAN NEFF: Well, and because they're not just like overlaps, but they kind of, we've talked about it on a recent episode, the idea that anxiety or OCD will like breed on, you know, autistic or ADHD core woundings. It's not just like they have a compounding experience, right? So, when you have OCD on top of being AuDHD, that is a different experience than just OCD. It's not like this plus this plus this. It's what is the phrase? The whole is greater than the sums of the parts. Like, the way they stack and then influence each other.

Or, like, in a recent episode, you were kind of like, well, was it ADHD? Was it addiction? It's like, well, those things are interacting in a way that it'd be probably impossible to pinpoint it's one thing, because it's how they compound.

PATRICK CASALE: Yeah, yeah, and exacerbate, or intensify, or reduce, even. So, complicated to say the least.

And I think you can get caught up in a lot of that thought post-discovery, immediately post-discovery. You almost like, okay, here's this answer, here's this, like, aha moment. Now, I'm going to unpack every single portion of my life, and I'm going to do it through this lens. But if it doesn't add up the way I need it to, you start to almost question every single thing of like, is that really real? Does this land for me?

And then, I think another bucket post-discovery is the disclosure bucket of, when do I feel confident enough to actually publicly share this with other people?

MEGAN NEFF: Yeah, yeah, yes. And that can get complicated, because, depending how that disclosure goes, we can then get pulled into feeling like we have to justify, like our autism or our ADHD, which that can also look like kind of, you know, one idea we talk about on here is like, what does autism or ADHD look like behind closed doors?

And sometimes it's like, I'm pulling out my dirty laundry to, I meant that figuratively, but I guess that could also be meant literally, to, like, try and show you how much I struggle to prove my autism or my ADHD. So, that can be a really awkward dynamic and also leave us feeling really raw and vulnerable. Of like, do I have to kind of unpack my trauma or the things I feel shame on for you to believe this thing I'm disclosing to you?

PATRICK CASALE: Yeah, absolutely, yep. So, that gets really complicated as well. So, I think there's a lot of overwhelm that happens immediately afterwards. And I think you want to have one or two safe people in your life who you can process some of this stuff with, because you've talked about it. I've talked about it at length. But sometimes this is not received the way you want it to be. I mean-

MEGAN NEFF: Yeah, and when there's, oh… I was just going to, to go with your metaphor of all these buckets, the roof is dripping with water. And then, when we're just letting someone into that, and it's like, it's kind of a half-constructed building that we're letting them in on. And so, the feedback they give us is going to be really kind of vulnerable. So, when we're already in that mess, and then we invite feedback in, that can be really destabilizing, because we haven't yet sorted it for ourselves. There's so much we're unpacking.

PATRICK CASALE: Right, right, yep, I like that.

MEGAN NEFF: Okay, but what… Oh…

PATRICK CASALE: No, go ahead.

MEGAN NEFF: I was just going to ask, what's the rain in this metaphor with the… What's the rain from the ceiling? What is that?

PATRICK CASALE: Oh, man. I don't know. I don't want to go, like, too extreme. It's certainly not like acid rain-esque. It's not like burning you.

MEGAN NEFF: I was just curious why your brain added that to the buckets of like, water dripping from a roof that is leaking.

PATRICK CASALE: Oh, yeah. I get the metaphor. I get the image of, like, patching the roof. Of like, patching each place that's leaking is a place of like, maybe you are intentionally spending time with it, deconstructing it, solidifying the foundation of it.

But at first, it's like patchwork, because you are trying to do so many different things simultaneously that you are missing a lot of it, often, where you're like, overlooking certain aspects, or you get really firmly, like, entrenched in one area and let the other stuff go.

And I think it's hard you're trying to, like, kind of do it all at the same time. And I think a lot of our mentality and brain are often like, I need to do it all at once. Like, it feels chaotic.

MEGAN NEFF: So, it's kind of the whack-a-mole all idea that you brought into like, yeah, we have these buckets of identity. We don't always have control over when, like, questions pop up around them. That's the leaky roof that you're like, patching.

PATRICK CASALE: Yeah.

