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Signs You’re Stuck: Four Faces of a Dysregulated Autonomic Nervous System (ANS)

How to spot the hidden signals, plus easy at home self-tests to see if you’re dysregulated.

The Autonomic Nervous System (ANS) in the human body is comprised of two primary branches you may already know about: the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is often referred to as the "fight or flight" system, activating the body's stress responses by increasing heart rate, dilating pupils, increased sweating to preparing the body for immediate action. On the other hand, the parasympathetic nervous system is known as the "rest and digest" system, promoting relaxation, slowing the heart rate, and aiding in digestion allowing blood flow to prioritize digestive organs as opposed flooding to muscles in the legs to run away. In conditions like Postural Orthostatic Tachycardia Syndrome (POTS), Ehlers-Danlos Syndromes (EDS), and other chronic illnesses, the ANS can be dysregulated, leading to imbalances between these two systems and causing various symptoms and challenges for affected individuals. Let’s learn how.

When your autonomic nervous system is affected by a chronic illness, you may begin to notice one of the four reactions of a dysregulated nervous system. These reactions are known as Fight, Flight, Freeze, and Fawn. These healthy stress responses are not necessarily negative; they usually act as a protective mechanism during short-term challenges, enhancing blood flow to muscles, reducing pain perception, and sharpening hearing. However, when chronic illness, long-term stress and/or trauma imposes persistent stress on the body, it can lead the nervous system to deregulate for longer periods, manifesting in symptoms like anxiety, depression, fatigue, and even cognitive difficulties. Let's delve into the four reactions in the context of chronic illness to see if you might recognize these behaviors or feelings you might be experiencing and what you can do about them.


First is FIGHT mode: A fight response you’ve likely heard about is a basic human response to stress where our bodies recruit hormones such as adrenaline to combine with blood flow to help us respond to overwhelming stresses - like a saber-toothed tiger in our presence. You’ve all felt it before because of being startled or the adrenaline rush you probably can recognize. In the context of chronic illness, it can manifest as a subconscious belief that by confronting our symptoms or challenges head-on, we can regain control over our illness or situation – which can be very challenging. Patients might experience signs of intolerable frustration due to dismissal and medical gaslighting causing their body to feel tense, have an upset stomach or IBS, cry often, become argumentative, or experience a tight clenched jaw caused by the overflow of these hormones.

A regular, healthy person in FIGHT mode could look like someone trying to exert control their circumstances in these ways:

  • Workaholic

  • Over-thinker

  • Anxiety, panic stricken

  • OCD or perfectionist

  • Hyperactivity or attention issues

  • Relentless sadness, unresolved grief or long-term loneliness

Someone in FIGHT mode due to chronic illness might demonstrate it in these ways:

· Have anxiety about their health

· Follow a strict adherence to treatment regiments

· Seem perfectionist in managing their symptoms

· Be constantly active pushing their limits, despite fatigue

· Possess feelings of sadness, frustration, and isolation


Second is FLIGHT mode: When faced with a dangerous situation, the body’s flight response corresponds typically with avoidant behavior - to literally get away from the tiger. When you're healthy, you're usually able to be discerning in stressful situations and disengage within limits. However, as an over sensitized EDSer or potential trauma victim, it can go a step further resulting in isolating yourself entirely. If we understand the goal of our prehistoric lizard brain is to seek comfort – then we believe we are able to escape the threat and avoid conflict, then we will not be harmed.

In the context of chronic illness patients, the flight response can manifest into patterns of avoiding reminders of the illness or the proverbial ‘burying your head in the sand’ approach. This could mean patients might evade necessary medical appointments, avoid discussions about illness, deny the scary realties of the situation, or try not to think about the symptoms or their impact on their ability to function. It's a method of coping by distancing oneself from the distressing reality of chronic illness, hoping that distance might offer a reprieve from the pain or discomfort.

A normal, healthy person in FLIGHT mode could exhibit the following behaviors:

  • Avoiding or hiding

  • Procrastinating

  • Self-harm

  • Eating or substance abuse problems

  • Hidden or explosive anger

  • Anxiety

Someone in FLIGHT mode due to chronic illness might demonstrate these behaviors:

· Avoid medical discussions or say they’re “fine” despite the facts

· Miss follow up doctor appointments

· Engage in distractions

· Withdraw from friends or support groups

· Reduce their compliance with treatments

· Not acknowledge symptoms or flare-ups

· Denial of illness severity

Keep in mind, both the fight and flight responses are normal for every human and completely expected behavioral responses due to the struggles of chronic stress and immune system over activity, but they are not always helpful. Also try to remember, these reactions are natural and can vary based on individual experiences with chronic illness. It's essential to be compassionate with oneself and seek support when navigating the challenges posed by chronic conditions.

Most people are aware of the fight or flight response, but not many are also aware of the two additional faces in fawn and freeze.


Third is the FREEZE mode: When healthy, the freeze response can help you slow down and appraise the situation carefully to determine the next steps. When unhealthy, the freeze response relates to dissociation and immobilizing behaviors. Think of putting your foot on the gas and the brake of a car at the same time. When this defense is enacted, it often results in literally "freezing"—feeling frozen and unable to move or finding yourself spacing out as if you're in a haze or detached from reality. You don't feel like you're really there, and you're mentally checked out as you leave momentarily from what's happening in your surroundings and what you're feeling in an attempt to find emotional safety. It‘s your body and brain’s way of going into survival mode from self-preservation instincts.

