September 3, 2023 • 36 mins
Dr. Kim Sage is a licensed clinical psychologist in southern California. Dr. Sage joins me to discuss her discovery that she may be autistic, the problem of autism underdiagnosis, and the close connection between autism and personality disorders (especially narcissistic personality disorder) within families.
Dr. Sage also talks about her early autistic traits, friendship challenges, autistic traits' impacts on romantic relationships, and more.
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Theme music: "Everything Feels New" by Evgeny Bardyuzha.
All episodes written and produced by Kristen Hovet.
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Episode Transcript
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Kristen Hovet (00:00):
Today I'm speaking with Dr Kim Sage, a
licensed clinical psychologistbased in Southern California,
but before I share ourconversation, I'd like to thank
Colette for your generousone-time show of support to the
Other Autism podcast.
Colette used the Buy Me aCoffee link to send in a
(00:22):
one-time donation.
If you find this podcastvaluable, useful and or
informative and would like to dothe same, please check out the
link in the show notes that saysBuy Me a Coffee.
Please say hello to my guestfor today, Dr Kim Sage.
Hi there.
Dr. Kim Sage (00:40):
Hi, my name is Kim Sage.
I'm a licensed clinicalpsychologist in Southern
California.
I really do specialize in, Iwas kind of thinking this
through.
It's really people that havehad and are still living with,
in some way, a complicatedchildhood and that can really
run the spectrum from yourclassic this is trauma to that
constant little relationaltraumas that are being repeated
(01:02):
down their adult life indifferent ways.
That's kind of how I didn'treally start that way, but you
get a collection of people.
It tends to be those types ofindividuals.
Kristen Hovet (01:13):
I initially found you when a listener reached out
to let me know that they'rewatching one of your videos on
YouTube and you had mentioned anarticle I wrote about autistic
traits, I think, as theycommonly present in late-
diagnosed individuals.
In your video, you weredocumenting your thought process
in how you were applying thesetraits to yourself and having
(01:34):
what appeared to be a series ofepiphanies about this.
You also mentioned that many ofyour own clients in your
therapy practice likely alsorelate and therefore could
potentially be autistic as well.
That was a few months ago now.
What has your thought processbeen since then?
Dr. Kim Sage (01:52):
It's interesting.
It's continued to evolve,though I am still very much in
the inquiry does this really fit?
How could it not fit?
Kind of stage.
I found that the more Iresearch high masking, the more
I'm like, oh my gosh, it startsto explain so many things and
yet then I start to researchwhat does it look like?
And I'm sure we'll get to thatgetting a diagnosis or not, and
(02:14):
whether that's helpful or notand how that's helpful or not,
depending upon where yourchallenges are and where you
might need accommodations orthings like that.
I feel like I'm there but I'mnot fully ready to, I'm saying
it and not saying it.
I feel like that I'm on thespectrum, but then looking at my
kids and their dad and familyand all these things are
(02:34):
emerging.
And then I would say withclients, a lot of my clients,
unless they find me on socialmedia, they don't necessarily
watch me on social media that Iknow of.
So there's a lot of clients Ihave, they probably have never
seen any of my TikToks and neverseen on YouTube where I've
talked about even this formyself, and so it's this weird
place, other people that arefinding me that way, it's a
(02:55):
shortcut.
So in terms of saying to themoh, I think you're on the
spectrum.
That's not happening unlessthey're raising it with me at
this point.
It's not something that I feellike okay, because they're
obviously very high masked ifthat's happening, but it's
really made me start to go, hmm,I wonder if this explains
things.
So I feel like we're going tohave to get to it, but I still
(03:15):
think it's a very delicate topicfor a lot of people.
Kristen Hovet (03:18):
Definitely, and how did you first come across it
?
Dr. Kim Sage (03:22):
Honestly, your article was one of the first
places and I made that by entirevideo about your article
because I was like, oh my gosh,I relate to every single one of
these, right down to theautoimmune disease, which I know
there are links with yourarticles about the research.
And so then that just sort ofprompted I had been hearing a
lot on TikTok about neuro tribesand unmasking autism.
(03:43):
So all of that had been goingon for a while and I started to
feel like I was making a lot ofcontent on the CPTSD and people
would say in the comments, okay,well, how is this different
from autism?
And I would sort of give backthe answer that is what the DSM
says, for the most part tryingto, until this kind of
conversation sort of started toblow up, really I think for me
(04:05):
on TikTok, and then I startedgoing wait a minute, like there
are things I may be missing thatI don't understand.
And then I read your article, Iread neuro tribes and unmasking
autism.
I was like, oh my God, this islike I feel like it's unethical
to not be doing a deep dive onautism right now as a clinician,
let alone just as a society tounderstand each other.
Kristen Hovet (04:24):
I really appreciate that stance because
I've seen a lot of the opposite.
I think, especially peoplewho've been in the industry for
a while and they've been workingwith so many clients over the
years, they don't want to haveto go back and fix the
perceptions or even the way theyapproach therapy.
So that's awesome that you'redoing this.
Dr. Kim Sage (04:45):
Yeah.
I will say that that once Istarted making a few videos, I
started seeing clinicians .
.
making these very rigid videos,like this is what autism is,
just repeating the DSM.
I was like no, you think thisis the one video you need?
I'm like no, you're actually,why don't you go read all the
books and then we'll have thisconversation.
(05:06):
I feel like it's still a bigissue for our community, but I'm
hoping that's changing.
Kristen Hovet (05:11):
In your personal life, have you told people close
to you about this potentialidentification as autistic?
If so, what have theirresponses been?
Dr. Kim Sage (05:19):
It's interesting.
I haven't really shared much,except with my kids, to be
honest, because my kids are all16 to 24.
They're older and so initiallyit's like, hmm, and then it's
like I want to keep their livesprivate, but they're all,
they're like huh, that makessense, or they're able because
of their own stuff, they'relike, hmm, I don't know about
that.
So it's been this interestingthing where I feel like I've
(05:40):
been most open with it, honestly, randomly, on social media,
with strangers on TikTok.
They're not strangers, peoplethat I connect with there.
So that's been interesting.
And I started following a lotof autistic creators because I
kept hearing you need tounderstand things outside of
textbooks and things like that.
You need to understand thelived experience, and so that's
something else I started doingand so I feel like with those
(06:03):
creators there's like I justfeel this connection.
I'm also a very private person.
I don't, I have a small, I meanfriendships have been an issue,
so there aren't a lot for me totell if that makes sense.
Kristen Hovet (06:13):
Definitely.
As the community of therapists,counselors and psychologists is
becoming more aware of late-diagnosed autism, often
synonymous with level- oneautism, there's been a kind of
collective reckoning or comingto terms with the high number of
people who've been in some formof therapy for years, who've
gone undiagnosed, incorrectlydiagnosed or partially diagnosed
(06:35):
.
So how big of a problem wouldyou say this actually is?
Dr. Kim Sage (06:39):
I mean, honestly, at this point where I'm still,
you know, I'm still on myinquiry, I've been reading and
educating myself, I think it's amassive problem.
I think that people have beenmet with therapists who are or
aren't educated, notintentionally, they just I mean,
even in my programs not thatlong ago, they just I just
didn't know, you know, it wasthat stereotyped version, and so
I think it's a problem unlesspeople are willing to learn and
(07:02):
educate themselves.
And then, as I was sayingearlier, I think the challenge
is how do you say to a client,for example, who has no
knowledge of any of this, right,they don't go on social media,
they're not on TikTok, they'renot reading your articles, and
I'm thinking, okay, this personis high masking.
To try to tell that personyou're maybe autistic, that's a
big.
I think therapists are afraid ofthat.
Like I'm afraid of that.
It's a little scary.
(07:22):
Like I'm not going to withholdthat because I think that's
important for treatment, but ithas to be in the right place or
time.
And I think that many of us arelike probably scared to face
what does that really look like?
And then what do I need to doto shift my awareness and
training and education to be agood support for this person to
help them.
Kristen Hovet (07:39):
That makes sense, and I'm hoping at some point
there's some kind of guide ortraining for people in this
predicament, basically fortherapists and counselors,
because right now I thinkeveryone's kind of not sure what
to do about that.
I know you specialize inworking with clients who have
trauma as a result of growing upwith parents with personality
(08:00):
disorders such as NPD, as Imentioned before.
