A scoping review of 48 studies found consistent evidence that autistic camouflaging (masking autistic traits to fit social norms) is associated with poor mental health outcomes including depression, anxiety, and burnout. The relationship appears strongest for assimilation behaviors (trying to fit in socially) rather than skill-based compensation, and the pattern holds in both autistic and non-autistic populations.
Researchers at Frontiers in Psychiatry conducted a scoping review examining the relationship between autistic camouflaging and mental health across peer-reviewed literature. The team searched four databases (Google Scholar, PsycINFO, PubMed, and JSTOR) for studies involving autistic participants that measured camouflaging behaviors alongside mental health outcomes like depression, anxiety, stress, wellbeing, and burnout. Forty-eight studies met eligibility criteria and were included in the analysis.
The core finding was unambiguous: camouflaging behavior shows a positive relationship with poor mental health outcomes. Effect sizes reported across studies ranged from small to large, indicating this is not a marginal association. The research spanned qualitative, quantitative, and mixed-method designs, all converging on similar conclusions. Notably, this relationship appeared across different age groups and demographic subsets within the autistic population, suggesting it is a consistent phenomenon rather than an artifact of study design.
A critical distinction emerged from the data: not all camouflaging is equal in its mental health impact. The studies differentiated between three types of camouflaging behavior. First, assimilation behaviors (attempting to fit in during social interactions and conform to social expectations) showed the strongest association with poor mental health. Second, compensation strategies (learning and practicing specific social skills to function in neurotypical environments) showed weaker associations. Third, masking (actively suppressing or hiding autistic traits) fell somewhere between these two. This hierarchy suggests that the subjective effort of trying to be someone you are not carries greater psychological cost than developing practical skills or managing outward presentation.
The qualitative studies in the review indicated a bidirectional relationship: camouflaging appears to contribute to poor mental health, but poor mental health may also increase reliance on camouflaging behaviors. This feedback loop could explain why some autistic individuals report escalating mental health challenges over time. An unexpected finding was that non-autistic individuals demonstrated similar relationships between camouflaging and mental health outcomes, suggesting this is not unique to autism but rather a broader human phenomenon. Camouflaging one's authentic self, regardless of neurology, appears costly to wellbeing.
If you are autistic or work with autistic individuals, this review offers important perspective on the social pressure to "mask" or conform. The evidence suggests that interventions and social expectations that encourage camouflaging, particularly assimilation-focused camouflaging, should be approached with caution. Supporting authentic self-expression appears protective for mental health.
For practitioners working with autistic clients, the finding that assimilation carries higher mental health costs than skill-building suggests a shift in focus. Teaching practical social tools and skills (compensation) may be less harmful than promoting conformity for its own sake. Similarly, if you are autistic, distinguishing between learning functional skills and attempting to hide your fundamental nature may help you make decisions about which adaptation efforts are worth the psychological cost.
The bidirectional relationship between camouflaging and mental health suggests that addressing mental health directly, rather than assuming it will improve once camouflaging stops, is important. Supporting practices like journaling, social-connection, and creative-expression may help interrupt this cycle.
The fact that this pattern appears in non-autistic populations too is worth noting: anyone camouflaging their authentic self faces similar mental health risks. This is a human issue, not merely an autism issue.
| Aspect | Details |
|---|---|
| Study Type | Scoping review (systematic review of published literature) |
| Studies Reviewed | 48 peer-reviewed publications |
| Population | Autistic participants (primary); non-autistic participants in secondary analysis |
| Databases Searched | Google Scholar, PsycINFO, PubMed, JSTOR |
| Outcomes Measured | Depression, anxiety, stress, mental wellbeing, burnout |
| Key Finding | Positive association between camouflaging and poor mental health (effect sizes small to large) |
| Effect Size Range | Small to large across studies |
| Notable Subfindings | Assimilation behaviors > masking > compensation in mental health impact; bidirectional relationship; pattern holds in non-autistic samples |
| Evidence Tier | (multiple study designs and samples converging on same conclusion) |
| Journal | Frontiers in Psychiatry |
| PubMed ID | 42311563 |
Primary source: Mantzalas, J., et al. "The relationship between autistic camouflaging and mental health: a scoping review." Frontiers in Psychiatry. PubMed: https://pubmed.ncbi.nlm.nih.gov/42311563/
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