Autism in Women: Masking and Misdiagnosis
Autism Spectrum Disorder (ASD) affects how a person communicates and interacts with others and the world around them. It should be noted that each autistic individual has very different experience. Generally, an autistic individual may have more challenges adhering to social norms regarding communication as compared to their allistic, or not autistic, peers. For example, an autistic individual may not be able to easily pick up on social cues. An autistic individual may have very intense interests that may seem unusual to others. They may have difficulty adapting to changes in their routine. An autistic individual may have sensitivities or fascinations with certain sensory inputs such as lights, smells, tastes and textures. Research suggests that there are sex differences in rates of individuals diagnoses with ASD, as it is more commonly diagnosed in males (Green et al., 2019). As such, symptoms of ASD that are more common in women may be overlooked.
As compared to autistic men, women tend to present with different symptoms. For example, in general, engage in less make-believe play as compared to allistic peers. However, it is more common in autistic females as compared to autistic males to engage in pretend play (Green et al., 2019). Autistic females also tend to have a larger vocabulary of emotion related words as compared to males, making them less likely to fit the diagnostic criteria for ASD in the area of social-emotional communication (Green et al., 2019). Some studies have also shown that autistic females have greater social awareness and more desire for social interactions as compared to male counterparts (Green et al., 2019). Having very intense interests is often seen in autistic individuals. For autistic males these interests may be inanimate objects that are easier for others to note as “unusual”, while autistic females are more likely to have intense interests related to people and animals, which can be overlooked as they are more “socially acceptable” (Green et al., 2019). Autistic females are also more likely to present with perfectionistic tendencies and disordered eating, which may contribute to them receiving services that overlook how those symptoms interact with autism.
Autism may manifest differently in the lives of women due to cultural expectations within our society. Autistic women may face gender norms that have shaped the way they behave in order to get by in the world. For women, there is more pressure to develop relationships with others, be “modest”, and act “nicely” (Green et al., 2019). Even for allistic women, adherence to these norms can cause distress. These roles may not be compatible with what comes naturally to them, or how they would ideally want to live their lives. However, if they do not conform to these standards, they can face difficulties from others.
Autistic individuals often learn that they must behave in a certain way that fits in with societal demands. Due to this pressure, they may engage in a strategy called “masking” or “camouflaging”. This refers to when an autistic individual hides behaviors related to ASD in social situations to avoid negative responses from others. Masking can include forcing oneself to make eye contact even when it makes one uncomfortable, changing the volume of one’s voice, using rehearsed phrases or jokes, and mimicking others’ facial expressions and gestures (Green et al., 2019). The act of masking can be exhausting, as well as harmful to one’s self-image. It may encourage an idea within a person that there is something wrong with who they naturally are. Research suggests the autistic women may engage in masking more often than autistic men (Green et al., 2019). This is perhaps due to increased societal pressure and expectations for women to act in a certain way. This masking can result in increased stress and depression (Green et al., 2019). It may also lead to autistic women not being diagnosed with ASD due to their perceived “social competency”. This limits an autistic woman’s ability to receive support and services that they need, which can further worsen mental health outcomes. Research suggests that autistic woman may experience higher rates of mental health disorders that are classified as “internalizing” such as depression, anxiety, and eating disorders (Green et al., 2019). It is possible that the intense social pressure that autistic women face that may lead them to mask, as well as the increased likelihood that they will receive a later in life diagnosis can contribute to the development an maintenance of these disorders.
Obtaining a diagnosis of ASD can be a difficult journey for many autistic women. However, it is likely a worthwhile undertaking. Receiving a diagnosis of ASD may improve one’s self-view and promote a sense of belonging (Green et al., 2019). People can experience an intense with a diagnosis of ASD. With it, there is an explanation to the way one views and interacts with the world. It can help others in that person’s life better understand their experience. It can also lead to one getting the support and services they need. Being able to connect with other autistic individuals can show a person that they are not alone in their experience. This may be especially relevant for autistic women, who may relate to each other’s experiences with diagnosis and societal expectations. Receiving a diagnosis may lead to an autistic woman seeking therapy. In therapy, it is important for to receive treatment that is validating of one’s experience as an autistic woman and is in line with one’s goals and values. Special care should be taken not to encourage the masking of autistic behaviors. Instead, therapy can focus on self-acceptance, developing self-esteem, and encouraging the skills and interests of the individual. For example, if one’s goal is to increase communication with others, therapy may look like incorporating one’s strengths and learning skills to make socializing with others easier.
In conclusion, receiving and navigating a diagnosis of ASD can be difficult for autistic women. With masking of ASD behaviors being especially common in autistic women, they may receive a diagnosis much later in life. This can mean years of not receiving the support and services they need and feeling intensely misunderstood. This may result in more significant mental health concerns. Finding support in a diagnosis, interaction with other autistic individuals, and therapy may improve mental health outcomes.
Written by Katelyn Talbot, M.A.