So a lot of us working inautism self-advocacy have noted
an overlap in families betweennarcissism and autism and other
personality disorders, and ofcourse, autism is not a
personality disorder.
I just want to make that veryclear.
So have you noticed thisoverlap as well and if so, why
(08:22):
do you think this is?
Dr. Kim Sage (08:24):
Well, I mean that's interesting because when
I first heard someone make theassociation between autism and
narcissism, I was like my mindwas just kind of blown it made a
lot of sense, especially in mypersonal life, also with people
who have been described asarrogant, certain things that
you look at like, orstereotypical autistic traits
that may have been misperceivedand misinterpreted.
(08:45):
I think it's a massive problem.
I also think it's a problemthat we demonize narcissism so
much and we say, oh, but it cancome from trauma or autism or
whatever's going on.
But then other disorders, wedon't allow the space, there's
just not a really good dialogueabout it.
It's like, how do we addressall that?
I think that's a shortcut oh,they're narcissistic, not to say
OK, but maybe they're not,maybe there's something else
(09:06):
going on, and so I think itchanges everything, to be honest
, just to think about neurotypesin terms of how our brains work
and without necessarilylabeling.
But I also think sometimeslabeling gives us a sense of
like, oh, that explains it, it'snot my fault, my brain's like
this, whether it's borderline ornarcissism or whatever.
So I do think it's a largeproblem to address and the
(09:28):
overlap is significant.
Kristen Hovet (09:30):
Yeah, I've been trying to find articles,
research about it because I'veseen articles on the overlap
between schizophrenia and autismexisting in the same family or
in the same individual, samewith bipolar disorder.
So I'm wondering if personalitydisorders fit in there as well,
(09:52):
if there's a genetic component,because it seems like every
single person I've spoken withwho's autistic, and especially
late- diagnosed, has a parent ora grandparent that's more
toxically narcissistic or evencovert narcissism, and some of
them have autistic traits, someof them don't.
So it's just teasing apartthese different traits and how
(10:16):
they all fit together and howthat fits with so many of us
autistic folks have trauma andthat actually made it very
challenging to get our diagnosisbecause we for the longest time
thought, oh, I'm highlysensitive, plus PTSD.
So I know for me thatdefinitely delayed a diagnosis
or even looking in thisdirection at all.
Dr. Kim Sage (10:37):
Yeah, that's something I learned a lot, too,
which is that overlap that youalmost cannot.
My initial inquiry was how do Iseparate complex trauma from
autism, from high- maskingautism?
And the more I've gotten intoit then, and I've obviously
listened to a lot of otherpeople, that it's almost
impossible to separate in manyregards or some things you can
tease out, but because it seemsto be inherently part of the
(10:59):
autistic experience toexperience trauma, especially
relational trauma at a minimum Iwould say, because I think of
the PTSD and then relationaltrauma tend to go together.
Most people have both.
And I also noticed that withinfamily systems, like things like
borderline, and the researchhad shown like you're more
likely with everything, you know, the more closely related you
are to have these certaindisorders.
And so how much of that isgenetics, how much is
(11:20):
environment, I think i t getsreally confusing, like you're
saying.
It's like how do you start totease those things out?
Kristen Hovet (11:25):
And what would you say, you mentioned the
overlap or we were talking aboutPTSD and autism.
So what are some of thedifferences or things that can
basically indicate that aperson's not autistic, but they
maybe do have PTSD or complexPTSD?
Dr. Kim Sage (11:42):
You know, as I've continued and I want to keep
saying, like I'm still, you know, trying to fully understand,
but when I start to look at,like myself, for example, all
the things I am now identifyingwith as potentially autism, as
autism, to be honest, I thoughtwere only all complex trauma,
they could be explained bycomplex trauma.
And then when I started to diveinto it, I'm like, well, that
doesn't really make sense, likea lifetime of sensory issues.
(12:04):
Okay, yes, theoretically youhad the same mother and she had
the same struggles.
And so it's like, it feels likethe degree, the intensity of
certain things, like sensoryresponses, social dynamics, like
that makes sense from a certainperspective with complex trauma
, but not to the degree that itfeels like with autism.
You know it could if you hadtrauma around certain social
environments or interactions,and so I feel like it's in
(12:26):
itself, it's kind of a spectrumof degrees and so I don't think
you could absolutely say, youknow, it feels like at this
point it's hard to say, well,that's this and that's that.
It feels like the collection of, when you start to look at
autism, you have these pieces ofrepetitive behavior and social
dynamics or difficulties, andyou know dysregulation and all
of that.
That, when it starts to reallycluster, it feels like that
(12:46):
feels more autistic than if youjust pick out a few pieces that
are complex trauma, if thatmakes sense.
Kristen Hovet (12:51):
Definitely, and I've had the same kind of
thoughts about that.
It's like I've met people withcomplex trauma and they have no
issues with socializing.
Or maybe they did rightinitially after their trauma but
then they didn't at all after.
So there's things like thatthat always stood out to me and
I was like, that doesn'texplain, PTSD doesn't explain
this at all when you get down toit on the details.
(13:13):
I guess to switch gears now andtalk about you and growing up,
what traits did you have as achild that you now know to be
related to autism?
Dr. Kim Sage (13:25):
I think the first thing, I'm laughing because my
daughter, I just shared this onanother video, she had said to
me one day in the car as I wasdoing this, she's like, oh my
God, everything bothers you andI was kind of horrified, like in
the moment.
But then, because we were likegetting a drive- through food
and I was upset because the foodwasn't hot, which sounds, that
doesn't make me autistic, but Imean it was like this,
everything it's just like andI'm deeply bothered by it in a
(13:46):
way that's embarrassing that Ishouldn't be.
As a child it was like extremesensitivity to clothing, to
textures, to fabrics, to noise,to sound, to light, like I would
say my sensory issues were atfirst I was like, okay, is this
just like a sensory processingdisorder?
What is this?
Because that part has alwaysbeen not being able to be
comfortable, feeling like I wasdifferent, like an alien, like
(14:09):
what am I doing?
Why does everyone seem to getwhat's happening here?
I'm faking it and then I'mgetting misperceived as being a
bitch or not open, like what ishappening with my face right now
or whatever.
So those things I think werehuge.
And then I was a very shy child, extremely shy.
I'd have to rehearse like evenin my twenties, which seems
funny now, but no one makesphone calls anymore.
But I'd forgotten that, likeI'm 55 now.
(14:30):
So like I've learned a lot ofskills and probably have been
masking for so long, but so muchanxiety about everything, which
I also was thinking, okay, thisis all attachment, and I was
like, yes, and.
And then a lot of some stimmingbehaviors that I didn't realize
were stimming.
When I started researching Iwas like, oh, I definitely do
this.
Kristen Hovet (14:50):
What was school, like for you?
Dr. Kim Sage (14:52):
You know I think I did relatively well in school.
It's because of my generation,you know, I mean it's not true
for everybody, but our parentswere generally not involved at
all, so you're just on your ownfiguring it out.
And so I think school was oneplace, not so much socially but
academically, I could handle aslong as I was working at it.
I'm a huge procrastinator.
I mean, all my kids are likethis, too.
(15:12):
It's bad that anxiety.
We put everything off and thenyou power through it at the end
and you do well enough so thatyou're not really motivated to
like plan ahead again.
You know.
So, like that constant dynamic,I really enjoy learning.
Like I just started a Frenchclass and I was like, oh, I'm
back in a classroom, you know,which is like whatever, I enjoy
that part.
Kristen Hovet (15:31):
Do you wish you'd been identified as autistic in
early childhood?
Why or why not?
Dr. Kim Sage (15:36):
I have to say, like knowing the way that autism
has been stereotyped, likethrough the lens of today, I
probably wouldn't want to bediagnosed because of what I'm
still witnessing and watching inthe world.
I hope that changes.
I wish that someone could haveseen me in all of the
difficulties that I had, and soI guess that would have meant
yes, right.
I mean the collection of why iseverything so hard for you?
(15:58):
Why do you cry so much?
Why are you so emotional?
Why does everything bother you?
Because that gets internalized.
It's like what, alongsidechildhood trauma, what is wrong
with me?
Why am I like this?
And it's frustrating to otherpeople that don't understand it.
It's like you're just beingdifficult, you're just high
maintenance.
It's like, no, I'm not, but Ican't help it, you know.
So yes, I guess, if that makessense, like yes and no, I would
(16:19):
have wanted to be identified.
