A review published in Autism in Adulthood explores the concept of autistic masking and its psychosocial origins. Masking refers to the tendency to suppress a natural autistic response in favor of alternatives that are perceived as more socially acceptable. In this research article, the authors provide a comprehensive overview of masking and suggest directions for future research.

Masking encompasses a range of behaviors, including making eye contact despite feeling uncomfortable doing so or avoiding discussing special interests for fear of judgment. The authors hypothesize that masking largely stems from the marginalization of people with autism.

Surveys conducted among autistic people reveal frequent experiences with bullying, harassment, and ostracization. Even in the medical field, autistic traits are frequently seen as symptoms to be “cured” rather than understood or accepted.


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“[A]utistic people are viewed as being on the fringe of human normality both in academia, and in society in general,” the authors write. Thus, autistic masking is often a result of the desire to “pass as normal” and avoid external stressors, such as bullying.

Masking, however, is associated with significant internal stress, burnout, and even suicidality. In many individuals, frequent masking can result in the inability to identify or regulate stress.

The authors of the review urge the medical community to acknowledge masking as a “fully interactive construct” of autism and to investigate means of stress reduction among those negatively impacted by masking. For autistic people who experience marginalization from other aspects of identity, masking-related stress may be compounded.

The gender gap in autism diagnoses is well-noted: About 1 woman is diagnosed with autism for every 4 men. The many reasons for this gender gap include homogeneity in the original diagnostic criteria and the small number of women enrolled in early autism studies.

Although research is inconclusive about whether women are more likely to mask than men, some studies suggest that women with autism may show a greater difference between self-reported autistic traits and observed autistic traits. However, the authors write, the measurement of self-reported and observer-rated autistic traits is based on tools developed with male patients in mind.

Existing metrics for autism likely exclude individuals with “atypical” manifestations of autism. “A reliance on stereotypical…expectations of what an autistic person might ‘look like’ to an observer means that a person not fitting this stereotype may be coded as masking, as opposed to a recognition that autistic people vary in their behavioral expression as much as the nonautistic population,” the authors write.

To better accommodate the full spectrum of people with autism, the authors advocate for expanded research into both masking and traits of autism as a whole. The relationship between autistic traits and identity is complex and often not appropriately considered in autism research.

“Future research should [also] consider…the outside pressures that led to the initial development [of masking], and the impact that this has had upon the individual,” the authors wrote. “The interaction between these processes and outcomes is likely to be an essential factor in understanding what can be done to provide better support for those whose mental health is negatively impacted by masking.”

Reference

Pearson A, Rose K. A conceptual analysis of autistic masking: understanding the narrative of stigma and the illusion of choice. Published online January 22, 2021. Autism in Adulthood. doi:10.1089/aut.2020.0043

This article originally appeared on Psychiatry Advisor