Measuring Social Camouflaging in Individuals with High Functioning Autism: A Literature Review

Abstract

In the recent years, growing attention has been paid to the use of camouflaging strategies by adult populations suffering from autism spectrum disorder (ASD) with milder manifestations and without intellectual impairment, which may lead to a delay in diagnosis or even a misdiagnosis. In fact, high-functioning ASD individuals were reported to be more aware of their communication difficulties and were more likely make considerable efforts to adjust their behavior to conventional rules of non-autistic individuals, learning to imitate other non-ASD individuals. Moreover, females reported a higher frequency of camouflaging strategies, suggesting a role of camouflaging in the gender gap of the ASD diagnosis. Although camouflaging strategies can sometimes grant a better level of adjustment, even resulting in a hyper-adaptive behavior, they are also often correlated with negative mental health consequences due to the long-term stress associated with continuous attempts to adapt in day-to-day life. In this framework, the aim of the present work was to review the available studies that assessed the presence and correlates of camouflaging strategies in individuals with ASD. Although the literature available on the topic is still scarce, some interesting correlations between camouflaging and anxious and depressive symptoms, as well as suicidality, were highlighted. In particular, the controversial and sometime opposite thoughts and results about camouflaging may be clarified and integrated in light of a dimensional approach to psychopathology.

Comorbidity and Overlaps between Autism Spectrum and Borderline Personality Disorder: State of the Art

“…Despite some controversial results and lack of homogeneity in the methods used for the diagnostic assessment, the literature seems to globally point out an increased prevalence of ASD and subthreshold autistic traits in subjects with PD [ 87 ] and, specifically, with BPD, as well as an increased prevalence of BPD among subjects with ASD [ 83 , 90 ]. These data should be also considered in light of the recent literature which focused on possible causes of under-recognition of ASD among females [ 94 , 95 ], hypothesizing that females may undergo a greater societal pressure to conform, being more motivated to learn how to hide their autism (camouflaging) [ 95 , 96 , 97 ].…”

“…In particular, females with ASD may show a reduced impairment in social communication and interactions and be more aware of their social difficulties, thus developing higher social anxiety levels and more frequently adopting social camouflaging strategies in order to mask their difficulties [ 18 , 97 , 98 , 99 ]. This kind of coping strategy, while sometimes being socially advantageous, may cause many ASD females to go “under the radar” and so remain undiagnosed, besides implying a lot of mental fatigue, stress and increased anxiety and depressive symptoms [ 91 , 96 , 97 ]. Noticeably, another feature typical of ASD females was reported to be a different pattern of restrictive interests, which may include a specific focus on food and diet.…”

Special considerations for assessing and caring for autism in girls and women

“…This mismatch across social expectations, individual social needs, and social skills exposes girls with ASD to additional interpersonal challenges, possible social neglect and exclusion, and feelings of loneliness, leading to downstream mental health problems. Additionally, autistic girls and women are found to make more effort in social camouflaging, that is, masking the symptoms of autism in social contexts [4,10], which has been linked to higher levels of distress and depression [4,15,35,[81][82][83].…”

Autistic Traits and Somatic Symptom Disorders: What Is the Link?

“…Noticeably, increasing research is stressing the presence of gender-specific presentations of the autism spectrum, with female-specific characteristics being often under-recognized [ 5 , 18 , 19 , 20 , 21 , 22 ]. Females on the autism spectrum often show a reduced impairment in social interaction, partly due to their greater ability to mask their symptoms using social camouflaging strategies, but with higher levels of social anxiety as a consequence [ 18 , 19 , 20 , 21 , 22 , 23 ]. Moreover, they seem to show restricted interests more oriented towards animals or people, such as spending time with animals, enjoying fiction, and focusing on food and diet [ 18 , 19 , 20 , 21 , 22 ].…”