Kristen Hovet (16:21):
What were friendships like when you were
younger?
Dr. Kim Sage (16:24):
I think friendships.
I didn't realize this until thelast, honestly, several years,
but I think I've alwaysstruggled with friendships.
Choosing certain very strongpersonalities, I think, and then
it being too strong for melater and lacking good
communication skills, and thenmy feelings getting hurt a lot
and then not saying why it wasgoing on and then ending
friendships.
(16:44):
And then, frankly, like I'vealways loved, I'm an only child,
I love to be alone and I'vebeen raising four kids, so I
don't feel very socially driven.
Like I want that, but it's like, oh but I could be home, like
eating sushi and watchingNetflix by myself.
Like I'll just do that! I wouldsay they've been more of a
struggle than I would havewanted to admit and still, it's
still something I have to workon.
Kristen Hovet (17:06):
And did you tend to, I know, for me, I would just
kind of focus on one person,one friendship.
Yeah.
Out of all of the autistictraits that we read about, what
are some that you identify withmost or resonate with most?
Dr. Kim Sage (17:21):
In terms of like the criteria you're saying?
I think the two biggest ones,for me are, well, definitely
routines.
I definitely realized I have mylife set up a certain way and
it's difficult for me.
I can manage it, like when I'mtraveling or something it's
difficult.
But I would say that outside ofthat, the sensory issues and
the social dynamics are the twothings that really started to
(17:42):
drive me to think, okay, beinghighly sensitive, all of those
types of things, and how thatmanifests in my daily
functioning and relationshipswith myself and everybody else.
Kristen Hovet (17:52):
I was wondering if you ever came across Elaine
Aron's work on highly sensitiveperson and if you had, a lot of
us have a story of like that'swhat we identified with first,
well before autism.
Dr. Kim Sage (18:05):
Absolutely.
That's part of what I found inyour article is that that whole
conversation around HSP isreally just code for autism
became a conversation Iwitnessed on TikTok, frankly.
And then being in this world Ihad always, when I heard about
Elaine's work, oh, that makessense.
I'm a highly sensitive person.
It's HSP with CPTSD.
You start doing all thesethings like we're separating
(18:26):
things out.
And now, I mean, I have to saywhen I look at the criteria, to
me it feels like this is autismand I know there was later
people she based her work on.
I guess it was her nephews orgrandnephews who were later
diagnosed.
There's some pushback on thatside sometimes, it feels like, I
think because people don't wantto make the leap towards, to
say the word autism, butabsolutely every single HSP, oh
(18:49):
I'm an HSP long before this.
Kristen Hovet (18:52):
I was wondering if you could describe your
perfect day starting from themoment you wake up.
The reason I'm asking this isbecause hearing about everyday
life and preferences of autisticindividuals is helpful, I think
, for both autistic andnon-autistic people.
Both are able to seesimilarities and differences
between themselves and theperson answering the question.
Dr. Kim Sage (19:13):
I was thinking about this.
I mean, honestly, it's usuallya day where I wake up, ideally
without my cat waking me up, soI wake up alone without
interference in some way, whichis very rare because I wake up
pretty early, like five o'clockusually most mornings.
I wake up and then I have mycoffee and spend my time just
usually with like low lightingand candles, which is my routine
every day, and I would probablyeventually take a walk by
(19:36):
myself at the beach, have agreat dinner for myself, watch a
movie.
Like a lot of it, to me, it'sreally it's solitary time.
I'd love being with my kidsif that worked out, but they're
all scattered and older, so atthis point there's just a lot of
like peace, and I initially hadthought that the reason why I
enjoyed that was because of myCPTSD and living in
hypervigilance, that beingaround other people is stressful
(19:58):
, like my nervous system is, soI do think that that's part of
it.
I also just enjoy doing my ownthing, and so my nervous system
feels regulated alone.
I don't have to like be orpresent or do anything and be on
, you know, and so I think forme a day that allows me to just
sort of pursue the things that Ienjoy in a kind of peaceful,
quiet way is probably a reallygood day.
Kristen Hovet (20:19):
We talked about friendships, but I was wondering
also if you're comfortabletalking about relationships, so
romantic relationships, and howhave these traits kind of
impacted relationships?
Dr. Kim Sage (20:32):
I mean this is more of in retrospect because at
this point I'm not in arelationship, but I would say
that this new awareness has mademe understand my partner, my
partner choice, the things thatI struggled with that I, you
know, like I was just making avideo about this the other day,
where I think I was very rigidand controlling about things in
a way that I needed to feel safeas a result of my childhood.
(20:54):
And when I was doing it Ithought like, oh, I'm just being
the parent that I wanted, thatI wish I'd had.
But I do think that there's been, like my whole life, an attempt
to control, not just fromtrauma but my nervous system,
but like the way my brain works.
And so I think, you know, Irealized it recently, like that
might not have been easy to bewith me in that dynamic where I
(21:15):
was so affected by thetemperature in the room or
whatever it was, like the waythe mattress was, like things
that other people like why doyou care about this?
Like I can't not care aboutthis! And so I think in that
regard it's just made me hadincreased awareness about the
way those partners have shown upand the way that I've shown up.
Kristen Hovet (21:32):
That makes sense and I think when we're going
through those sensory issues andwe don't know what's causing it
, I think that it even adds tothe frustration and kind of
builds into, like, I think, aworse meltdown in some ways.
Because now that I know, I cande-escalate myself a lot easier.
The other thing I thought ofwhen we were talking is I did an
(21:56):
episode on narcissism and sonot only do we have this in our
families, it seems, a lot of us,but we're also, we end up in
relationships with narcissistsor people with very high
narcissistic traits, whether ornot we have this in our families
.
So I don't really have like astrong question formulated, but
I guess if you could speak onthat connection or maybe what is
(22:19):
it about autistic people thatis attractive to narcissists and
vice versa?
Dr. Kim Sage (22:25):
One of the things I have come to learn is that
it's very common for people who,I believe, are raised by
parents who struggle withborderline, for example, for
those people to actually beattracted to narcissists
themselves.
So let's say, if I haveborderline, I'm more attracted
to narcissists.
So what I realize is that thesame thing I feel like has
applied as a child of bothparents, I think, with my
parents and I've questionedwhether they're on the spectrum
(22:47):
or not, too, which is adifferent conversation but with
their severe emotional andrelational dysregulation, I
think for like something likecovert narcissists, what I've
talked about is that they don'tfeel, unless they have rage
issues, like this, like a parentwho struggles with emotional
and relational dysregulation.
Initially they feel likeconfident and containing and
maybe there's a little arrogancethere, but it feels like, oh,
(23:09):
this person has it figured out.
I think there's a draw to that,like I'm going to take over, I'm
going to take care of you,which I think, from a child
trauma perspective, is what wewant.
We all long for that.
And then, if I think aboutautism, I'm thinking, if I
thought about my dysregulationand just everything being so
hard and not having safe parents, oh yeah, it's great to have
(23:29):
someone feel like they're goingto finally be there for me and
take care of it.
Now it flips, it doesn't end upstaying that way, whether it's
the love bombing stage or all ofthat, and so that's definitely
been something that I have triedto reconcile.
And why did I choose someonelike that to create a family
with, honestly.
It's because of that, in largepart, and also maybe there's
autism in there, too.
So, who knows, you know?
Kristen Hovet (23:51):
Definitely, and I think to the narcissist, as
well, I don't want to say we'reeasy targets, but it's almost
like we're good at perspective-taking, which is sort of
contrary to the traditional, youknow, autistic criteria, almost
to a fault.
I know for myself I can takesomeone's perspective too much
(24:13):
and not remember that I alsohave a perspective in this and
have to remember myself.
Dr. Kim Sage (24:17):
I think that's actually really true.
I think that also this conceptabout being naïve with autism I
talked about this where Ithought, see, I thought all of
these were trauma- related, like, oh, you know, I take good
perspective because I wasn'tlistened to, and that may be the
case, but it also may be thatwe're so invested in hearing all
the sides or being in thatregard.
So I think that, and then beingnaïve, like just trusting
(24:39):
people, like I just I've said,like I don't think, oh, they're
going to screw me over.
I'm not like, oh, I see thegood, but like I really just
didn't.
I just took things at facevalue, even as a parent.
My kids are like mom, like whydidn't you like check on that?
