Distinct Anxiety:
The Often-Misunderstood Need for Certainty
Anxiety is not one-size-fits-all. Yet, many of us—both clinicians and clients—are still working from generalized frameworks that don’t capture the nuanced, lived realities of neurodivergent individuals.
Let’s talk about Distinct Anxiety
Sometimes referred to as Anticipatory Anxiety, Distinct Anxiety isn’t always about panic attacks or constant worry. It’s rooted in something deeper: a profound need for certainty and predictability in a world that often feels chaotic, overwhelming, and impossible to decode.
For some, especially many late-diagnosed Autistic women and neurodivergent folks, this anxiety doesn’t look like restlessness or rumination. It looks like:
- Constantly needing to plan for every possible outcome
- Avoiding new experiences out of fear of the unknown
- Feeling physically ill in the face of uncertainty
- Emotional dysregulation when routines are disrupted
Often, Distinct Anxiety is misunderstood or misdiagnosed, folded into broader categories like Generalized Anxiety Disorder or dismissed entirely because it doesn’t ‘fit the mold.’
Research has shown that Autistic individuals experience higher levels of anxiety than the general population, and much of this anxiety is situation-specific and contextually bound rather than generalized (Kerns et al., 2014). This includes anticipatory anxiety related to transitions, social interactions, and changes in routine—what many of us experience as Distinct Anxiety.
In fact, the need for predictability and resistance to uncertainty is a core cognitive style in many neurodivergent individuals (South & Rodgers, 2017), and yet it’s rarely centered in anxiety treatment protocols.
Reframing the Narrative
When we acknowledge Distinct Anxiety for what it is, we can begin to offer support that aligns with someone’s actual needs—not just clinical checklists.
This might include:
- Co-creating predictability and structure
- Building emotional tolerance for uncertainty—gently and compassionately
- Addressing sensory overload and social exhaustion as valid contributors to anxiety
- Exploring how past trauma and masking compound the need for control
Let’s broaden our understanding of anxiety to be more inclusive, trauma-informed, and neurodiversity affirming.
We don’t need to pathologize this kind of anxiety—but we do need to name it. Because when we name it, we can work with it.
Have you or someone you work with experienced Distinct Anxiety? I’d love to hear your thoughts. Let’s open up this conversation—together.
References:
Kerns, C. M., Kendall, P. C., Zickgraf, H., Franklin, M. E., Miller, J., & Herrington, J. (2014). Not all anxiety is the same: Differentiating features of anxiety in children with Autism Spectrum Disorder. Journal of Clinical Child & Adolescent Psychology, 44(1), 45–59
South, M., & Rodgers, J. (2017). Sensitivity to uncertainty: A review of the relationship between intolerance of uncertainty and anxiety in Autism. Clinical Psychology Review, 55, 128–138.