MEGAN NEFF: All right. I like that metaphor because, yeah, it is a lot to be tracking if our relationships are shifting, if our career shifting, if we're queering identities. And it can feel really whack-a-mole, and out of control. And, again, it's not an autistic friendly process. It is a, my life has been deeply destabilized, and I'm trying to patchwork it back together. But there's not a linear process for this.

PATRICK CASALE: Yeah, exactly.

MEGAN NEFF: Okay

PATRICK CASALE: That's kind of where my brain goes. And I think it, you know, gets easier over time, at least, to solidify each of those buckets. And, like, not have it feel so whack-a-mole-esque, but at first, I do think it feels very much like chaos in a lot of ways.

MEGAN NEFF: Yeah, so I don't do much research anymore these days, but this is something if I magically had like, extra hours I could pull out of my pocket. I'd actually really love to do a qualitative study, like, looking at the identity experience post-discovery for adults, because I think it is such a complex process for all the reasons we've just named. And I'm sure there would be themes that emerged. And it'd just be so interesting to, like, do a proper research study on that.

PATRICK CASALE: Yeah, yeah. I mean, it's fascinating to see all the different things that come up for people and their own experiences after post-discovery, with something that feels really significant.

MEGAN NEFF: Yeah, yeah. And I think, like, ultimately, for me, it was more stabilizing. But I've definitely seen for some people, it really is more destabilizing than stabilizing coming to this identity, or it takes a lot of destabilization to get to something that feels more stabilizing.

PATRICK CASALE: Yeah, for sure.

MEGAN NEFF: For you, how destabilizing was the process like in the first year?

PATRICK CASALE: It was very destabilizing. And, you know, unfortunately, that process coexisted with my second, like, major throat surgery and losing my voice. So, it was really what symbolism.

MEGAN NEFF: Yeah, yeah.

PATRICK CASALE: But it was a rough couple of years of like losing, and re-shifting, and reframing identity in multitudes of ways. So, it was not just coming to terms with an ADHD identity. It was also losing my voice simultaneously.

And that was a really weird psychological and emotional place to be of trying to make sense of this and communicate some of this stuff out into the world, and only being able to speak for X amount of hours per day, because my vocal cords wouldn't allow for it, coming to terms of, like, chronic, rare medical conditions simultaneously. It was not a pleasant couple of years.

MEGAN NEFF: Yeah, yeah, we were recording during that.

PATRICK CASALE: Yeah, shortly thereafter, yeah, we were recording in that. And, yeah, it's been a journey, for sure.

MEGAN NEFF: I mean that that gets back to, like, it's not neat and tidy. Like, for me, too, is a similar experience, in the sense of, I was discovering this early in the pandemic. And then, I also had, so the first time I had COVID, I had pretty significant symptoms for the first, like, nine months. So, grappling with, like, long COVID pieces, autism, working remote for the first time, parenting in a pandemic context.

And all of these overlapped in ways. So, like, then, you know, for years I really left my house. And it's like, I think I almost diagnostically overshadowed, because of the fatigue, and the brain fog, and the fear of contracting COVID, I just made my life really small.

And I kept being like, "Well, that's the autism. I'm accommodating my autism." But actually, it was a bit more complex, because there was also discovery of the health piece my life also had shifted significantly because of the pandemic.

So, yeah, similar for you, it's like it was this really layered experience. And I almost overshadowed by saying everything was the autism when actually looking back, it's like, that was the long COVID, or like there are other pieces at play.

PATRICK CASALE: Yeah, yeah, yeah. I think it's got to be really rare for someone to probably have, like, go through this process, and then, like, just be unpacking one of these buckets or boxes, so to speak. Like, there's multitudes of things going on simultaneously, unfortunately. And often, it's chronic health or whatever else.

MEGAN NEFF: Because, usually, that's what makes the autism apparent. Is either a burnout or because there's been a health condition, so now the autism becomes more apparent. Yeah, absolutely.

Or a child that's been diagnosed, so you're also wrapping your mind around parenting an autistic kid or an ADHD kid, while also your identity. So, yeah, usually, because there's something that caused the awareness. So, usually, there's another big thing in the mix.