I'm like I don't know, becauseI believed you! And I think I'm
a relatively smart person, butlike I just I don't know.
I think there's something aboutthat that also may be part of
(25:03):
it.
I don't know.
Kristen Hovet (25:04):
For sure.
The other thing is high empathy.
For those of us with reallyhigh empathy, I think that makes
it even more dangerous in someways, unless we have blatantly
been trained like this is what anarcissist looks like, and most
of us haven't been.
So I think that's anotherfuture goal is to create some
kind of training for, you know,adult autistics going into
(25:27):
relationships.
But just trying to think likeif you have high empathy and
someone's coming at you andthey're trying to blame shift
and doing things like that, it'slike I feel like we take the
person's perspective and like,yeah, yeah, maybe I am doing
that, right.
So that's another element,possibly.
Dr. Kim Sage (25:45):
Yeah, I agree.
Kristen Hovet (25:47):
And how has it been working in a caring
profession, having to work one-on- one, face- to- face, with
people who have sometimes very,very traumatic experiences, and
they're sharing this with you?
Dr. Kim Sage (25:59):
Outside of the very early years where I was
working with a population thathad been the victim of sexual
assault within families, like alot of abuse in families
sexually, that work was, it feltso intense and so difficult,
like I had to really work at thebarrier of self- protection
while also letting myself bepresent and connect.
When I started working, andthis is not to minimize, because
(26:21):
everybody at every level hasissues, but when I started
working in Newport Beach with ahigh- functioning population,
whatever that looks like, Idon't mean in terms of autism,
but just like a highlysuccessful population, there
were lots of issues there, too,but i t wasn't that same level.
Like, you know, people ofcourse have sexual trauma and
assault also, but not to thesame degree and the lack of
resources and support.
(26:42):
I've always been pretty good atbeing able to sit with people in
their trauma, and I think thisis true for most therapists,
because we've had a lot oftrauma.
Like I always say, I wouldnever want a therapist who's
never had anything happen intheir life.
What would that?
No, thank you.
I wouldn't want somebody who'slike it's all about them and
their trauma, either,of course, that wouldn't be
appropriate.
But there's something about, Ithink, when you grow up in a
chaotic environment, that youhave built up a tolerance and if
(27:04):
you have high empathy, it'slike I can be with you in this,
and this doesn't have topermeate my boundary.
I mean, some sessions are hardand you have to manage that and
work at it.
Everyone always is like how doyou do that?
How do you do that job whenyou're not a therapist?
It's like how can you not dothis job?
It's incredible.
You know people let you intotheir most sacred parts of their
lives and it's an honor.
I don't know, I don't take iton.
(27:26):
Like I said, it might bedependent upon, though, also,
what kind of work I'm doing andwho I'm working with.
Kristen Hovet (27:31):
I guess in terms of also having to mask, because
we're definitely high maskersbeing late- identified, because
there's also masking within yourprofession and masking with
clients and things like that.
So have you experienced burnoutin your profession or would you
say that you have enough kindof more protective elements in
(27:51):
your life that have kind ofreduced the risk of that?
Dr. Kim Sage (27:55):
I'm pretty mindful of keeping my case load in a
place where I feel like I canmanage it.
So that has meant not taking onall the clients I could take on
because I know that I couldn'thandle that.
It has meant sometimes when Ihaven't taken enough vacation
and I can feel it, it's likeokay, because I do tend to work
a lot, it's time for you to dothat.
So I balance it.
I don't think I do it perfectly.
(28:15):
I think that my personal lifehas been probably more
challenging raising four kidsalone, like that part and so
when all of that would mix withwork, that would be even more
difficult.
But I'm starting to realize Ithink the way that burnout has
presented has been in my body,in my physical health, in
neglecting my physical healthand having autoimmune disease
and not dealing with that.
(28:36):
That's where I think a lot ofmy trauma and my burnout because
I'm such an achiever, like I'lljust push through things.
But you know, as you get older,too, your body's like, sorry,
we're not, that doesn't, youcan't do that anymore without
feeling it.
So that's something I'm stillin the middle of trying to work
on right now.
It's interesting I was a verysickly kid.
So chronic ear infections, sickall of the time and always very
(29:01):
tired.
I even look back now in betweenhigh school I would take a lot
of naps, I slept a lot and Ididn't really think much about
that until I started hitting, Iwould say, as I got close to
menopause, which I think is awhole other conversation around
menopause and autism, which Idon't even know where the data
is on that.
But I started really strugglingwith chronic fatigue and just
(29:22):
to the point where I was likeyou know I would push to where I
would literally like allweekend I just couldn't do
anything.
My kids would, I had majorityof custody but if they would be
gone for the weekend I wouldliterally lay on the couch the
whole weekend.
You know, I just was like Ican't.
And then my daughter,unfortunately, has had a lot of
serious illnesses and infectionsand has been hospitalized like
(29:42):
over a month and we finally gother diagnosis with Sjogren's
disease several years ago andthen around that time I was
getting diagnosed with, likeit's connective tissue disorder
is basically like you know, thiscombination of symptoms.
So I started really seeing howoften those symptoms were
manifesting, with justexhaustion and fatigue and being
emotional and not sleeping welland insomnia, and then,
(30:04):
unfortunately, menopause justlike, made all of those things
you know worse.
Because you don't sleep, youdon't feel well unless you're
managing your treatment, andthat's a whole other thing.
Kristen Hovet (30:14):
Do you have a message for adults who are in
the process of contemplating orgetting an autism assessment?
Dr. Kim Sage (30:19):
You know, this is a place where I don't feel like
I have the expertise to have anopinion, except for what I've
been reading is that in someareas, having a diagnosis can be
detrimental to like adoption,things like that, in other
places, you know, and so I thinkit depends on your level of
accommodation and need, and itseems like that everybody I mean
(30:40):
everybody theoretically needsaccommodations with autism.
I've grown up with just no helpwith anything in my generation.
Like I think the idea of like,what, there could be help with
that?
It's like, no, that's notpossible.
So I think the idea of beingidentified and supported is
incredibly important.
I guess I worry about, rightnow, where we're at in terms of
like the stereotypes, withpeople getting stigmatized,
(31:00):
being denied access to thingsthat they should not be denied
access to.
I don't really feel like I'meducated enough to have a full
opinion on that, to be honest.
Kristen Hovet (31:08):
One thing I've noticed is kind of an explosion
of autistic therapists andthey're sort of going through
this thought process of like, doI disclose to my clients?
I think we talked about that alittle bit, they may be like
further from their diagnosis andthey still haven't, they don't
put it on their website, theydon't disclose it, but I know it
would be so helpful forautistic folks who are looking
(31:30):
for therapists specifically whoare neurodivergent.
And I think there's like,autistic people love psychology,
maybe because it sort of helpsexplain human nature and I don't
know.
Dr. Kim Sage (31:45):
I've seen so many therapists, too, on TikTok
coming out and saying that theyare, and on YouTube and stuff,
and so it's like I think we'restill wrestling and I'm
obviously, these are many ofthem are younger therapists, but
our own internal stigma aboutautism, our own stuff we're
trying to deal with.
I mean I think that's what'sscary.
It's like I'm saying, how doyou navigate that for yourself
with a client you've beenworking with for like three
years, and now you've learnedall of this and do you go, hey,
(32:07):
by the way, I think you'reautistic.
Like obviously you don't dothat, but I mean, you know what
I mean.
It's hard to reconcile.
And yet I also think, likeyou're saying, but what a
beautiful bridge to say, hey,I've learned about this for
myself and I'm seeing thesequalities in you and maybe that
helps explain these strugglesyou have and what supports you
might need.
So I think we're still likefiguring that out, a lot of us.
Kristen Hovet (32:30):
Definitely.
And what about the ADHDcomponent?
Because a lot of late-diagnosed folks are also finding
that diagnosis, too, at thesame time.
Dr. Kim Sage (32:38):
Yes, and I've been learning more about that.
It seems like that's extremelycommon for those with autism,
like it's a pretty significantoverlap.
Was it like 30 to 80 percent orsomething like that?
Kristen Hovet (32:46):
Yeah, something super high.
Dr. Kim Sage (32:49):
I don't know, it's pretty high! Which makes a lot
of sense, I think, in someregards.
The whole AuDHD, there's like awhole subset of that going on.
I don't see how all thesethings aren't connected and
aren't helpful to understand.
