Consequences of autistic camouflaging

Everyone—with or without autism—camouflages at times. If you feel shy about meeting someone new, you might pretend to be brave even though you do not feel that way. But for autistic people, camouflaging is not just about acting confident.

Camouflaging

Many autistic people need to hide their autistic traits to avoid stigma and unwanted attention. Still, the deeper goal is generally because they want to make friends and form connections.^[1]“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions (Hull et al., 2017)^[2]Quantifying and exploring camouflaging in men and women with autism (Lai et al., 2017)^[3]Social camouflaging in autism: Is it time to lose the mask? (Mandy, 2019)^[4]Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder (Livingston et al., 2019) That might include forcing yourself to make eye contact (masking) or thinking of—and potentially rehearsing—a list of questions to ask when you meet someone new so you may avoid social faux pas (compensation).

Some people might camouflage when they are at school or work so that people do not treat them differently. Some autistics camouflage when they meet new people to make a good impression and maybe a new friend. Others will stop camouflaging once they know someone and think they will accept their natural selves. Camouflaging is not necessarily conscious or deliberate; finding ways to hide autistic proclivities or trying to be perceived as socially appropriate can happen even when the autistic person is unaware. In many cases, camouflaging starts out as a conscious strategy but quickly evolves into an automatic process. You can read more on the consequences of that here:

Masking: is it good or bad?

Benefits & motivations

Camouflaging is an adaptive and resourceful strategy to deal with social difficulties,^[5]Resilience in autism: Research and practice prospects (Lai & Szatmari, 2019) which obviously has some desirable outcomes, or we wouldn’t engage in it. Autistic people report that camouflaging can aid us^[6]“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions (Hull et al., 2017) in achieving goals such as getting an education and holding down a job or establishing relationships—perhaps in particular with non-autistic people.^[7]Quantifying and exploring camouflaging in men and women with autism (Lai et al., 2017)^[8]Social camouflaging in autism: Is it time to lose the mask? (Mandy, 2019)

According to research from 2019 by Eilidh Cage and Zoe Troxell-Whitman, autistic people most commonly report camouflaging for the following reasons:^[9]Understanding the Reasons, Contexts and Costs of Camouflaging for Autistic Adults (Cage & Troxell-Whitman, 2019)

• To fit in and pass [as neurotypical] in a neurotypical world
• To avoid retaliation and bullying by others
• To make a better impression (one rather sad example was an autistic man who camouflages because it made his wife less embarrassed to be seen with him)
• Out of habit after a lifetime of conditioning
• To address internalized stigma (one autistic person indicated camouflaging because they felt being themselves wasn’t good enough)

In terms of our professional lives, autistic people tend to camouflage for the following reasons:^[10]Understanding the Reasons, Contexts and Costs of Camouflaging for Autistic Adults (Cage & Troxell-Whitman, 2019)

• To communicate ideas or work
• To perform well at job or at university
• To aid in working with classmates or colleagues
• To get others to take one’s ideas, or work seriously
• To reduce awkwardness in social interactions

And the personal reasons for camouflaging are:^[11]Understanding the Reasons, Contexts and Costs of Camouflaging for Autistic Adults (Cage & Troxell-Whitman, 2019)

• To make friends
• To seem attractive to a potential romantic partner
• To appear likeable
• To bond with others
• To fit in with others

Consequences

But camouflaging also goes at the expense of personal well-being; research shows that camouflaging is associated with:^[12]Social camouflaging in autism: Is it time to lose the mask? (Mandy, 2019)

• Exhaustion — Autistic people describe camouflaging as both physically and mentally exhausting^[13]“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions (Hull et al., 2017)
• Stress & anxiety — Autistic people report feeling anxious and stressed after camouflaging^[14]“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions (Hull et al., 2017)
• Burnout — Camouflaging is commonly reported to be exhausting and stressful, potentially leading to autistic burnout^[15]Compensatory strategies below the behavioural surface in autism: a qualitative study (Livingston, Shah & Happé, 2019)^[16]Looking behind the mask: Social coping strategies of girls on the autistic spectrum (Tierney, Burns & Kilbey, 2016)
• Depression — Autistic people who reported camouflaging showed greater symptoms of depression and felt less accepted by others.^[17]Experiences of Autism Acceptance and Mental Health in Autistic Adults (Cage et al., 2018)
• Identity — The habitual practice of pretending not to be autistic can erode your sense of identity; autistic people report feeling as though they were not being their “true selves”, and camouflaging negatively impacted their identity^[18]“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions (Hull et al., 2017)^[19]The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype (Bargiela, Steward & Mandy, 2017)
• Suicidality — Camouflaging has also been found to be a risk marker for suicidality in autistic adults^[20]Risk markers for suicidality in autistic adults (Cassidy et al., 2018)

Camouflaging can also lead to more challenges, such as:^[21]The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype (Bargiela, Steward & Mandy, 2017)

• Misunderstanding — Because camouflaging can hide your difficulties, it can lead to people around you misunderstanding you and your needs
• Not getting help — Because camouflaging can hide your difficulties, it can lead to your needs being misunderstood or overlooked entirely, thus preventing you from getting the help you need—either from friends or family or from medical professionals
• Wrong help — Even worse, camouflaging can prevent medical professionals from assessing you correctly, which can lead to getting the wrong treatments. Those treatments can be a waste of time and money or even cause harm
• Delayed diagnosis — Because camouflaging can hide your autistic traits, it can delay your diagnosis or prevent it entirely

In addition, Cage, Di Monaco, and Newell (2018) have suggested that camouflaging may mediate the relationship between social stressors (e.g. bullying and lack of autism acceptance) and subsequent anxiety and depression.

How much do you camouflage?

You can find out by taking the CAT-Q

CAT-Q scores significantly correlate with autistic-like traits, but there are some other correlations:^[22]Gender differences in self-reported camouflaging in autistic and nonautistic adults (Hull et al., 2019)

• High CAT-Q scores correlate with social anxiety in both autistics and neurotypicals, with the exception of Masking
• In autistic people, the total CAT-Q score and the assimilation score negatively correlate with well-being. The higher your scores on these measures, the lower your well-being tends to be
• In neurotypical people, all CAT-Q scores negatively correlate with well-being—not just total score and assimilation
• In autistic people, all CAT-Q scores were correlated with depression and generalised anxiety

Conclusions

There is a strong association between camouflaging and mental health. Research found mental health is linked to the degree of camouflaging and not to the severity of autistic traits being camouflaged. Psychological distress, depression, generalized anxiety, social anxiety, suicidality, and decreased well-being are associated with higher CAT-Q scores.^[23]Looking good but feeling bad: “Camouflaging” behaviors and mental health in women with autistic traits (Beck et al., 2020)

In general, autistic females report camouflaging more often, in more situations and more of the time than autistic males. In addition, research has found that that camouflaging tends to decrease as the person identifies being autistic and discloses their diagnosis to others.^[24]Camouflaging in autism: A systematic review (Cook et al, 2021)