Autistic Adults' Experiences of Camouflaging and Its Perceived Impact on Mental Health

Abstract

Background: Camouflaging (also referred to as ''masking'') is a commonly reported strategy used by autistic adults in everyday life to help them cope in social situations. Autistic adults report that camouflaging can have a devastating effect on mental health and well-being, yet little is known about the lived experiences of camouflaging and its impact. Methods: We designed an online survey in partnership with autistic adults, to explore the experiences of camouflaging and its impact on mental health. Participants self-reported the lifetime experience of camouflaging, where they camouflaged the frequency and length of time spent camouflaging. Four open questions allowed participants to elaborate their answers to the closed questions on frequency and length of time, and subsequently any positive and negative aspects of their experience of camouflaging. Two hundred seventy-seven autistic adults who self-reported a diagnosis of an autism spectrum condition (128 female, 78 male) or self-identified as autistic (56 female, 15 male) were included in the analysis of qualitative responses to the open-ended questions. Findings: We thematically analyzed participant answers from the open questions. Three main themes emerged. First, ''dangers of camouflaging'' described how the amount of time spent camouflaging led to exhaustion, isolation, poor mental and physical health, loss of identity and acceptance of self, others' unreal perceptions and expectations, and delayed diagnosis. Second, ''positive aspects of camouflaging'' included greater access to social spaces, and protection from harm. Camouflaging was, therefore, seen as necessary to survive in a world designed for the neurotypical majority. Third, autistic adults described being diagnosed and accepted for who they are as reasons for ''why I don't need to camouflage like I used to.'' Conclusions: Time spent camouflaging is what seems to be most damaging for the participants' mental health. The main reason reported for needing to spend so much time camouflaging is society's lack of awareness and acceptance of autism.

Exploring Autistic Adults’ Psychosocial Experiences Affecting Beginnings, Continuity, and Change in Camouflaging Over Time- A Qualitative Study

“…This fits with findings from a study by Sasson and Morrison (2019) that non-autistic people's first impressions of autistic adults improved with diagnostic disclosure and with increased autism knowledge. Overall, our findings echo recent qualitative studies that suggest that the transition to reduced camouflaging over time stems from a process of selfacceptance (aided by an autism diagnosis for some) and other-acceptance (Bradley et al, 2021;. The quote by participant [P07] presented earlier that talking to their classmates about being autistic resulted in them becoming a "fellowship" and a "safe space" for them aptly sums up the potential positive impact an autistic person's surrounding community can have.…”

“…and "automatic", resonating with experiences of autistic adults in other qualitative studies (Bradley et al, 2021;Cage & Troxell-Whitman, 2019;Miller et al, 2021). Many of our participants viewed this as an adaptive change from their earlier much more pressurising and taxing camouflaging efforts.…”

“…Despite camouflaging bringing several potential benefits to autistic people, such as enabling them to form relationships and find employment (e.g., Cage & Troxell-Whitman, 2019;Livingston et al, 2019), it has also consistently been described as stressful (Cage & Troxell-Whitman, 2019), physically and mentally exhausting (Bradley et al, 2021;Hull et al, 2017), confusing and detrimental to one's self-identity (Leedham et al, 2019), and a potential barrier to timely and accurate autism diagnosis (Bargiela et al, 2016;Begeer et al, 2013) and appropriate support (e.g., in the workplace; Livingston et al, 2019). Cross-sectional self-report questionnaire studies to date have found that increased camouflaging behaviours are associated with a range of poorer mental health outcomes in autistic people, including depression, anxiety, and suicidality (Beck et al, 2020;Cassidy et al, 2018Cassidy et al, , 2020Hull, Levy, et al, 2021).…”

Autism Through the Ages: A Mixed Methods Approach to Understanding How Age and Age of Diagnosis Affect Quality of Life

“…Renty and Roeyers’s ( 2006 ) study on linking QoL with formal services was interesting in that it was the perception of services and supports, rather than the actual usage of these supports, that predicted wellbeing in autistic adults. Receiving a diagnosis may also help reduce the urge to mask autistic symptoms (Bradley et al, 2021 ). Once diagnosed, autistic people feel more comfortable not conforming to neurotypical behavioral expectations.…”

Conceptualising Autistic Masking, Camouflaging, and Neurotypical Privilege: Towards a Minority Group Model of Neurodiversity

“…The present study aims to highlight how this Neurodiversity Movement campaign can improve research understandings of the social drivers of masking and camouflaging. The importance of researching this topic is highlighted through Autistic calls for social acceptance in the absence of masking and camouflaging (Bradley et al, 2021), alongside new research linking masking and camouflaging to poor mental and physical health (Cage et al, 2018;Lai & Baron-Cohen, 2015;Sasson & Morrison, 2019).…”