I just think that we are, Ikeep saying I think we're at
this beginning of where we needto be.
Kristen Hovet (33:05):
Definitely.
A huge thank you to Dr Sage forbeing my guest on The Other
Autism podcast.
And that's all I have for youtoday.
Thank you so much for beinghere.
Until next time, bye.
Today I'm speaking with Dr Kim Sage, a
licensed clinical psychologistbased in Southern California,
but before I share ourconversation, I'd like to thank
Colette for your generousone-time show of support to the
Other Autism podcast.
Colette used the Buy Me aCoffee link to send in a
(00:22):
one-time donation.
If you find this podcastvaluable, useful and or
informative and would like to dothe same, please check out the
link in the show notes that saysBuy Me a Coffee.
Please say hello to my guestfor today, Dr Kim Sage.
Hi there.
Dr. Kim Sage (00:40):
Hi, my name is Kim Sage.
I'm a licensed clinicalpsychologist in Southern
California.
I really do specialize in, Iwas kind of thinking this
through.
It's really people that havehad and are still living with,
in some way, a complicatedchildhood and that can really
run the spectrum from yourclassic this is trauma to that
constant little relationaltraumas that are being repeated
(01:02):
down their adult life indifferent ways.
That's kind of how I didn'treally start that way, but you
get a collection of people.
It tends to be those types ofindividuals.
Kristen Hovet (01:13):
I initially found you when a listener reached out
to let me know that they'rewatching one of your videos on
YouTube and you had mentioned anarticle I wrote about autistic
traits, I think, as theycommonly present in late-
diagnosed individuals.
In your video, you weredocumenting your thought process
in how you were applying thesetraits to yourself and having
(01:34):
what appeared to be a series ofepiphanies about this.
You also mentioned that many ofyour own clients in your
therapy practice likely alsorelate and therefore could
potentially be autistic as well.
That was a few months ago now.
What has your thought processbeen since then?
Dr. Kim Sage (01:52):
It's interesting.
It's continued to evolve,though I am still very much in
the inquiry does this really fit?
How could it not fit?
Kind of stage.
I found that the more Iresearch high masking, the more
I'm like, oh my gosh, it startsto explain so many things and
yet then I start to researchwhat does it look like?
And I'm sure we'll get to thatgetting a diagnosis or not, and
(02:14):
whether that's helpful or notand how that's helpful or not,
depending upon where yourchallenges are and where you
might need accommodations orthings like that.
I feel like I'm there but I'mnot fully ready to, I'm saying
it and not saying it.
I feel like that I'm on thespectrum, but then looking at my
kids and their dad and familyand all these things are
(02:34):
emerging.
And then I would say withclients, a lot of my clients,
unless they find me on socialmedia, they don't necessarily
watch me on social media that Iknow of.
So there's a lot of clients Ihave, they probably have never
seen any of my TikToks and neverseen on YouTube where I've
talked about even this formyself, and so it's this weird
place, other people that arefinding me that way, it's a
(02:55):
shortcut.
So in terms of saying to themoh, I think you're on the
spectrum.
That's not happening unlessthey're raising it with me at
this point.
It's not something that I feellike okay, because they're
obviously very high masked ifthat's happening, but it's
really made me start to go, hmm,I wonder if this explains
things.
So I feel like we're going tohave to get to it, but I still
(03:15):
think it's a very delicate topicfor a lot of people.
Kristen Hovet (03:18):
Definitely, and how did you first come across it
?
Dr. Kim Sage (03:22):
Honestly, your article was one of the first
places and I made that by entirevideo about your article
because I was like, oh my gosh,I relate to every single one of
these, right down to theautoimmune disease, which I know
there are links with yourarticles about the research.
And so then that just sort ofprompted I had been hearing a
lot on TikTok about neuro tribesand unmasking autism.
(03:43):
So all of that had been goingon for a while and I started to
feel like I was making a lot ofcontent on the CPTSD and people
would say in the comments, okay,well, how is this different
from autism?
And I would sort of give backthe answer that is what the DSM
says, for the most part tryingto, until this kind of
conversation sort of started toblow up, really I think for me
(04:05):
on TikTok, and then I startedgoing wait a minute, like there
are things I may be missing thatI don't understand.
And then I read your article, Iread neuro tribes and unmasking
autism.
I was like, oh my God, this islike I feel like it's unethical
to not be doing a deep dive onautism right now as a clinician,
let alone just as a society tounderstand each other.
Kristen Hovet (04:24):
I really appreciate that stance because
I've seen a lot of the opposite.
I think, especially peoplewho've been in the industry for
a while and they've been workingwith so many clients over the
years, they don't want to haveto go back and fix the
perceptions or even the way theyapproach therapy.
So that's awesome that you'redoing this.
Dr. Kim Sage (04:45):
Yeah.
I will say that that once Istarted making a few videos, I
started seeing clinicians .
.
making these very rigid videos,like this is what autism is,
just repeating the DSM.
I was like no, you think thisis the one video you need?
I'm like no, you're actually,why don't you go read all the
books and then we'll have thisconversation.
(05:06):
I feel like it's still a bigissue for our community, but I'm
hoping that's changing.
Kristen Hovet (05:11):
In your personal life, have you told people close
to you about this potentialidentification as autistic?
If so, what have theirresponses been?
Dr. Kim Sage (05:19):
It's interesting.
I haven't really shared much,except with my kids, to be
honest, because my kids are all16 to 24.
They're older and so initiallyit's like, hmm, and then it's
like I want to keep their livesprivate, but they're all,
they're like huh, that makessense, or they're able because
of their own stuff, they'relike, hmm, I don't know about
that.
So it's been this interestingthing where I feel like I've
(05:40):
been most open with it, honestly, randomly, on social media,
with strangers on TikTok.
They're not strangers, peoplethat I connect with there.
So that's been interesting.
And I started following a lotof autistic creators because I
kept hearing you need tounderstand things outside of
textbooks and things like that.
You need to understand thelived experience, and so that's
something else I started doingand so I feel like with those
(06:03):
creators there's like I justfeel this connection.
I'm also a very private person.
I don't, I have a small, I meanfriendships have been an issue,
so there aren't a lot for me totell if that makes sense.
Kristen Hovet (06:13):
Definitely.
As the community of therapists,counselors and psychologists is
becoming more aware of late-diagnosed autism, often
synonymous with level- oneautism, there's been a kind of
collective reckoning or comingto terms with the high number of
people who've been in some formof therapy for years, who've
gone undiagnosed, incorrectlydiagnosed or partially diagnosed
(06:35):
.
So how big of a problem wouldyou say this actually is?
Dr. Kim Sage (06:39):
I mean, honestly, at this point where I'm still,
you know, I'm still on myinquiry, I've been reading and
educating myself, I think it's amassive problem.
I think that people have beenmet with therapists who are or
aren't educated, notintentionally, they just I mean,
even in my programs not thatlong ago, they just I just
didn't know, you know, it wasthat stereotyped version, and so
I think it's a problem unlesspeople are willing to learn and
(07:02):
educate themselves.
And then, as I was sayingearlier, I think the challenge
is how do you say to a client,for example, who has no
knowledge of any of this, right,they don't go on social media,
they're not on TikTok, they'renot reading your articles, and
I'm thinking, okay, this personis high masking.
To try to tell that personyou're maybe autistic, that's a
big.
I think therapists are afraid ofthat.
Like I'm afraid of that.
It's a little scary.
(07:22):
Like I'm not going to withholdthat because I think that's
important for treatment, but ithas to be in the right place or
time.
And I think that many of us arelike probably scared to face
what does that really look like?
And then what do I need to doto shift my awareness and
training and education to be agood support for this person to
help them.
Kristen Hovet (07:39):
That makes sense, and I'm hoping at some point
there's some kind of guide ortraining for people in this
predicament, basically fortherapists and counselors,
because right now I thinkeveryone's kind of not sure what
to do about that.
I know you specialize inworking with clients who have
trauma as a result of growing upwith parents with personality
(08:00):
disorders such as NPD, as Imentioned before.
So a lot of us working inautism self-advocacy have noted
an overlap in families betweennarcissism and autism and other
personality disorders, and ofcourse, autism is not a
personality disorder.
I just want to make that veryclear.
So have you noticed thisoverlap as well and if so, why
(08:22):
do you think this is?
