Masking and Mental Health
By Dr Laura Hull
This piece summarises some recent research conducted with colleagues, including Lily Levy, at University College London.
We wanted to examine the relationship between masking (also known as camouflaging or compensation) and mental health problems in autistic adults. Masking is a response by many autistic people to being treated differently or stigmatised, which can involve hiding autistic traits or finding alternate ways to meet non-autistic social expectations. For example, someone might mask their autism by forcing themselves to make eye contact, even if it causes them discomfort. Another person might mask by stopping themselves from stimming, since they have been told it looks weird.
Autistic people have described for many years how masking their autism has led to distress and mental health problems, as well as burnout and breakdowns. However, there is still limited research in this area. For this study, we used an online survey to ask over 300 autistic adults about their masking and mental health problems. Participants (181 women, 104 men, and 18 non-binary people) completed surveys about 1) their use of masking strategies, 2) symptoms of depression, 3) symptoms of generalised anxiety, and 3) symptoms of social anxiety.
We found that participants’ self-reported level of masking (as measured by the Camouflaging Autistic Traits Questionnaire) predicted their level of mental health symptoms. People who mask more have higher levels of general anxiety and social anxiety symptoms, and slightly higher levels of depression symptoms. We also examined whether this differed across genders, but found that there was no difference in the impact of masking on mental health for men and women. We didn’t include enough non-binary people to be able to compare.
It’s important to note that our results are only correlational – we can’t say for sure that masking causal mental health problems as it may be that the relationship is the other way around, or that something else entirely causes both masking and mental health problems in autism. However, our findings provide more evidence for what autistic people have been saying for a long time: masking leads to mental health problems for autistic people, and masking should not be encouraged.
We still need to know more about exactly how masking impacts mental health; some autistic people say that they find masking useful sometimes (although most people report some negative outcomes). We also want to find out what masking looks like in children and teenagers, and whether it leads to mental health problems in younger people as well. This would suggest that trying to reduce levels of masking in children might reduce the likelihood of developing mental health problems later in life.
Wow what an interesting read! Thank you for sharing your current research Dr Hull.
Do you think understanding how maskings contributes to mental health development in autistic individuals could lead to better intervention and prevention of some of the mental health issues associated with autism? Great article!
Should definitely encourage autistic people to not mask more in both adults and children. We all should be encouraged to talk about and deal with mental health issues. Stimming can help but it also can cause problems.