A review published in Autism in Adulthood examines the concept of autistic masking and its psychosocial origins. Masking refers to the tendency to suppress a natural autistic response in favor of alternatives that are perceived as more socially acceptable. In this research article, the authors provide a comprehensive overview of masking and suggest directions for future research.
Masking involves a range of behaviors, including making eye contact when you are uncomfortable or avoiding discussing special interests for fear of judgment. The authors believe that the masking is largely due to the marginalization of people with autism.
Surveys among autistic people show frequent experiences of bullying, harassment and exclusion. Even in the medical field, autistic traits are often viewed as symptoms that need to be “cured” rather than understood or accepted.
“[A]utistic people are seen in both science and society in general as being on the verge of human normality, ”the authors write. Therefore, autistic masking is often the result of wanting to “exist normally” and avoiding external stressors such as bullying.
However, masking is associated with significant internal stress, burnout, and even suicide. For many people, frequent masking can prevent stress from being identified or regulated.
The authors of the review urge the medical community to recognize masking as a “fully interactive construct” of autism and to investigate ways of reducing stress in those who are negatively affected by masking. For autistic people who are marginalized due to other aspects of identity, masking-related stress can be compounded.
The gender gap in diagnosing autism is well known: about 1 woman is diagnosed with autism for every 4 men. The many reasons for this gender gap are the homogeneity of the original diagnostic criteria and the small number of women participating in early autism studies.
Although research is inconclusive as to whether women mask more often than men, some studies suggest that women with autism may have a greater difference between self-reported autistic traits and observed autistic traits. However, the authors write that the measurement of self-reported and observer-rated autistic traits is based on instruments developed for male patients.
Existing metrics for autism are likely to exclude individuals with “atypical” manifestations of autism. “Confidence in stereotypical … expectations of what an autistic person might” look like “to an observer means that a person who does not fit that stereotype can be coded as a mask, as opposed to realizing that autistic people are in theirs Behavioral expressions are as diverse as the non-autistic population, ”the authors write.
In order to better take into account the full spectrum of people with autism, the authors advocate further research into both the masking and the characteristics of autism as a whole. The relationship between autistic traits and identity is complex and is often not adequately addressed in autism research.
“Future research should [also] Look at … the outside pressure that led to the initial development [of masking]and the effect this has had on individuals, ”the authors wrote. “The interaction between these processes and outcomes is likely to be a major factor in understanding what can be done to better support those whose mental health is negatively affected by masking.”
Pearson A, Rose K. A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice. Published Online January 22, 2021. Adult Autism. doi: 10.1089 / aut.2020.0043
This article originally appeared on Psychiatry Advisor