Dr. Kim Sage (08:24):
Well, I mean that's interesting because when
I first heard someone make theassociation between autism and
narcissism, I was like my mindwas just kind of blown it made a
lot of sense, especially in mypersonal life, also with people
who have been described asarrogant, certain things that
you look at like, orstereotypical autistic traits
that may have been misperceivedand misinterpreted.
(08:45):
I think it's a massive problem.
I also think it's a problemthat we demonize narcissism so
much and we say, oh, but it cancome from trauma or autism or
whatever's going on.
But then other disorders, wedon't allow the space, there's
just not a really good dialogueabout it.
It's like, how do we addressall that?
I think that's a shortcut oh,they're narcissistic, not to say
OK, but maybe they're not,maybe there's something else
(09:06):
going on, and so I think itchanges everything, to be honest
, just to think about neurotypesin terms of how our brains work
and without necessarilylabeling.
But I also think sometimeslabeling gives us a sense of
like, oh, that explains it, it'snot my fault, my brain's like
this, whether it's borderline ornarcissism or whatever.
So I do think it's a largeproblem to address and the
(09:28):
overlap is significant.
Kristen Hovet (09:30):
Yeah, I've been trying to find articles,
research about it because I'veseen articles on the overlap
between schizophrenia and autismexisting in the same family or
in the same individual, samewith bipolar disorder.
So I'm wondering if personalitydisorders fit in there as well,
(09:52):
if there's a genetic component,because it seems like every
single person I've spoken withwho's autistic, and especially
late- diagnosed, has a parent ora grandparent that's more
toxically narcissistic or evencovert narcissism, and some of
them have autistic traits, someof them don't.
So it's just teasing apartthese different traits and how
(10:16):
they all fit together and howthat fits with so many of us
autistic folks have trauma andthat actually made it very
challenging to get our diagnosisbecause we for the longest time
thought, oh, I'm highlysensitive, plus PTSD.
So I know for me thatdefinitely delayed a diagnosis
or even looking in thisdirection at all.
Dr. Kim Sage (10:37):
Yeah, that's something I learned a lot, too,
which is that overlap that youalmost cannot.
My initial inquiry was how do Iseparate complex trauma from
autism, from high- maskingautism?
And the more I've gotten intoit then, and I've obviously
listened to a lot of otherpeople, that it's almost
impossible to separate in manyregards or some things you can
tease out, but because it seemsto be inherently part of the
(10:59):
autistic experience toexperience trauma, especially
relational trauma at a minimum Iwould say, because I think of
the PTSD and then relationaltrauma tend to go together.
Most people have both.
And I also noticed that withinfamily systems, like things like
borderline, and the researchhad shown like you're more
likely with everything, you know, the more closely related you
are to have these certaindisorders.
And so how much of that isgenetics, how much is
(11:20):
environment, I think i t getsreally confusing, like you're
saying.
It's like how do you start totease those things out?
Kristen Hovet (11:25):
And what would you say, you mentioned the
overlap or we were talking aboutPTSD and autism.
So what are some of thedifferences or things that can
basically indicate that aperson's not autistic, but they
maybe do have PTSD or complexPTSD?
Dr. Kim Sage (11:42):
You know, as I've continued and I want to keep
saying, like I'm still, you know, trying to fully understand,
but when I start to look at,like myself, for example, all
the things I am now identifyingwith as potentially autism, as
autism, to be honest, I thoughtwere only all complex trauma,
they could be explained bycomplex trauma.
And then when I started to diveinto it, I'm like, well, that
doesn't really make sense, likea lifetime of sensory issues.
(12:04):
Okay, yes, theoretically youhad the same mother and she had
the same struggles.
And so it's like, it feels likethe degree, the intensity of
certain things, like sensoryresponses, social dynamics, like
that makes sense from a certainperspective with complex trauma
, but not to the degree that itfeels like with autism.
You know it could if you hadtrauma around certain social
environments or interactions,and so I feel like it's in
(12:26):
itself, it's kind of a spectrumof degrees and so I don't think
you could absolutely say, youknow, it feels like at this
point it's hard to say, well,that's this and that's that.
It feels like the collection of, when you start to look at
autism, you have these pieces ofrepetitive behavior and social
dynamics or difficulties, andyou know dysregulation and all
of that.
That, when it starts to reallycluster, it feels like that
(12:46):
feels more autistic than if youjust pick out a few pieces that
are complex trauma, if thatmakes sense.
Kristen Hovet (12:51):
Definitely, and I've had the same kind of
thoughts about that.
It's like I've met people withcomplex trauma and they have no
issues with socializing.
Or maybe they did rightinitially after their trauma but
then they didn't at all after.
So there's things like thatthat always stood out to me and
I was like, that doesn'texplain, PTSD doesn't explain
this at all when you get down toit on the details.
(13:13):
I guess to switch gears now andtalk about you and growing up,
what traits did you have as achild that you now know to be
related to autism?
Dr. Kim Sage (13:25):
I think the first thing, I'm laughing because my
daughter, I just shared this onanother video, she had said to
me one day in the car as I wasdoing this, she's like, oh my
God, everything bothers you andI was kind of horrified, like in
the moment.
But then, because we were likegetting a drive- through food
and I was upset because the foodwasn't hot, which sounds, that
doesn't make me autistic, but Imean it was like this,
everything it's just like andI'm deeply bothered by it in a
(13:46):
way that's embarrassing that Ishouldn't be.
As a child it was like extremesensitivity to clothing, to
textures, to fabrics, to noise,to sound, to light, like I would
say my sensory issues were atfirst I was like, okay, is this
just like a sensory processingdisorder?
What is this?
Because that part has alwaysbeen not being able to be
comfortable, feeling like I wasdifferent, like an alien, like
(14:09):
what am I doing?
Why does everyone seem to getwhat's happening here?
I'm faking it and then I'mgetting misperceived as being a
bitch or not open, like what ishappening with my face right now
or whatever.
So those things I think werehuge.
And then I was a very shy child, extremely shy.
I'd have to rehearse like evenin my twenties, which seems
funny now, but no one makesphone calls anymore.
But I'd forgotten that, likeI'm 55 now.
(14:30):
So like I've learned a lot ofskills and probably have been
masking for so long, but so muchanxiety about everything, which
I also was thinking, okay, thisis all attachment, and I was
like, yes, and.
And then a lot of some stimmingbehaviors that I didn't realize
were stimming.
When I started researching Iwas like, oh, I definitely do
this.
Kristen Hovet (14:50):
What was school, like for you?
Dr. Kim Sage (14:52):
You know I think I did relatively well in school.
It's because of my generation,you know, I mean it's not true
for everybody, but our parentswere generally not involved at
all, so you're just on your ownfiguring it out.
And so I think school was oneplace, not so much socially but
academically, I could handle aslong as I was working at it.
I'm a huge procrastinator.
I mean, all my kids are likethis, too.
(15:12):
It's bad that anxiety.
We put everything off and thenyou power through it at the end
and you do well enough so thatyou're not really motivated to
like plan ahead again.
You know.
So, like that constant dynamic,I really enjoy learning.
Like I just started a Frenchclass and I was like, oh, I'm
back in a classroom, you know,which is like whatever, I enjoy
that part.
Kristen Hovet (15:31):
Do you wish you'd been identified as autistic in
early childhood?
Why or why not?
Dr. Kim Sage (15:36):
I have to say, like knowing the way that autism
has been stereotyped, likethrough the lens of today, I
probably wouldn't want to bediagnosed because of what I'm
still witnessing and watching inthe world.
I hope that changes.
I wish that someone could haveseen me in all of the
difficulties that I had, and soI guess that would have meant
yes, right.
I mean the collection of why iseverything so hard for you?
(15:58):
Why do you cry so much?
Why are you so emotional?
Why does everything bother you?
Because that gets internalized.
It's like what, alongsidechildhood trauma, what is wrong
with me?
Why am I like this?
And it's frustrating to otherpeople that don't understand it.
It's like you're just beingdifficult, you're just high
maintenance.
It's like, no, I'm not, but Ican't help it, you know.
So yes, I guess, if that makessense, like yes and no, I would
(16:19):
have wanted to be identified.
Kristen Hovet (16:21):
What were friendships like when you were
younger?
Dr. Kim Sage (16:24):
I think friendships.
I didn't realize this until thelast, honestly, several years,
but I think I've alwaysstruggled with friendships.