PATRICK CASALE: Yeah.

MEGAN NEFF: Yeah, yeah.

PATRICK CASALE: [CROSSTALK 00:24:35]-

MEGAN NEFF: The identity spiral.

PATRICK CASALE: Light note that you wanted to end.

MEGAN NEFF: No, we are failing. We are failing at finding our lightness in our play.

PATRICK CASALE: That's okay. I think, you know, we need both sides of the coin.

MEGAN NEFF: Yeah. I don't know how many episodes we've recorded, but we've recorded, I don't know? Seven? Why do you think it's harder to find our playfulness in this series we're recording? Do you think it's the content? Do you think it's where we're at?

PATRICK CASALE: Well, when we did the burnout city series, I was in pretty bad burnout, and I still am.

MEGAN NEFF: Yeah, I was too. I was actually really depressed.

PATRICK CASALE: [CROSSTALK 00:25:16] enjoying laughing at it.

MEGAN NEFF: Do we record best when we're depressed?

PATRICK CASALE: Probably, yeah. I mean, yeah.

MEGAN NEFF: That doesn't make sense.

PATRICK CASALE: I mean, I feel often more like creative when I'm depressed. I don't know. But I think, and this is just a hypothesis, is because we are not structuring it. We're just kind of like jumping all over the place. So, maybe it's just harder for us to feel as anchored into a concept, because it's like, because burnout, it was like eight episodes of burnout, right? So, like, the themes change, but the common construct was the same. That was probably somewhat helpful in a way.

MEGAN NEFF: Yeah, which is interesting. That's how I often talk about my ADHD and autism play best together when there's a really solid frame container. And then, my ADHD kind of knows the parameters from which it can play. And so, yeah, we had that in that series, which the series we have more of a ADHD container of like, let's tackle this topic or this question, yeah.

PATRICK CASALE: Yeah, yeah. And actually, doing the math, this is now episode 10 that we've recorded in a week. I think there's that too. I mean, I know we batched burnout, but I think we did eight episodes over two weeks, right?

MEGAN NEFF: Yeah, yeah.

PATRICK CASALE: So, now, here we are, Monday to Monday. This is the finality of 10, and with four more days of recording set up trying to get to like 18 to 20. It's a lot. I mean-

MEGAN NEFF: Yeah. Also, I do feel like we're talking about heavier topics. And like it's interesting, because we are coming in with, like, a question that someone asked, because we, like, asked listeners, you know, if you're just entering the ADHD or autism conversation, what are topics?

And I don't think we necessarily expected that, but I feel like in a lot of these episodes, we start talking, and then we kind of bump into things that feel emotionally complex or heavy. And so, I also think maybe it's a reflection of the heaviness that is wrapped into this experience of discovering you're autistic or ADHD later in life or at any point in your life.

PATRICK CASALE: I agree, yeah. I think that's probably exactly it. And like, with burnout, right? It's like it's a concept. It sucks. I'm not minimizing how bad autistic burnout sucks, but it's also like one thing, right? It's like this immovable object, in a way that we're thinking about. What we're talking about now is a lot of identity-focused stuff, opposed to, like, hey, we're in burnout. It sucks. Like, I don't know what to tell you. It's inevitable for the most part. Yeah, it feels a bit more personal in this regard, I would say, so it's probably just heavier in that way too.

MEGAN NEFF: Yeah, yeah, yeah. I know I'm going to feel a lot more vulnerability when they start airing than past stuff that we've recorded, yeah.

PATRICK CASALE: Yeah, [INDISCERNIBLE 00:28:19] sharing with you. So, yeah, we'll create that buffer, minus The Nook for yourself. But, yeah, I think that's probably it.

MEGAN NEFF: Yeah.

PATRICK CASALE: Life is weird right now, too. I mean-

MEGAN NEFF: It's just weird right now.

PATRICK CASALE: [CROSSTALK 00:28:36]. So, all right, we're going to wrap up, I suppose. New episodes on Fridays and on platforms and YouTube. So, goodbye.