Behind the Smile: The Mental Health Cost of Masking in Adult Female Autism
Discover how the female autism phenotype and chronic masking behaviors contribute to delayed diagnosis, shame, and mental health struggles. Learn how Embodied Wellness and Recovery supports neurodivergent women through compassionate, neuroscience-informed care.
Do you feel exhausted from pretending to be someone you're not just to feel accepted?
Many women and AFAB (assigned female at birth) individuals live their lives shadowed by an unrecognized truth: they are autistic. But because autism in women often looks different than the male-centric diagnostic criteria used in traditional assessments, their symptoms go unnoticed or misinterpreted for years, sometimes decades. This is known as the female autism phenotype, and one of its most defining features is masking.
What is Masking in Autism?
Masking refers to the conscious or unconscious effort to hide or suppress natural autistic behaviors in order to blend into neurotypical social environments. This can include forcing eye contact, mimicking others’ speech patterns, scripting conversations, or suppressing stimming behaviors.
Masking often begins in childhood and becomes more sophisticated over time. For many autistic women, masking is a survival skill, a way to avoid bullying, rejection, or punishment in a world that often doesn’t understand neurodivergence.
But this constant self-monitoring comes at a cost.
The Female Autism Phenotype: Why It’s Often Missed
The female autism phenotype includes traits that are less outwardly disruptive and more internalized, making them harder to detect. These can include:
– Social mimicry and blending in
– High sensitivity to sensory input
– Intense special interests that may appear socially acceptable (e.g., animals, books, or fantasy worlds)
– High empathy that masks emotional dysregulation
– Deep people-pleasing tendencies developed from fear of rejection
Because many women are socialized to be nurturing, accommodating, and emotionally intelligent, their autistic traits are often dismissed or praised as personality quirks. As a result, they may be misdiagnosed with anxiety, depression, Borderline Personality Disorder (BPD), or ADHD while the underlying autism remains unidentified.
The Mental Health Consequences of Chronic Masking
Masking is more than exhausting—it can be psychologically devastating.
Research by Hull et al. (2019) finds that chronic masking is associated with increased rates of:
– Anxiety and depression
– Burnout (mental, emotional, and physical exhaustion)
– Low self-esteem and identity confusion
– Suicidal ideation
Imagine constantly policing your facial expressions, tone of voice, or word choice just to feel safe in social spaces. Many autistic women describe feeling like they are "performing life" rather than living it authentically.
Over time, the disconnect between one’s inner world and outer behavior can lead to profound feelings of isolation, self-doubt, and shame.
Why Shame Often Accompanies a Late Diagnosis
For women who receive an autism diagnosis in adulthood, the experience is often bittersweet. On one hand, it’s a relief to have a framework that explains lifelong struggles. On the other hand, it can stir up deep grief and regret:
– Why didn’t anyone see this sooner?
– How might my life have been different if I had known?
– Have I built my entire identity around masking who I really am?
This shame is not inherent to autism. It’s the byproduct of living in a society that pathologizes difference and rewards conformity.
Understanding the Neuroscience Behind Masking
From a neuroscience perspective, masking activates the brain’s social surveillance system, an ongoing process where the brain monitors others' reactions for cues of approval or threat. This lights up regions of the brain involved in hypervigilance, especially the amygdala and prefrontal cortex, which regulate fear, inhibition, and social reasoning.
Long-term activation of these systems, especially when paired with early relational trauma, can lead to dysregulation in the autonomic nervous system, driving chronic stress and even physical health issues.
How Embodied Wellness and Recovery Can Help
At Embodied Wellness and Recovery, we understand that autism is not a disorder to be fixed. It’s a neurotype to be understood and honored. We support adult women and AFAB individuals in:
– Exploring late diagnosis with compassion
– Healing shame around masking and missed diagnosis
– Reconnecting with their authentic selves
– Regulating their nervous systems through somatic therapy
– Processing trauma and reclaiming a coherent identity
Our trauma-informed, neurodivergence-affirming approach integrates:
– EMDR for trauma and internalized shame
– Somatic Experiencing to reconnect with bodily signals and reduce dysregulation
– Attachment-based therapy to heal relational wounds
– Psychoeducation to help clients understand their neurobiology and advocate for their needs
Moving from Survival to Authenticity
Unmasking isn’t about throwing away every coping strategy you’ve ever used. It’s about noticing where your strategies come from, fear or authenticity, and gently, lovingly, allowing your true self to emerge.
Healing begins with self-understanding and community. When you're supported in expressing who you are without shame, you begin to shift from surviving to thriving.
Are You Ready to Stop Performing and Start Living Authentically?
If you're an adult woman or AFAB person who suspects you may be autistic, or if you’ve been diagnosed and are struggling to navigate what comes next, Embodied Wellness and Recovery is here to help.
Our team of compassionate clinicians offers trauma-informed care for neurodivergent individuals navigating masking, identity, and intimacy. Let us support you in rediscovering who you are beneath the mask. Reach out to schedule a free 20-minute consultation to discuss whether Embodied Wellness and Recovery could be an ideal fit for your support needs.
📍 Serving Los Angeles, Nashville, and clients nationwide (via telehealth)
📞 Call us at (310) 651-8458
📱 Text us at (310) 210-7934
📩 Email us at admin@embodiedwellnessandrecovery.com
🔗 Visit us at www.embodiedwellnessandrecovery.com
👉 Check us out on Instagram @embodied_wellness_and_recovery
🌍 Explore our offerings at Linktr.ee: https://linktr.ee/laurendummit
🧠 References
– Dean, M., Harwood, R., & Kasari, C. (2017). The Art of Camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21(6), 678–689.
– Hull, L., Mandy, W., Lai, M. C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833.
– Livingston, L. A., Shah, P., & Happé, F. (2019). Compensatory Strategies below the Surface in Autism: A qualitative study. The Lancet Psychiatry, 6(11), 766–777.