Choosing certain very strongpersonalities, I think, and then
it being too strong for melater and lacking good
communication skills, and thenmy feelings getting hurt a lot
and then not saying why it wasgoing on and then ending
friendships.
(16:44):
And then, frankly, like I'vealways loved, I'm an only child,
I love to be alone and I'vebeen raising four kids, so I
don't feel very socially driven.
Like I want that, but it's like, oh but I could be home, like
eating sushi and watchingNetflix by myself.
Like I'll just do that! I wouldsay they've been more of a
struggle than I would havewanted to admit and still, it's
still something I have to workon.
Kristen Hovet (17:06):
And did you tend to, I know, for me, I would just
kind of focus on one person,one friendship.
Yeah.
Out of all of the autistictraits that we read about, what
are some that you identify withmost or resonate with most?
Dr. Kim Sage (17:21):
In terms of like the criteria you're saying?
I think the two biggest ones,for me are, well, definitely
routines.
I definitely realized I have mylife set up a certain way and
it's difficult for me.
I can manage it, like when I'mtraveling or something it's
difficult.
But I would say that outside ofthat, the sensory issues and
the social dynamics are the twothings that really started to
(17:42):
drive me to think, okay, beinghighly sensitive, all of those
types of things, and how thatmanifests in my daily
functioning and relationshipswith myself and everybody else.
Kristen Hovet (17:52):
I was wondering if you ever came across Elaine
Aron's work on highly sensitiveperson and if you had, a lot of
us have a story of like that'swhat we identified with first,
well before autism.
Dr. Kim Sage (18:05):
Absolutely.
That's part of what I found inyour article is that that whole
conversation around HSP isreally just code for autism
became a conversation Iwitnessed on TikTok, frankly.
And then being in this world Ihad always, when I heard about
Elaine's work, oh, that makessense.
I'm a highly sensitive person.
It's HSP with CPTSD.
You start doing all thesethings like we're separating
(18:26):
things out.
And now, I mean, I have to saywhen I look at the criteria, to
me it feels like this is autismand I know there was later
people she based her work on.
I guess it was her nephews orgrandnephews who were later
diagnosed.
There's some pushback on thatside sometimes, it feels like, I
think because people don't wantto make the leap towards, to
say the word autism, butabsolutely every single HSP, oh
(18:49):
I'm an HSP long before this.
Kristen Hovet (18:52):
I was wondering if you could describe your
perfect day starting from themoment you wake up.
The reason I'm asking this isbecause hearing about everyday
life and preferences of autisticindividuals is helpful, I think
, for both autistic andnon-autistic people.
Both are able to seesimilarities and differences
between themselves and theperson answering the question.
Dr. Kim Sage (19:13):
I was thinking about this.
I mean, honestly, it's usuallya day where I wake up, ideally
without my cat waking me up, soI wake up alone without
interference in some way, whichis very rare because I wake up
pretty early, like five o'clockusually most mornings.
I wake up and then I have mycoffee and spend my time just
usually with like low lightingand candles, which is my routine
every day, and I would probablyeventually take a walk by
(19:36):
myself at the beach, have agreat dinner for myself, watch a
movie.
Like a lot of it, to me, it'sreally it's solitary time.
I'd love being with my kidsif that worked out, but they're
all scattered and older, so atthis point there's just a lot of
like peace, and I initially hadthought that the reason why I
enjoyed that was because of myCPTSD and living in
hypervigilance, that beingaround other people is stressful
(19:58):
, like my nervous system is, soI do think that that's part of
it.
I also just enjoy doing my ownthing, and so my nervous system
feels regulated alone.
I don't have to like be orpresent or do anything and be on
, you know, and so I think forme a day that allows me to just
sort of pursue the things that Ienjoy in a kind of peaceful,
quiet way is probably a reallygood day.
Kristen Hovet (20:19):
We talked about friendships, but I was wondering
also if you're comfortabletalking about relationships, so
romantic relationships, and howhave these traits kind of
impacted relationships?
Dr. Kim Sage (20:32):
I mean this is more of in retrospect because at
this point I'm not in arelationship, but I would say
that this new awareness has mademe understand my partner, my
partner choice, the things thatI struggled with that I, you
know, like I was just making avideo about this the other day,
where I think I was very rigidand controlling about things in
a way that I needed to feel safeas a result of my childhood.
(20:54):
And when I was doing it Ithought like, oh, I'm just being
the parent that I wanted, thatI wish I'd had.
But I do think that there's been, like my whole life, an attempt
to control, not just fromtrauma but my nervous system,
but like the way my brain works.
And so I think, you know, Irealized it recently, like that
might not have been easy to bewith me in that dynamic where I
(21:15):
was so affected by thetemperature in the room or
whatever it was, like the waythe mattress was, like things
that other people like why doyou care about this?
Like I can't not care aboutthis! And so I think in that
regard it's just made me hadincreased awareness about the
way those partners have shown upand the way that I've shown up.
Kristen Hovet (21:32):
That makes sense and I think when we're going
through those sensory issues andwe don't know what's causing it
, I think that it even adds tothe frustration and kind of
builds into, like, I think, aworse meltdown in some ways.
Because now that I know, I cande-escalate myself a lot easier.
The other thing I thought ofwhen we were talking is I did an
(21:56):
episode on narcissism and sonot only do we have this in our
families, it seems, a lot of us,but we're also, we end up in
relationships with narcissistsor people with very high
narcissistic traits, whether ornot we have this in our families
.
So I don't really have like astrong question formulated, but
I guess if you could speak onthat connection or maybe what is
(22:19):
it about autistic people thatis attractive to narcissists and
vice versa?
Dr. Kim Sage (22:25):
One of the things I have come to learn is that
it's very common for people who,I believe, are raised by
parents who struggle withborderline, for example, for
those people to actually beattracted to narcissists
themselves.
So let's say, if I haveborderline, I'm more attracted
to narcissists.
So what I realize is that thesame thing I feel like has
applied as a child of bothparents, I think, with my
parents and I've questionedwhether they're on the spectrum
(22:47):
or not, too, which is adifferent conversation but with
their severe emotional andrelational dysregulation, I
think for like something likecovert narcissists, what I've
talked about is that they don'tfeel, unless they have rage
issues, like this, like a parentwho struggles with emotional
and relational dysregulation.
Initially they feel likeconfident and containing and
maybe there's a little arrogancethere, but it feels like, oh,
(23:09):
this person has it figured out.
I think there's a draw to that,like I'm going to take over, I'm
going to take care of you,which I think, from a child
trauma perspective, is what wewant.
We all long for that.
And then, if I think aboutautism, I'm thinking, if I
thought about my dysregulationand just everything being so
hard and not having safe parents, oh yeah, it's great to have
(23:29):
someone feel like they're goingto finally be there for me and
take care of it.
Now it flips, it doesn't end upstaying that way, whether it's
the love bombing stage or all ofthat, and so that's definitely
been something that I have triedto reconcile.
And why did I choose someonelike that to create a family
with, honestly.
It's because of that, in largepart, and also maybe there's
autism in there, too.
So, who knows, you know?
Kristen Hovet (23:51):
Definitely, and I think to the narcissist, as
well, I don't want to say we'reeasy targets, but it's almost
like we're good at perspective-taking, which is sort of
contrary to the traditional, youknow, autistic criteria, almost
to a fault.
I know for myself I can takesomeone's perspective too much
(24:13):
and not remember that I alsohave a perspective in this and
have to remember myself.
Dr. Kim Sage (24:17):
I think that's actually really true.
I think that also this conceptabout being naïve with autism I
talked about this where Ithought, see, I thought all of
these were trauma- related, like, oh, you know, I take good
perspective because I wasn'tlistened to, and that may be the
case, but it also may be thatwe're so invested in hearing all
the sides or being in thatregard.
So I think that, and then beingnaïve, like just trusting
(24:39):
people, like I just I've said,like I don't think, oh, they're
going to screw me over.
I'm not like, oh, I see thegood, but like I really just
didn't.
I just took things at facevalue, even as a parent.
My kids are like mom, like whydidn't you like check on that?
I'm like I don't know, becauseI believed you! And I think I'm
a relatively smart person, butlike I just I don't know.
I think there's something aboutthat that also may be part of
(25:03):
it.
I don't know.
Kristen Hovet (25:04):
For sure.
The other thing is high empathy.
