"Why Do I Feel This Way?" Understanding Trauma, Autism, and PMDD

People usually come to therapy and ask "why do I feel this way?". They have often spent years wondering why certain things seem harder for them than they appear to be for everyone else. They describe feeling exhausted by social situations, left deeply impacted by conflict, or report they can manage well at work only to have "nothing left" by the time they get home. When we don't have an explanation or understanding of these experiences, we will create one. Often that results in the belief "there must be something wrong with me".

This causes people to label themselves negatively: lazy, too sensitive, too difficult, overreacting. But what if there is a reason that you feel this way that isn't because of an internal flaw?

When Coping Becomes So Normal That We Stop Noticing It

The people who come to me for therapy are usually exceptionally good at coping. They are able to work, maintain relationships, care for other people, and juggle life's various demands. From the outside they appear to be doing well, but what isn't recognised is the sheer effort involved in this. People report they can spend an entire working day appearing confident and social, but then need hours alone afterwards to recuperate. They share that they spend the day constantly monitoring other people's moods so they can anticipate whether something is 'wrong'. They tell me that they rehearse conversations before they happen, and analyse them afterwards. Some are also deeply impacted by their menstrual cycle and struggle to make sense of this when things feel 'normal' again.

"But I'm Functioning"

One of the most common misconceptions of mental health difficulties is that struggle is visible to the outside world. This isn't always the case. Someone can hold down a career and still be struggling psychologically, they can have deeply meaningful friendships and still be autistic, they can love their partners and still experience relationship doubts during their luteal phase, or they might describe their childhood as "fine" while carrying patterns that developed in response to difficult early relationships. Functioning does not necessarily mean thriving. Sometimes functioning means you have developed effective ways of surviving environments that you find difficult.

Understanding Trauma Differently

People often come to me unsure if they have experienced trauma as they don't believe they have experienced catastrophic events, or don't recognise that their experiences taught them the world was a dangerous place. When we explore this in therapy, we might realise that you learned expressions of anger meant danger, that other people's needs were more important than your own, that making a mistake leads to rejection, that being useful made you lovable, or that relying on people wasn't safe. These beliefs and fears continue long after the event that caused them has passed. It is those beliefs, responses, and meaning making of situations in the present day that manifest as trauma symptoms.

As such, trauma therapy isn't just about understanding the past, but also about recognising how it continues to show up in the present. Approaches such as EMDR can help people to process experiences that continue to be emotionally reactive. This allows the brain to recognise these experiences as something that happened in the past, rather than something the nervous system needs to respond to now.

Understanding Yourself Through An Autism Lens

For people querying a late diagnosis of autism, having an assessment can provide an entirely different framework for understanding themselves. Experiences that were previously interpreted as personal failures finally begin to make sense. They recognise that they weren't antisocial, but that social interaction required significant effort. They aren't "too sensitive", their sensory system genuinely reacts to the environment differently. They aren't rigid or inflexible, but find that predictability helps them to feel regulated. Suddenly there is the recognition that considerable effort has to go into functioning. This is especially important when we think about masking and how someone has learned to navigate day-to-day experiences.

An autism assessment is less about "can you do this?" and more about "what does it cost you to do this?". The assessment isn't about trying to fit someone into a label, but is an opportunity to explore patterns across the lifespan and to consider whether autism provides a meaningful explanation for the person's experiences.

Understanding Yourself Through A Hormonal Lens

Premenstrual Dysphoric Disorder (PMDD) can create another painful form of misunderstanding. For part of the menstrual cycle you might feel like yourself, and then suddenly you might feel intensely anxious, depressed, irritable, or overwhelmed. Relationships that usually feel secure suddenly feel unstable, you are unable to tolerate stress, and small things are interpreted as being catastrophic. Then your period arrives and the intensity and distress lifts. People often look back with confusion, wondering how they felt so bad or if they imagined their experiences. This can lead to intense self-doubt and confusion.

I understand this experience not only from my work as a Clinical Psychologist, but also from my own experience of PMDD. One of the things that is particularly difficult with PMDD is that knowing your symptoms are cyclical doesn't necessarily make them any easier to deal with. You can know "this is my PMDD" and still feel "everything is hopeless". Recognising the patterns doesn't invalidate or "get rid of" the symptoms, but it can give us important feedback about when they occur, when they are most intense, and what support is needed at different times of the cycle.

Sometimes There Is More Than One Explanation

Humans do not feel neatly into categories. You can be autistic and have trauma, you can have PMDD and be neurodivergent. One explanation does not cancel out the other, and often they overlap and interact with each other. Good psychological work involves curiosity about the whole person and understanding multiple explanations, rather than trying to make one "fit" someone perfectly.

From "What Is Wrong With Me?" To "What Happened To Me?"

For me, this is one of the most important shifts that can happen when developing a better understanding of ourselves. Instead of asking "why can't I cope?", we might ask "what is making this so difficult?". This rephrasing leaves room for curiosity, and curiosity allows us to look at things differently.

People often worry that they don't have a clear understanding of their experiences when they come to therapy. You don't need to have the answers before coming to therapy. Often this is why people come to therapy, because they need help and support with understanding and making sense of their experiences. The first step is recognising their might be an explanation for your experiences, and exploring what that explanation is is something we work on together.

How I Can Help

At Equilibrium Online Therapy we can explore:

• Trauma and Complex Trauma: Psychological therapy, including EMDR, to understand work with the impact of difficult or traumatic experiences.

• Adult Autism Assessment: Comprehensive online autism assessments exploring your experiences across the lifespan, including masking and sensory profiling.

• PMDD: Psychologically informed resources and support informed by both clinical expertise and lived experience of PMDD.

If something in this post has resonated with you, you can find out more about my services here.