Autistic Masking in Women and Girls | Our Blog

Author: Maria Bell

 

Since its identification in the 1940s, autism has been viewed through a male lens. This has led to a significant oversight in the diagnosis and understanding of autistic women and girls. For decades, the autistic traits presented by women often didn't fit the classic diagnostic stereotype (like lining up toy trains or overt difficulties in socialising).

Instead, many autistic women develop highly sophisticated, internalised coping mechanisms known as masking. This intense, pervasive, and often unconscious effort to suppress autistic traits and imitate neurotypical social behaviour is the single biggest factor contributing to the under-diagnosis and misdiagnosis of autism in females (Lai et al., 2015; Botha & Gillespie-Lynch, 2022).

Differences for autistic women

Research overwhelmingly suggests that autistic women tend to mask more frequently and more effectively than their male counterparts (Hull et al., 2017). This difference can be attributed to several social and psychological factors:

• Social Expectations: Girls are typically socialised to prioritise conformity and empathy. This intense pressure to be agreeable and socially skilled drives many autistic girls to become hyper-aware of social cues and expectations, leading to more elaborate masking efforts.
• Motivations for Connection: Autistic women often report a strong desire for peer relationships, even if the execution of those relationships is challenging. They may mask heavily not just to avoid bullying, but actively to seek and maintain social bonds.
• Internalisation of Traits: While autistic boys and men might externalise their distress (e.g. through noticeable meltdowns), autistic girls and women are more likely to internalise difficulties, which manifests as anxiety, depression, and self-criticism, further masking their autism beneath mental health difficulties and sometimes leading to missed or misdiagnosis.

 The Tools of the Mask

Autistic women frequently use unique and demanding camouflaging strategies that are particularly effective at fooling diagnostic systems and even themselves.

Autistic women are particularly adept at observational learning:

Hyper-Attention to Detail: They keenly observe non-autistic peers in TV shows, movies, and real life, meticulously collecting information on appropriate behaviour, tone, and body language.

Complex Scripting: They might pre-plan responses, rehearse entire conversations, and prepare exit strategies. If an interaction deviates from the planned script, this can lead to overwhelming anxiety.

Forced Eye Contact: While potentially painful and cognitively distracting, many autistic women force themselves to make eye contact in order to appear ‘neurotypical’.

 

“Sometimes I’ve noticed that I’ve internalised masking as a survival strategy, without even knowing that I’m doing it”

 

While focused interests are a core autistic trait, women often use their interests in ways that blend in:

• Socially Appropriate Interests: Their interests might centre on ‘socially acceptable’ or hyper-feminine topics, such as pop culture, specific fashion trends, or observing celebrity social dynamics, which can help them blend in with societal norms.
• Curation of Friendships: Some women develop an interest in ‘collecting’ or ‘curating’ friends, treating social relationships themselves as a highly organised, systematic interest, where they analyse and classify interactions to predict outcomes.

 

Autistic women are experts at concealing their sensory distress:

• Subtle Stimming: They often replace obvious stims (such as rocking or hand-flapping) with more subtle or ‘socially acceptable’ movements, such as tapping a foot under a table, playing with jewellery, doodling, or fiddling with their hair.
• Faking Tolerance: They may actively suppress the urge to flee or react to overwhelming sensory input (e.g. loud music, perfumes, scratchy clothing), instead internalising the physical pain and distress until they reach a safe place to have a delayed reaction in private.

 

“I am a fidgeter and often find something to play with in my hands like a pen or a piece of paper which helps to make me feel less stressed… I don’t really stim in an obvious way”

 

The Consequences of the Masking

The significant cognitive effort required for effective, lifelong masking carries severe and well-documented psychological and physical health costs.

Delayed Diagnosis and Misdiagnosis

The effective camouflage may contribute to the significantly later diagnosis of autistic women than men, often in their 20s, 30s, or later (Lai et al., 2015). This delay means decades without appropriate understanding or support.