For those of us with reallyhigh empathy, I think that makes
it even more dangerous in someways, unless we have blatantly
been trained like this is what anarcissist looks like, and most
of us haven't been.
So I think that's anotherfuture goal is to create some
kind of training for, you know,adult autistics going into
(25:27):
relationships.
But just trying to think likeif you have high empathy and
someone's coming at you andthey're trying to blame shift
and doing things like that, it'slike I feel like we take the
person's perspective and like,yeah, yeah, maybe I am doing
that, right.
So that's another element,possibly.
Dr. Kim Sage (25:45):
Yeah, I agree.
Kristen Hovet (25:47):
And how has it been working in a caring
profession, having to work one-on- one, face- to- face, with
people who have sometimes very,very traumatic experiences, and
they're sharing this with you?
Dr. Kim Sage (25:59):
Outside of the very early years where I was
working with a population thathad been the victim of sexual
assault within families, like alot of abuse in families
sexually, that work was, it feltso intense and so difficult,
like I had to really work at thebarrier of self- protection
while also letting myself bepresent and connect.
When I started working, andthis is not to minimize, because
(26:21):
everybody at every level hasissues, but when I started
working in Newport Beach with ahigh- functioning population,
whatever that looks like, Idon't mean in terms of autism,
but just like a highlysuccessful population, there
were lots of issues there, too,but i t wasn't that same level.
Like, you know, people ofcourse have sexual trauma and
assault also, but not to thesame degree and the lack of
resources and support.
(26:42):
I've always been pretty good atbeing able to sit with people in
their trauma, and I think thisis true for most therapists,
because we've had a lot oftrauma.
Like I always say, I wouldnever want a therapist who's
never had anything happen intheir life.
What would that?
No, thank you.
I wouldn't want somebody who'slike it's all about them and
their trauma, either,of course, that wouldn't be
appropriate.
But there's something about, Ithink, when you grow up in a
chaotic environment, that youhave built up a tolerance and if
(27:04):
you have high empathy, it'slike I can be with you in this,
and this doesn't have topermeate my boundary.
I mean, some sessions are hardand you have to manage that and
work at it.
Everyone always is like how doyou do that?
How do you do that job whenyou're not a therapist?
It's like how can you not dothis job?
It's incredible.
You know people let you intotheir most sacred parts of their
lives and it's an honor.
I don't know, I don't take iton.
(27:26):
Like I said, it might bedependent upon, though, also,
what kind of work I'm doing andwho I'm working with.
Kristen Hovet (27:31):
I guess in terms of also having to mask, because
we're definitely high maskersbeing late- identified, because
there's also masking within yourprofession and masking with
clients and things like that.
So have you experienced burnoutin your profession or would you
say that you have enough kindof more protective elements in
(27:51):
your life that have kind ofreduced the risk of that?
Dr. Kim Sage (27:55):
I'm pretty mindful of keeping my case load in a
place where I feel like I canmanage it.
So that has meant not taking onall the clients I could take on
because I know that I couldn'thandle that.
It has meant sometimes when Ihaven't taken enough vacation
and I can feel it, it's likeokay, because I do tend to work
a lot, it's time for you to dothat.
So I balance it.
I don't think I do it perfectly.
(28:15):
I think that my personal lifehas been probably more
challenging raising four kidsalone, like that part and so
when all of that would mix withwork, that would be even more
difficult.
But I'm starting to realize Ithink the way that burnout has
presented has been in my body,in my physical health, in
neglecting my physical healthand having autoimmune disease
and not dealing with that.
(28:36):
That's where I think a lot ofmy trauma and my burnout because
I'm such an achiever, like I'lljust push through things.
But you know, as you get older,too, your body's like, sorry,
we're not, that doesn't, youcan't do that anymore without
feeling it.
So that's something I'm stillin the middle of trying to work
on right now.
It's interesting I was a verysickly kid.
So chronic ear infections, sickall of the time and always very
(29:01):
tired.
I even look back now in betweenhigh school I would take a lot
of naps, I slept a lot and Ididn't really think much about
that until I started hitting, Iwould say, as I got close to
menopause, which I think is awhole other conversation around
menopause and autism, which Idon't even know where the data
is on that.
But I started really strugglingwith chronic fatigue and just
(29:22):
to the point where I was likeyou know I would push to where I
would literally like allweekend I just couldn't do
anything.
My kids would, I had majorityof custody but if they would be
gone for the weekend I wouldliterally lay on the couch the
whole weekend.
You know, I just was like Ican't.
And then my daughter,unfortunately, has had a lot of
serious illnesses and infectionsand has been hospitalized like
(29:42):
over a month and we finally gother diagnosis with Sjogren's
disease several years ago andthen around that time I was
getting diagnosed with, likeit's connective tissue disorder
is basically like you know, thiscombination of symptoms.
So I started really seeing howoften those symptoms were
manifesting, with justexhaustion and fatigue and being
emotional and not sleeping welland insomnia, and then,
(30:04):
unfortunately, menopause justlike, made all of those things
you know worse.
Because you don't sleep, youdon't feel well unless you're
managing your treatment, andthat's a whole other thing.
Kristen Hovet (30:14):
Do you have a message for adults who are in
the process of contemplating orgetting an autism assessment?
Dr. Kim Sage (30:19):
You know, this is a place where I don't feel like
I have the expertise to have anopinion, except for what I've
been reading is that in someareas, having a diagnosis can be
detrimental to like adoption,things like that, in other
places, you know, and so I thinkit depends on your level of
accommodation and need, and itseems like that everybody I mean
(30:40):
everybody theoretically needsaccommodations with autism.
I've grown up with just no helpwith anything in my generation.
Like I think the idea of like,what, there could be help with
that?
It's like, no, that's notpossible.
So I think the idea of beingidentified and supported is
incredibly important.
I guess I worry about, rightnow, where we're at in terms of
like the stereotypes, withpeople getting stigmatized,
(31:00):
being denied access to thingsthat they should not be denied
access to.
I don't really feel like I'meducated enough to have a full
opinion on that, to be honest.
Kristen Hovet (31:08):
One thing I've noticed is kind of an explosion
of autistic therapists andthey're sort of going through
this thought process of like, doI disclose to my clients?
I think we talked about that alittle bit, they may be like
further from their diagnosis andthey still haven't, they don't
put it on their website, theydon't disclose it, but I know it
would be so helpful forautistic folks who are looking
(31:30):
for therapists specifically whoare neurodivergent.
And I think there's like,autistic people love psychology,
maybe because it sort of helpsexplain human nature and I don't
know.
Dr. Kim Sage (31:45):
I've seen so many therapists, too, on TikTok
coming out and saying that theyare, and on YouTube and stuff,
and so it's like I think we'restill wrestling and I'm
obviously, these are many ofthem are younger therapists, but
our own internal stigma aboutautism, our own stuff we're
trying to deal with.
I mean I think that's what'sscary.
It's like I'm saying, how doyou navigate that for yourself
with a client you've beenworking with for like three
years, and now you've learnedall of this and do you go, hey,
(32:07):
by the way, I think you'reautistic.
Like obviously you don't dothat, but I mean, you know what
I mean.
It's hard to reconcile.
And yet I also think, likeyou're saying, but what a
beautiful bridge to say, hey,I've learned about this for
myself and I'm seeing thesequalities in you and maybe that
helps explain these strugglesyou have and what supports you
might need.
So I think we're still likefiguring that out, a lot of us.
Kristen Hovet (32:30):
Definitely.
And what about the ADHDcomponent?
Because a lot of late-diagnosed folks are also finding
that diagnosis, too, at thesame time.
Dr. Kim Sage (32:38):
Yes, and I've been learning more about that.
It seems like that's extremelycommon for those with autism,
like it's a pretty significantoverlap.
Was it like 30 to 80 percent orsomething like that?
Kristen Hovet (32:46):
Yeah, something super high.
Dr. Kim Sage (32:49):
I don't know, it's pretty high! Which makes a lot
of sense, I think, in someregards.
The whole AuDHD, there's like awhole subset of that going on.
I don't see how all thesethings aren't connected and
aren't helpful to understand.
I just think that we are, Ikeep saying I think we're at
this beginning of where we needto be.
Kristen Hovet (33:05):
Definitely.
A huge thank you to Dr Sage forbeing my guest on The Other
Autism podcast.
And that's all I have for youtoday.
Thank you so much for beinghere.
Until next time, bye.
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