Is Autistic Camouflaging Really Bad for Your Health?

The true impact of masking in women with autism.

Posted Oct 16, 2020

“Camouflaging,” also known as masking, is a strategy used by people with autism to help them “pass” as “normal” and blend in with their neurotypical peers. Camouflaging includes behaviours such as copying or mimicking the behaviour of neurotypicals, constantly changing one's image, learning “scripts” for future social situations, and hiding aspects of one’s personality which are considered unacceptable or inappropriate.

Autistic women aren’t the only people to camouflage—neurotypicals of both genders,1 as well as autistic men,2 also engage in this behaviour—but they do tend to mask to a higher degree than other groups (including their male autistic counterparts).

alphaspirit, 123rf
Source: alphaspirit, 123rf

Where’s the harm in masking, you might ask, particularly if it can help you secure a job or make friends? There are several areas to consider.

1. Lack of self-acceptance.

When you start from the perspective that you need to downplay your personality and express yourself in a way which isn’t authentic, you may develop a lack of self-acceptance and self-worth. You (and others) may see yourself as not just "shy," but too shy. You're not just “direct”; you’re too direct. You’re not just enthusiastic, you're too enthusiastic. Too tantrummy, too obsessive, too blunt, too sensitive—the list goes on.

There is a strong judgement inherent in these statements that your true self is not acceptable. And so, at the same time as you’re learning to smile, ask questions, and stifle your boredom when you’re subjected to small talk, you learn to hide, suppress, and deny those parts of your personality which other people consider less acceptable—until you consider them to be unacceptable, too. 

2. Suppressing interests and making inauthentic choices.

Judging yourself as unacceptable because you’re a bit different from many other people goes far beyond learning a few social skills. It means that you stop listening to and recognising what you need to feel fulfilled in life. It means making choices which don’t fit with your values or meet your needs. And it means that you lack the courage to show the rest of the world your wonderful personality because you are scared of rejection and judgement. 

3. Mental health issues.

Camouflaging has been linked to mental health issues including depression, anxiety,3 and suicidality.4 Research has shown that mental health issues tend to be related to the degree of masking a person engages in, rather than the severity of their autism.5 Consistently having to check in with yourself as to whether you’re following the script, acting in an appropriate way, and whether you’re about to say or do something wrong creates a huge amount of pressure and, consequently anxiety. Feeling that you’re unacceptable as you are can lead to low self-esteem and depression. 

4. Seeking help.

Women with autism often find it hard to seek out help, partly because they present as so “normal.”6 Primary caregivers may refuse to accept that they have a problem and may say things like, “But you’re having a conversation and looking into my eyes—that doesn’t seem like autism.” Having become so adept at camouflaging, it’s difficult to convey to others that yes, you do have issues with communication and other aspects of life—you’re just very good at hiding them.

5. Loss of a sense of self.

When you’re constantly trying to be all things to all people, you can experience a loss of a sense of self in the process. Camouflaging can lead to identity problems and an inability to know what it is you want from life and how to create a life which feels authentic. 

Until you can accept who you are and value yourself deeply enough to bring your true, authentic self to others, you will experience an incongruence between your values and your actions. When you keep acting in a certain way because you think you should—even when it feels wrong to you—you will end up anxious and disillusioned. When you fail to get in touch with what excites and nurtures you—because those things are considered weird and unnecessary—you will feel unfulfilled. When you cannot reveal who you are and what matters to you, you will feel frustrated and unseen. 

Taking the first tentative steps towards authenticity involves getting in touch with who you are and what you need and want out of life. When you’ve spent a lifetime being all things to all people, this can be particularly challenging. It’s a tough call for anybody and especially challenging for someone who is starting from a different point than most people—the point of being neurodiverse in a neurotypical world. 

Many women keep using masking as a coping strategy until they reach a point where camouflaging is causing them more difficulties than it is the solution to their problems. Learning as much as you can about autism, and identifying the ways in which you tend to camouflage—and the impact that camouflaging is having on you—is the first step in being able to move beyond the mask and embrace aspects of yourself which may have felt unacceptable in the past. 

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1.    Livingston, LA, Shah, P, Happe, F (2019) Compensatory strategies below the behavioural surface in autism: A qualitative study. Lancet Psychiatry, 6(9), 766-777

2.    Hull, L, Mandy, W, Lai, M-C, Baron-Cohen, S, Allison, C, Smith, P, Petrides, KV (2019) Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819-833

3.    Bargiela, S, Steward, R, Mandy, W (2016) The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281-3294

4.    Hirvikoski, T, Boman, M, Chen ,Q, D’Onofrio, BM, Mittendorfer-Rutz, E, Lichtenstein, P, Bolte, S, Larsson, H (2019) Individual risk and familial liability for suicide attempt and suicide in autism. A population-based study. Psychological Medicine, 1-12

5.    Lai, M-C, Lombardo, MV, Ruigrok, AN, Chakrabarti, B, Auyeung, B, Szatmari, P, Baron-Cohen, S (2017) Quantifying and exploring camouflaging in men and women with autism, Autism, 21, 690-702

6.    Gould, J & Ashton-Smith, J (2011) Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice (GAP), 12(1), 34-41