Introduction
In an era where autism awareness continues to grow, one critical aspect often remains hidden in plain sight: autism masking. This strategy, used consciously or unconsciously by some autistic people to appear non-autistic in order to blend in and be more accepted in society, carries profound implications for mental health and wellbeing. Understanding masking is crucial as we work toward a more inclusive world for neurodivergent individuals.
What Is Autism Masking?
Defining Masking
Masking is a strategy used by some autistic people, consciously or unconsciously, to appear non-autistic. Masking is the process of intentionally, or unintentionally, hiding aspects of yourself to avoid harm. Masking is sometimes referred to as ‘camouflaging’, ‘social camouflaging’, ‘compensatory strategies’ and ‘passing’.
The Mechanics of Masking
Research suggests autistic people learn how to mask by observing, analysing and mirroring the behaviours of others – in real life or on TV, in films, books, etc. The specific behaviors involved in masking can include:
- Making and maintaining eye contact despite being uncomfortable doing so
- Supressing repetitive hand movements, forcing eye contact, using conversational scripts, and using learned rules to respond to others’ non-verbal behaviour
- Mimicking facial expressions and social gestures
- Suppressing stimming behaviors in public
- Following predetermined social scripts
The Scope of Masking
Masking can happen in formal situations such as at school or work and in informal situations such as at home with family or socialising with friends. Although there may be elements of masking that seem familiar to everyone, such as changing how you present yourself in certain formal situations, autistic people have emphasised that masking is different to this. Masking is described as making efforts to manually act in ways that come naturally to non-autistic people, to meet social expectations and blend into society through exhausting effort that can lead to autistic burnout and other mental health issues.
Current Statistics and Prevalence
Rising Autism Diagnoses
The latest research in 2023 from the CDC shows that one in 36 children is now diagnosed with autism. This is an increase from one in 44 children two years ago. The 2023 prevalence estimate from data collected in 2020 is roughly 317% higher than estimates from 2000.
Gender Differences in Masking
Research reveals significant gender disparities in masking behaviors:
- People across the entire gender spectrum engage in masking, studies show, but people who identify as women may mask more often than people who identify as men
- Girls with autism may present different symptoms than boys, or they may be better at masking their symptoms in social situations. The CDC estimates that 1 in 189 girls are diagnosed with autism
- Women, girls, nonbinary people, and people of color report higher masking rates. This is likely due to misconceptions and stereotypes about what autism does or doesn’t “look like.”
Study Findings on Masking Prevalence
We conducted an online survey about experiences and views of masking in autistic people (n = 144), neurodivergent people without an autism diagnosis (n = 49), and neurotypical people (n = 45). Of these 461 participants, 144 autistic, 45 NT, and 49 ND- people provided textual data about masking.
The Mental Health Impact of Masking
Direct Psychological Effects
The mental health consequences of masking are both severe and well-documented:
Autistic people who mask more show more signs of anxiety and depression, and the strategy may even been linked to an increase in suicidal behaviours.
Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression.
Autism-Specific Mental Health Statistics
The mental health challenges faced by autistic individuals are staggering:
- Approximately 8 in 10 autistic people have a mental health problem in their lifetime, in comparison to 1 in 4 of the general population
- A 2019 meta-analysis found autistic people to be four times more likely to have depression than non-autistic people, with approximately 40% of autistic adults having depression
- Almost 10% of autistic youth and 15% to 25% of autistic adults have attempted suicide. Rates of suicide attempts and suicidal ideation are the same for people formally diagnosed with autism and people who have typical intelligence and are believed to be autistic but have not been diagnosed
The Exhaustion Factor
To put it simply, it is exhausting. People who mask regularly often say they feel drained and exhausted by the effort of trying to conform to neurotypical standards of behavior.
Both autistic and nonautistic participants wrote of the exhaustion and burnout that masking can bring, impacting on physical and mental health. For example, one autistic participant wrote, “I can manage to exist in an NT world as long as I’m ok mentally, if I’m stressed … it all turns to jelly, as do I”.
Autistic Burnout: The Ultimate Consequence
Defining Autistic Burnout
Autistic adults described the primary characteristics of autistic burnout as chronic exhaustion, loss of skills, and reduced tolerance to stimulus. Our findings confirm Raymaker et al.’s definition of autistic burnout as a syndrome characterized by long-term exhaustion, reduced ability to function, and increased sensory sensitivity caused by masking and life stressors that negatively impact mental health and quality of life.
