Looking good but feeling bad: “Camouflaging” behaviors and mental health in women with autistic traits

Abstract

Autistic traits are associated with frequent psychological distress, suicidal ideation, and everyday functional challenges. These associations may be especially prominent in women. Some women with autistic traits “camouflage” feelings of awkwardness in typical social situations by effortfully engaging in expected social behaviors. We explored camouflaging because emerging evidence posits an association between camouflaging behaviors and poorer outcomes related to mental health, daily functioning, and access to mental health care. We recruited a sample of 58 women (age M = 25 years; IQ M = 115) who reported that they find social situations confusing and who scored high on a measure of broad autistic traits ( Broad Autism Phenotype Questionnaire score > 3). The majority of participants reported significant levels of psychological distress, suicidal ideation, and daily functioning difficulties. Regression models showed that camouflaging efforts ( Camouflaging Autistic Traits Questionnaire) and autistic traits ( Social Responsiveness Scale, Second Edition) modestly but significantly predicted psychological distress and functional challenges, respectively. In a subgroup of participants with high Camouflaging Autistic Traits Questionnaire scores, camouflaging scores were significantly associated with psychological distress and functional challenges. Camouflaging may help predict when clinicians should be concerned about higher mental health distress in autistic women and may be beneficial to measure as part of a comprehensive, multimethod assessment of mental health in women who report difficulties fitting into social situations. Lay Abstract Women who try to hide or “camouflage” their autistic traits are likely to report that they feel distressed, think of suicide, and/or struggle to function in everyday life. We asked 58 women with autistic traits to complete questionnaires about camouflaging and mental health. Most of these women did not have a formal diagnosis of autism, yet a majority reported that they camouflaged autistic traits, and a large majority reported significant mental health challenges. Some researchers have suggested that women with autistic traits are more likely than autistic men to experience mental health challenges because women may try more to “fit in” socially by camouflaging their autistic traits. Analyses showed that camouflaging was associated with feeling distressed (depressed, anxious, and/or stressed). For women who reported above-average levels of camouflaging, camouflaging was also associated with having thoughts about suicide and struggling to function in everyday life. Trying to camouflage autistic traits was associated with mental health challenges, regardless of whether those traits were very mild or more severe. The findings of this study may influence how mental health professionals evaluate and treat women with autistic traits.

Camouflaging in Autism: Examining Sex‐Based and Compensatory Models in Social Cognition and Communication

“…In consideration of their better TOM skills, it may be the case that members of the Unknown group are aware of how they are viewed by others and this insight contributes to their anxiety. This finding supports the growing literature of higher stress and anxiety [Cage & Troxell-Whitman, 2019], psychological distress [Beck, Lundwall, Gabrielsen, Cox, & South, 2020] threats to self-perception , and experiences of thwarted belongingness and suicidality [Cassidy et al, 2020] associated with varying levels of camouflaging behaviors in males and females with ASD. Interestingly, the fact that there were a higher number of females and are comprised of individuals who demonstrate and report more anxiety suggests that this group requires additional characterization to understand and support their needs.…”

Is social camouflaging associated with anxiety and depression in autistic adults?

“…Lai et al [36] found that camouflaging predicted depressive symptoms in men, but not women. In a sample of women with high levels of autistic traits, camouflaging was found to predict psychological distress (a combined measure of anxiety, depression, and stress) and was significantly correlated with suicidal behaviours in a subsample who reported higher than average camouflaging [42]. This suggests the need for future investigations to consider moderating effects of sex/gender.…”

Mental health across the lifespan

“…This collection also informs our understanding of less well-studied groups: "Camouflaging" one's autism symptoms to fit into social contexts was associated with poorer mental health in a study of adult women with varying degrees of autistic traits (Beck et al, 2020). This finding has important implications in the long term, in terms of calls for societal acceptance over individual change, and in the short term, in terms of considering how best to support well-being holistically in the context of interventions that seek to improve adaptive and social functioning.…”