Are you someone who at times has great productivity and hyperfocus, but at other times can barely focus and get things done?

Do you have problems focusing and getting things done unless you’re under pressure? Do you tend to procrastinate?

Do you, after periods of high-intensity work — whether that’s physical or mental — crash and burn out afterward?

Do you feel that you dive deeply into an interest, but then lose interest and don’t know what just happened? Do you have serial interests, or even serial relationships?

Do you feel you have great abilities — you’re a quick learner, you go deep when you’re pursuing something you’re interested in, perhaps you’re even gifted — but then feel unable to harness those abilities and gifts, and feel like you’re on a roller coaster between hyperproductivity and an inability to focus and have motivation?

These are common patterns that I see in my practice, and they relate to arousal. I’m not referring to sexual arousal or emotional arousal, but arousal as far as our neurophysiology being in a place where we can ideally act — where we have focus, motivation, and energy — and not low arousal, where you can’t focus, and have low motivation, and low energy, nor hyper arousal, where we’re excessively focused in a physiologic stressed state. Many people find themselves fluctuating between both ends and having problems finding that sweet spot in the middle that allows them to sustain their interests, sustain the goals they’ve set for themselves, and harness their greatest gifts. Many of these individuals are extremely gifted — deep divers, can even be obsessive about their interests. But it can take that depth for people to function at a high level.

This newsletter and podcast are for educational purposes and aren’t a substitute for professional medical advice, diagnosis, or treatment. Please talk with your own doctor about any medical or psychiatric concerns.

What You’ll Learn

* (0:00) Recognizing the pattern of hyperfocus and burnout

* (3:43) What arousal actually means, physiologically

* (4:26) The RCCX connection

* (7:03) The crash, and why it happens

* (10:11) Finding our sweet spot — practical tools that help

Recognizing the Pattern

There’s a sweet spot of arousal where we have focus, motivation, and energy. On one side of it is low arousal — brain fog, low motivation, low energy, something that can look a lot like ADD in both children and adults. On the other side is hyper-arousal — when we have excessive focus and drive, often accompanied by physiological stress.

Many of the people I see fluctuate between both ends and struggle to find that middle place. They tend to have deep interests. They can dive deeply into something, even obsessive about it, and can have difficulty disengaging. When there is not enough stimulation, they tend to get bored. They often don’t enjoy small talk.

What Arousal Means Physiologically

When we talk about what can be happening here — when we are stressed, and again, when I’m talking about arousal, that’s a degree of stress, and we’re aiming for an optimal level of stress where we get things done and can enjoy what we’re doing.

What impacts arousal? One is cortisol. If we have adequate levels of cortisol, that gives us adequate energy. Along with cortisol, catecholamines fluctuate — things like norepinephrine, which gives us motivation, and dopamine, which helps us focus. Think of these three as moving up and down together for the most part. There are other things that can impact them separately, but generally they’re increasing together, and they can be decreased or low at the same time as well.

The RCCX Connection

The best explanation I’ve found for why some of us find ourselves at either end of the arousal spectrum and not easily in the middle sweet spot, is RCCX theory, developed by Dr. Sharon Meglathery. This is a theory I’ve described in previous newsletters and podcasts — it makes the connection between a gene for hypermobility, a gene for 21-hydroxylase (an enzyme in the hormone pathway that produces cortisol), and another gene that relates to autoimmunity. People don’t have to have all of these genes affected, but I’d say the most important one, from a psychiatric and brain-symptom perspective, is 21-hydroxylase, needed for the production of cortisol.

If we have a weakness on this gene — and it appears that likely 20% of people do — that could give us a baseline low cortisol level. It’s not as if we can pin this down to a single variant; there are likely a number of places on that gene that could be affected, and it’s not something that can currently be measured through genetic testing except in research settings. But if we have that weakness, we could still make adequate cortisol under stress — until we push it too far. Say, on one of these hyperproductive days, we push too far, and then we overwhelm that enzyme, and we don’t have enough cortisol.

So why would people who struggle with this already tend to be deep divers? It appears that a vulnerability in that enzyme, 21-hydroxylase, could have affected brain development in utero and in early life — causing higher androgens and spiking cortisol that can affect particular parts of the brain, including the amygdala, which senses threat and can contribute to this high-intensity difficulty putting on the brakes once we’re under stress. So these individuals, when they’re working on something, may have difficulty stopping — and then when they’re not able to keep producing the cortisol to meet the demands they’re placing on their physiology, they hit a wall.