A healthy person in a FREEZE mode could look like:

  • Having difficulty making decisions

  • Feeling stuck

  • Dissociation

  • Isolating

  • Numb

  • Shutdown

  • Poor health or hygiene habits

  • Don’t sleep well, insomnia or frequent waking

The freeze response is one of the body's primitive, protective, and automatic reactions to a perceived threat. For a patient with chronic illness, the freeze response might manifest in various ways, as their body and mind cope with the ongoing stresses of their condition. Here's how it might appear:

  • Physical Immobility: The most recognizable sign of the freeze response is physical stillness. A chronic illness patient might become suddenly motionless, finding it hard to move or react, especially during episodes of pain or other overwhelming symptoms.

  • Mental Stagnation: Just as the body might become immobilized, the mind can also "freeze." This can result in difficulty thinking clearly, making decisions, or even spacing out entirely.

  • Overwhelming Emotions: The patient might feel trapped by their condition, leading to feelings of helplessness and hopelessness. These emotions can be so overwhelming that they cause the individual to shut down emotionally, appearing numb or detached.

  • Hypervigilance: Even in the freeze state, the person might be hyper-aware of their surroundings, internal bodily sensations, or symptoms. This heightened sensitivity can make them more prone to overreacting to minor triggers related to their illness.

  • Avoidance Behavior: As a protective mechanism, those exhibiting the freeze response might avoid situations or activities that they associate with exacerbating their symptoms. This can lead to decreased social interactions or avoiding certain treatments.

  • Dissociation: In extreme cases, the person might feel disconnected from their body or surroundings, as if they are observing things from outside themselves. This detachment can be a way for the mind to protect itself from traumatic experiences or overwhelming sensations.

It's essential to recognize that the freeze response is an involuntary physiological reaction. For chronic illness patients, it can be a way their body and mind cope with the constant stress of managing their condition. It's always beneficial to seek professional guidance if one believes they or someone they know is frequently experiencing the freeze response, as therapy or counseling can offer strategies to manage and mitigate its effects.


Fourth and often forgotten is FAWN mode: At its core, fawning is about people-pleasing and engaging in pacifying behaviors. It's characterized by prioritizing other people above all else by doing whatever they want to diffuse conflict and receive their approval. It seems good to be well-liked and defer to others to secure safety, but not when it's at the cost of losing yourself. Reaching a point where you abandon yourself and your needs to please others will eventually have you feeling depleted by those around you.

A healthy person in FAWN mode could look like:

  • People pleaser or enabler

  • Overwhelmed

  • No boundaries

  • Lack of identity

  • Codependent

  • Appeasing

  • Self- critical

For a chronic illness patient, demonstrating the fawn response might manifest in several ways:

  • Over-compliance with medical professionals: The patient might not voice their own concerns or disagreements with a treatment plan and might agree with everything a healthcare provider says, even if they have reservations or feel that their personal needs aren't being met.

  • Avoidance of conflict: Even if they are in pain or discomfort, they might not communicate their needs or symptoms accurately to avoid "bothering" their caregivers or medical professionals.

  • People-pleasing behavior: They may go out of their way to be helpful or overly cooperative with caregivers, family members, or even other patients, even at the detriment of their own health or well-being.

  • Deprioritizing your own needs: They might neglect their own needs, whether they are physical, emotional, or social, in an effort to not be a burden to others.

  • Difficulty setting boundaries: They might have trouble asserting boundaries with caregivers, family members, or medical professionals, leading to potential overexertion or participating in activities that might not be beneficial for their health.

It's important to recognize these behaviors and address them appropriately, ensuring that the patient's genuine needs and concerns are acknowledged and met. As previously mentioned, therapy or counseling can help chronic illness patients develop coping strategies and assertiveness skills to navigate their health journey without resorting to the fawn response.

Home Self-Assessment Tests to Know if You’re Dysregulated

There are a couple of simple ways to test if you’re dysregulated.

  1. Place your index finger under your nose, forcibly exhale 3-5 times to determine which nostril produces a stronger breath output. The right side seeming to have more breath or force can mean you’re in a sympathetic or dysregulated state according to NIH medical research. The left side means you’re feeling calmer in rest and digest- the parasympathetic state. Read more here on this phenomenon from the NIH.

  2. Look into a mirror and watch (or video record) the inside of your mouth while opening your mouth wide saying “AAAHHHHH” for a several seconds (like the doctor asks us to do). You’re watching for the ‘dangly part’ hanging in the back of your throat (called the uvula) to see if it’s bent slightly to one side or hanging straighter. Bent can mean you’re dysregulated. Straight usually means calm. Watch Dr. Ron Hauser’s YouTube video about this here.

If you discover you are indeed dysregulated, the best approach is to find ways to calm your ASS, sorry I mean your ANS- autonomic nervous system. But calming your ass down would likely help too LOL.

What You Can Do to Calm Your Automatic Nervous System (ANS)

Seriously, as hard as it is to turn the reflective mirror toward yourself and potential ongoing stress responses, did you recognize yourself or your behaviors aligned with any of these Fight, Flight, Fawn or Freeze states? Knowing the four faces of dysregulated ANS for whatever reason (illness, stress, trauma, etc.) can allow you to learn to recognize and track which triggers you might have and better recognize chronic or heightened stress with the goal that you might affect change and bring about more calm. There are several simple calming techniques you can try such as vagus nerve stimulation, somatic exercises or deep breathing techniques like ‘box breathing’ – Google it - that can foster a mind-body connection to heal the hyper-reactive responses and bring yourself back to a place of peace and restoration.

If you’re interested in learning more, check out this short 30 minute video on why we can feel dysregulated as chronic illness patients and suggested ways to disrupt the patterns with polyvagal toning exercises that are easy to do anytime, anywhere - featured in Christie Cox’s EDS Empower Hour webinar shared on YouTube.

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