The Connection Between Masking and Burnout
Masking or “camouflaging” to pass as nonautistic was the most common reason participants gave for autistic burnout. Masking is consistently one of the highest predictors of burnout.
Masking their autistic traits, for example by suppressing autistic behaviours, pretending to be non-autistic, or working very hard to act in a non-autistic way represents a significant life stressor that contributes to burnout.
Long-term Consequences
Autistic burnout had many negative effects on their lives. Many highlighted difficulties with their health, especially their mental health. They talked about struggling with independent living, loss of self-belief, and being frightened that the loss of skills from the autistic burnout might be permanent.
The adults in this study said that autistic burnout was often first experienced during adolescence, lasted months or years, and was hard to recover from. They described severe direct and indirect consequences for their physical and mental health, capacity to function, and ability to achieve personal goals.
Who Is Most Affected by Masking?
Gender and Identity Factors
Research consistently shows that certain groups are more likely to engage in masking:
Women with ASD are more likely than men to engage in masking for conventional reasons, such as in an effort to succeed at work or school. Women who use masking have reported that the practice takes extreme cognitive effort and leaves them feeling anxious and exhausted.
Late-Diagnosed Individuals
People who are diagnosed with autism later in life tend to mask more than those diagnosed as children or in adolescence. For folks who weren’t diagnosed with autism until later in life, it is common to have unconsciously masked for many years.
Especially for people who discover their autistic identity later in life, it is common to have masked unconsciously for many years, meaning it can be difficult for those people to know what kind of a person they would have been and what interests and characteristics they would have allowed themselves to develop if they hadn’t suppressed their autistic traits and natural instincts throughout their life.
Educational Achievement and Masking
Camouflage is apparently a set of strategies and self-control skills used by autistic females who are more self-aware of their autistic symptoms. This also explains why camouflage correlates positively with university education.
The Paradox of Masking Success
The Invisible Struggle
Ironically, a study I recently conducted with colleagues found that masking didn’t change the judgements that non-autistic peers made towards autistic people’s social behaviours. Even when an autistic person is masking, non-autistic people will still rate them more harshly than non-autistic peers if they don’t know they are autistic. This unconscious bias is evident throughout society for anyone deemed to behave or think atypically by neurotypical standards.
Delayed Diagnosis
Masking can delay the diagnosis of ASD or lead to misdiagnosis, thus preventing individuals from receiving prompt, appropriate treatment. Some people are so successful with masking that their autism isn’t identified until they are much older. That delay can lead to mental health issues because people don’t get the support or understanding they need.
Specific Mental Health Consequences
Identity and Self-Concept Issues
Some people who mask their identity, interests, and traits end up feeling that they no longer know who they really are. Some have said masking feels like self-betrayal; others have said masking makes them feel they’re deceiving other people.
When late-diagnosed autistics finally learn of their neurodivergence, they might experience identity struggles or feelings of isolation. Chronic, unconscious masking can leave people confused about who they would have been if they didn’t constantly feel the need to suppress their autistic traits and interests.
Suicidal Ideation and Behaviors
The connection between masking and suicidality is particularly concerning:
Autistic participants also reported that masking can lead to increased suicidality, “I didn’t learn that I only get suicidal during meltdowns until I removed all masking obligations … I spent 13 years burnt out”.
Some people related an increase in suicidal ideation and suicidal behaviour as a consequence of autistic burnout, which is often triggered by prolonged masking.
However, it showed that masking led to feeling like a burden, which in turn led to more suicidal thoughts over the course of a lifetime.
Physical Health Impacts
Masking autistic characteristics and suppressing your needs, preferences, instincts and coping mechanisms (such as stimming) can result in: distressed behaviour, including meltdowns and/or shutdowns (often only expressed when it can’t be held in any longer or when the individual feels safe enough in their environment to do so, such as when they get home from school) mental and physical exhaustion (which can lead to autistic burnout).
Barriers to Support and Understanding
Professional Misunderstanding
They described a general lack of knowledge about autism, especially among health care professionals, which led to misdiagnosis and inadequate or inappropriate treatment.