The Crash — and Why It Happens

When the enzyme can no longer keep up with the demand, cortisol and those neurotransmitters drop — that’s the crash: low energy, poor focus, no motivation. For some people, hitting that wall can also trigger mast cell activation, through another mechanism I’ve talked about in a previous episode. There’s a hormone in the brain, corticotropin-releasing hormone (CRH), that tells the adrenal glands we need more cortisol. When that happens, CRH can bind to mast cells — inflammatory cells in the body — which release histamine and inflammatory mediators that can cause physical symptoms, and worsen fatigue and brain fog. Not everyone has this happen; most people with mast cell activation have something else going on too, like a biotoxin exposure.

This isn’t only about a single hard day. Zoom out, and I’ve seen people who were high-functioning — even hyper-functioning — for years, doing remarkable things across work, family, and adventure, before hitting a wall they never fully recovered from. Often there’s something else quietly using up their stress capacity underneath it all: mold or biotoxin exposure, mitochondrial dysfunction, a chronically stressful relationship, early attachment disruption, or even codependent relationship patterns that keep someone chronically stressed.

Once someone hits that wall, it’s common to unconsciously reach for something to bump cortisol and those neurotransmitters back up — compulsive eating, carbs, seeking stimulation online, risk-taking, or calling the one person who reliably stirs up drama. Beyond the physical crash, there’s a bigger cost: most people aren’t recognizing this as their neurophysiology. They’re experiencing it as being inconsistent, self-defeating, self-sabotaging, or a self-esteem problem, rather than recognizing it as a very common physiologic pattern involving our stress hormone pathways and neurotransmitters — and the bigger loss is all the abilities and gifts people aren’t able to harness because they’re on this roller coaster.

Finding the Sweet Spot

The first thing is to notice. Notice when you feel in that hypo-arousal state, when you’re having difficulty getting things done, and then recognize what you’re reaching for — is it carbs, is it eating, is it substances, is it the internet, is it risk-taking, is it the dramatic friend who stirs up trouble?

Notice

Also notice when you’re in a state of hyperarousal — doing an activity, powering through without being able to stop, unable to take breaks. If you’re observant enough, you’ll notice your muscles tightening around your neck and shoulders, and simply not being able to relax. When we notice which state of arousal we’re in, we know what tools we have access to, to help modulate it.

For High Arousal

When you’re in a state of hyperproductivity, the last thing you want to do is take a break. But to sustain a degree of productivity, it can require putting that intensity aside and taking a break, so the wall isn’t hit. Another approach is to alternate high-intensity work with low-intensity work — step away and move if the work is on a computer. It can help to chunk activities: set goals, and after reaching them, stop and take a break, rather than letting a project sprawl deeper and deeper. It’s also important to assess your stressors — stressors aren’t all negative, but if we’re not pacing, if we’re not setting aside time to calm our nervous system, we can still hit that wall. It’s really important to set an intention before starting — how it’s going to be broken up, setting a timer for how long before a break — to really be intentional.

For Low Arousal

Just recognizing that low baseline arousal can already have us thinking creatively about how to increase it. Do we need to change the setting where we’re working? Do we need to find a way to make what we’re doing more interesting — what is the why? Make it more creative. When we have that low arousal, instead of reaching for food or surfing the internet, we could instead have a creative outlet that’s stimulating and raises our arousal without being harmful to us. Movement is a way to raise arousal — getting up and moving around can help. It can also help to chunk activities and put a timer on; sometimes the challenge of getting something done in a certain amount of time will raise arousal on its own.

Everyone’s approach to this, and what works for them, will be different. But I do feel like this understanding can help us all recognize how we function best, recognize when we’re in that under-arousal or hyper-arousal state, and modulate — all with the intention of not being on that roller coaster, and instead finding that place in the middle where we can be in a state of flow, enjoying what we’re doing, finding meaning and purpose in it.

I’d love to hear your thoughts and experience. Have you found things that help you find your own sweet spot?

Until next time, take care.

Courtney

Courtney Snyder MD is a Holistic and Functional Child and Adult Psychiatrist who offers non-patient consultations to individuals and practitioners nationally and internationally in addition to her treatment practice serving FL, IN, KY, OH. Her educational content, shared through her website, Substack Newsletter, the Holistic Psychiatry Podcast and her YouTube Channel reaches readers and listeners in over 160 countries.

Resources

* RCCX Theory & Psychiatry. Dr. Sharon Meglathery

* RCCX Theory: Hypermobility, RCCX Theory, Mental Health & Complex Chronic Illness

* Recent newsletter on Hypersensitivity: High Sensitivity Through 3 Lenses (HSP, Pyrrole Disorder & RCCX Theory)

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