Mixed and Overlapping Patterns

Valsa Madhava, MD

7 days ago

4 min read

Updated: 1 day ago

Week 7 of the Symptom Patterns Series (Series 4)

Why many people don't fit neatly into one pattern — and why some symptoms are hard to place at all.

Why One Pattern Is Rarely the Whole Picture

The earlier articles described several recognizable patterns — threat and arousal, autonomic, motor, and changes in thinking, sensing, and self-experience. It would be easy to read those as separate boxes and expect that a person should fall into one of them.

In practice, it often does not work that way. A person experiencing benzodiazepine withdrawal may have features of more than one pattern at the same time, while some symptoms may not fit neatly into any of them.

The patterns are provisional, overlapping descriptions, not fixed categories. They are not meant to sort people into separate types.

Features of Several Patterns at Once

A person's symptom picture may draw on more than one pattern. For example:

Someone with prominent fear and a racing heart (threat and arousal) may also experience tremor and difficulty keeping still (motor).
Someone with digestive upset and light-headedness (autonomic) may also have mental fogginess and sound sensitivity (thinking and sensing).

These examples illustrate features from different patterns being present during the same period. They do not mean the symptoms share one cause, rise and fall together, or place the person in a particular category.

Symptoms That Are Hard to Place

Some symptoms do not fit neatly into the patterns described so far. People may report flu-like feelings, mucous-membrane symptoms, skin sensations, or new intolerances to certain foods, medicines, or sensory input such as light and sound.

These experiences are worth naming because they remind us that the patterns are not a complete map of withdrawal symptoms.

Naming them does not explain their cause. This article does not claim that they arise from the immune system, the autonomic nervous system, or any particular biological mechanism.

Another familiar example is what some people call "benzo belly" — digestive symptoms such as bloating, a hard or fluttering stomach, nausea, or changes in bowel habits. These symptoms may overlap several areas of regulation rather than fitting into one pattern.

The purpose is to recognize and describe the experience, not to assign it a single explanation.

What the Overlap Tells Us

Overlap is not a flaw in the patterns. It is part of the complex symptom picture this series is trying to describe.

The author's exploratory cross-sectional analysis of symptom reports from 39 people found evidence of overlapping, multidimensional symptom organization rather than cleanly separated groups. However, this analysis has not established validated subtypes or shown how these symptom relationships change within individuals over time.

Within the Five-Axis Stress Biology Framework™ educational framework, symptoms associated with several regulatory areas may be represented within one person's clinical picture. The framework helps describe that spread; it does not sort people into types.

What This Means for You

Recognizing patterns was never meant to place a person under one heading. The goal is to make a complicated experience easier to understand and describe.

Your symptoms may resemble more than one pattern. Some may not fit any of the patterns described in this series.

That does not mean the symptoms are unimportant or that the patterns have failed. It simply reflects the limits of using broad descriptions to organize a complex experience.

These patterns can provide a shared language for patients and clinicians. They are not diagnoses, do not establish the cause of individual symptoms, and do not replace appropriate medical evaluation.

Transition to Why Different Symptoms Become Prominent

Patterns can overlap, and the symptoms that stand out may also change over time. A racing heart may become less noticeable while poor sleep or sensory sensitivity becomes more prominent. This does not mean that one entire pattern has changed into another.

The next article examines this question: Why Different Symptoms Become Prominent.

Figure 7. Overlap Between Patterns

This figure illustrates how a person's symptom picture may include features of several provisional patterns. The overlapping regions represent the possibility of symptoms spanning more than one pattern, not separate biological categories or mechanisms. The box on the right gives examples of symptoms that are difficult to place within these broad descriptions. The figure does not establish that overlap occurs in every person or that symptoms rise and fall together over time.

About the Evidence

These patterns are provisional educational descriptions informed by published withdrawal literature, the author's own exploratory cross-sectional analysis of 39 people (in preparation for publication), the Five-Axis Stress Biology Framework™ educational framework, and clinical observation.

They are not diagnoses or fixed subtypes and do not establish a mechanism. The available evidence suggests that symptom organization can be overlapping and multidimensional, but it does not validate these named patterns or establish how symptoms change together within an individual.

Some symptoms remain difficult to place within these broad descriptions. Naming them does not establish their biological cause. These descriptions do not replace individual medical evaluation, and medication changes should not be made on the basis of them alone.

Selected Scientific References

Ashton, H. (1991). Protracted withdrawal syndromes from benzodiazepines. Journal of Substance Abuse Treatment, 8(1–2), 19–28. https://doi.org/10.1016/0740-5472(91)90023-4
Shade, K. N., et al. (2025). Long-term neurological consequences following benzodiazepine exposure: A scoping review. PLOS ONE, 20(8), e0330277. https://doi.org/10.1371/journal.pone.0330277

The withdrawal literature describes a broad, varied symptom set, including symptoms that may be difficult to place within any single pattern. This article names those experiences without assigning them a particular biological mechanism. The Series 4 organizational analysis is the author's own exploratory analysis of the same 39-person symptom matrix, in preparation for publication and not yet posted or externally replicated.

For educational purposes only. Not a substitute for individual medical evaluation.