Social Stigma and Discrimination
Outcomes of discrimination for autistic people include masking, social isolation and exclusion, trauma, and mental health problems. This discursive paper discusses the discrimination experienced by autistic people in health, education, employment, and media settings.
Overall, stigma, discrimination, and low awareness and acceptance of autism were responsible for the cycle of autistic burnout.
Recovery and Support Strategies
Community and Acceptance
Acceptance and support – interacting with others who could accept them for who they were, without any need to masking or pretend. This could be one-on-one with family members or friends; on a community level of groups with accepting cultures; or on a peer level, especially finding other autistic people who could validate their experiences and offer information and emotional/social support from lived experience.
The autistic community was an essential source of information and support for participants.
Unmasking and Self-Advocacy
Being autistic – attending to autistic needs like stimming and spending time with intense interests and comfort items, unmasking, using autistic strengths or doing things in an autistic way.
Self-advocacy and health – learning how to set healthy boundaries and expectations from others, and what to do when others aren’t respecting boundaries. Learning how to ask for help in a way others might be responsive to, and leading as healthy a lifestyle as possible.
Professional Support
Formal supports – receiving reasonable adjustments at school or work, physical support like someone to provide groceries, and mental health support.
Autistic people may find it helpful to speak to a therapist or professional for support if thinking about using these types of behavioural experiments.
Prevention and Awareness
Societal Change
The best solution to reducing the need for autistic people to mask is to spread awareness to non-autistic people of different neurodiverse behaviours and thinking patterns. When non-autistic people know someone is autistic, they seem to judge them less harshly.
One way to minimize the harmful effects of masking autism is to work toward a world in which neurodiverse people are accepted as they are, and people are treated with respect and kindness whether they communicate in neurotypical ways or not.
Professional Education
We recommend that therapists and clinicians learn to recognise autistic burnout in clients and offer strategies for relief. In general, we recommend others be aware of the potential dangers of teaching autistic people to mask or suppress their autistic traits.
Early Identification
Children who receive an Autism diagnosis by age 4, are more likely to receive services that lead to improved long-term outcomes. This confirms the need to urgently increase our capability to screen and effectively diagnose children as early as possible; the Autism Society recommends that children be screened at least three times before age three (9, 18, and 24 or 30 months), so that they can be referred for services to have the best chance of success to live fully.
The Path Forward
Understanding autism masking and its profound impact on mental health is crucial for creating a more inclusive society. Masking may help at times, but regular masking can have serious effects on mental and physical health. This may include anxiety, depression, exhaustion, a loss of identity, and suicidal thoughts.
The research is clear: masking takes a devastating toll on autistic individuals’ mental health and wellbeing. As we continue to learn more about autism and neurodiversity, it becomes increasingly important to create environments where autistic people can be their authentic selves without fear of judgment or discrimination.
By raising awareness, improving professional understanding, and fostering acceptance in our communities, we can help reduce the need for masking and support the mental health of autistic individuals across the lifespan.
Conclusion
Masking in autism represents a complex survival strategy that, while sometimes necessary in the current social climate, carries significant mental health costs. Recent research has suggested that autistic people might mask a lot and that this can lead to long-term problems in mental health. The statistics are sobering: higher rates of depression, anxiety, suicidality, and autistic burnout are all linked to masking behaviors.
As our understanding of autism continues to evolve, it’s essential that we work toward a world where the need to mask is reduced through increased acceptance, better support systems, and greater awareness of neurodiversity. Only then can we truly support the mental health and wellbeing of autistic individuals and help them thrive as their authentic selves.
References:
- National Autistic Society UK – Masking: https://www.autism.org.uk/advice-and-guidance/topics/behaviour/masking
- Pearson, A. et al. (2021). “Masking Is Life”: Experiences of Masking in Autistic and Nonautistic Adults. Autism in Adulthood: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8992921/
- Bradley, L. et al. (2021). Autistic people and masking. National Autistic Society: https://www.autism.org.uk/advice-and-guidance/professional-practice/autistic-masking
- Young, H. et al. (2021). Is social camouflaging associated with anxiety and depression in autistic adults? Molecular Autism: https://molecularautism.biomedcentral.com/articles/10.1186/s13229-021-00421-1
- Healthline. (2021). Understanding Autism Masking and Its Consequences: https://www.healthline.com/health/autism/autism-masking