Common Misdiagnoses: Many masked autistic women receive diagnoses for conditions that are secondary to the stress of masking, such as:

• Generalised Anxiety Disorder (GAD)
• Major Depressive Disorder (MDD)
• Emotionally Unstable Personality Disorder (EUPD, previously BPD)
• Eating Disorders

 

Exhaustion and Burnout

Sometimes, the constant performance leads to chronic, debilitating exhaustion, known as autistic burnout.

• Autistic Burnout: This is a severe form of exhaustion marked by a temporary or long-term loss of skills (e.g. ability to speak, manage daily tasks, or maintain the mask), intense fatigue, and significantly increased sensory sensitivity (Higgins et al., 2021). Burnout often happens when the energy required to mask finally collapses.
• Physical Health: the stress of masking and burnout can manifest as physical health problems, including raised cortisol levels, tension headaches, physical exhaustion, and other stress-related illnesses. 

“The exhaustion that comes from masking can put me into a heightened emotional and anxious state, making me more vulnerable to meltdown or shutdown”

 

3. Elevated Suicide Risk

Crucially, research has identified a direct and alarming link between autistic masking and an increased risk of suicidal ideation and attempts in autistic adults (Cassidy et al., 2018). This risk is likely driven by the cumulative distress from chronic burnout, lack of acceptance, and the emotional toll of social pressure.

Unmasking: Towards Acceptance and Self-Discovery

Masking is not an individual coping mechanism, but a survival skill for the ‘neurotypical’ designed society. Therefore, to reduce the pressure on autistic women to mask, we need greater neurodiversity acceptance in society.

• Affirming Support: Clinicians, partners, and family members must understand that any autistic person can experience burnout from masking while hiding it well. Listen to the person’s internal struggles, rather than judging their external presentation. Support should focus on validating the individual's sensory and social needs. Give autistic people time to recover from social interaction to reduce burnout from masking.
• Creating Safe Spaces: Autistic women need safe environments to drop the mask, embrace their natural stimming, communicate authentically, and explore their true interests without fear of judgment. Consider what reasonable adjustments you can make to accommodate the individual. For employers, read blog post on how to support your autistic employees better: Creating an Autism-Friendly Workplace: Supporting Your Autistic Employees | Our Blog - South London and Maudsley
• Peer Community: Connecting with other autistic women is vital. Sharing experiences of camouflaging and burnout provides validation and allows for the development of an authentic autistic identity (Botha & Gillespie-Lynch, 2022).

 

“I’ve been working remotely for the last few years, which has really helped as there is less demand for masking as I can turn off my camera if I need to... I can work more hours now because I save energy on masking. Before, I found work a lot more exhausting and had to work a lot fewer hours.”

 

By recognising the intense, often-hidden effort of autistic masking in women, we can shift the focus from pushing conformity to fostering acceptance, ensuring that autistic women can lead supported, authentic, and fulfilling lives, free from the pressures of masking.

Thank you to the autistic women who shared their quotes and experiences for this blog piece. 

Want to learn more?

There are still a few places available for our upcoming ‘Autism and Women’ programme in January 2026. Read more here and book your place: Estia Module 1 - Autism and Women - South London and Maudsley

If you or someone you know is experiencing suicidal thoughts, please call NHS 111 to be connected to a crisis line or text SHOUT to 85258. More support is available here: Help for suicidal thoughts - NHS

About the author

Maria is the Learning and Development Lead at the Estia Centre. She delivers many of our training programmes, from short course webinars to multi-day-long workshops, including the Oliver McGowan Lead Trainer training on Autism and Learning Disability.  

References

• Botha, M., & Gillespie-Lynch, K. (2022). How do Autistic and Non-Autistic Women Experience and Understand Camouflaging? A Mixed Methods Study. Journal of Autism and Developmental Disorders, 52, 4075–4089.
• Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(42)
• Higgins, J. M., Arnold, S. R. C., Foley, K. R., & Trollor, J. N. (2021). The experience of autistic burnout: A qualitative study. Autism, 25(2), 438–448
• Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M-C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534.
• Lai, M-C., Veenstra-Vanderweele, J., & Weinberger, D. R. (2015). Molecular neurobiology of autism: The search for the next generation of therapeutics. Current Psychiatry Reports, 17(12), 101.