The best description of Masking that I have ever seen

From "The Adult Autism Assessment Handbook"

Hull et al. (2017) found that motivations for masking included societal expectations that Autistic individuals had to change to be accepted by others, and that the neurotypical population viewed ‘sticking out’ or being different as unacceptable, leading Autistic people to feel they had to change how they were to be seen as fitting in. Autistic participants in Hull et al.’s (2017) study also reported that they were motivated to mask to access and retain employment. They felt that if they were more visibly Autistic, this would reduce their employment opportunities. Others reported that masking was essential for safety reasons – they had experienced being physically and emotionally attacked or intentionally isolated and left out when they had not masked their Autistic features.

Research suggests Autistic people may learn to mask as children, learning masking tactics from reading fiction or analysing soap operas, and may repeat phrases from TV series or mimicking socially successful peers. They may use toys to figure out past situations and experiences and to understand neurotypical social events, or as practice for future neurotypical-dominant interactions regarding what to say or do. Therefore, they may appear ‘less’ Autistic at face value and appear more like neurotypical children, but their presentation mechanisms are very different from those of neurotypical children (Hull et al. 2017). Autistic people may learn to consciously be less noticeable or to keep more distance from others, or refrain from making personal comments about others, either from consciously modelling neurotypical behaviour to gain greater social acceptance or learning from past negative feedback (Lai et al. 2017).

Research has shown that masking can have a considerable negative effect on mental health. It involves high levels of cognitive effort and can be exhausting and lead to increased stress, burnout and mental health challenges such as depression and anxiety (Lai et al. 2017). Cage and Troxell-Whitman (2019) found that constant masking and intermittent masking had a high price in terms of stress and anxiety, with participants reporting high-stress symptoms and anxiety. In contrast, those who consistently engaged in no or low masking had a significantly lower level of stress symptoms and anxiety.

Masking has been linked to the extremely high rates of suicide seen in the Autistic population (see the section on suicide and self-harm in ‘Co-occurring mood disorders’). Cassidy et al. (2018) reported that what participants described as camouflaging was an independent risk factor for long-term suicidality in their Autistic participants, as were unmet support needs.

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Mundy (2022) proposes that an alternative conceptualization of masking might be ‘shielding’, which represents a more active and protective choice to create a safe ‘bubble’ around oneself. Mundy (2022) suggests that shielding strategies may include building connections within the Autistic community as a protective space, describing shielding as a ‘force field, a membrane by which I can (usually) decide what comes in and out of my inner world, this shield protects me’. They highlight that while their shield is protective, it also contains great joy, such as following interests, talking deeply about things and being unique (Mundy 2022).

Community and practice-based learning
Many Autistic people describe an ‘imposter syndrome’ that is borne out of masking and not having a clear sense of who they really are behind that mask, or that their true authentic self feels much younger than their actual age because it has been trapped behind the mask and unable to get out and explore and develop in the world.

Overall, there is a greater number of undiagnosed women, and many who are wrongly misdiagnosed. Many Autistic people mask. While masking may be particularly pertinent for anyone who is not the stereotypical cis male, it occurs across Autistic experience. Clinicians need to be aware of masking, and naming it during the assessment meetings can be valuable to clients. Masking has significant negative effects on mental health, and bullying experiences can intensify the ‘need’ for masking.

Autistic people learn to mask from an early age. This is typically achieved through mirroring others, especially during school, and is typically in full force by secondary school, when social challenges exceed their capabilities. Our experience has been that many Autistic people describe feeling ‘like an alien’ and finding the multiplicity of social challenges in each interaction so overwhelming that they default to a position of ‘copying’ the person in front of them. Professionals may find themselves perplexed by clients who describe themselves as most likely being Autistic, and yet show very little observable ‘evidence’ of this. At such times, it is very useful to consider masking.

We have found the Camouflaging Autistic Traits Questionnaire (CAT-Q) screener useful (Hull et al. 2019). While it is not diagnostic, it is a simple and easy way to explore the degree of masking a person may be engaging in. Conflict avoidance often abounds to the point of agreeing with others whom they really disagree with, laughing when they do not know why, or finding something amusing and generally adjusting their own behaviour and actions vis-à-vis mirroring others present in order to cope with social interactions and events.

While the overlap with social anxiety can be glaring, on investigation it often transpires that Autistic people do not share the same fear aspects akin to social anxiety, and nor do they always present with any predisposing or precipitating factors or events that often pre-date and underscore social anxiety. Rather, Autistic people often report confusion and not fear in social settings. The masking itself becomes so taxing that rather than enhance social engagement, it further exacerbates avoidance of this.

The Privilege of Being Unmasked

To live unmasked is a privilege and option that not all Autistic people have, regardless of how much they embrace their authentic Autistic self, and no matter how much they wish to live as openly neurodivergent. We can only be unmasked if it is safe to do this. Safety can be a key driver of masking. Masking can be an essential survival strategy, and to drop the mask, even slightly, can put us at great risk. This may be due to many situations. Masking may be one of the few survival strategies available to someone and to drop it, even fleetingly, may put the person at risk of both physical and emotional harm (e.g., in an abusive relationship, or for Black Autistic people living in a hostile country).

We need to consider intersectionality as it relates to masking. Autistic people may have multiple identities that each lead to masking, and these will cumulatively impact on how safe someone feels to be authentically themselves, or the more they must mask an element of the Self. We have heard from Black Autistic parents in the USA who explain that they have had no choice but to put their children in an ABA programme to teach them to mask, regardless of their personal beliefs about ABA, because their child would be in danger if they were to be their true Autistic self. Others have described having to mask in specific situations growing up, as they were physically at risk in their environment, for example having been assaulted for not making eye contact with those living on their estate, and therefore learning that it is not just emotionally unsafe to be themselves, but also physically unsafe.

Unmasking is a privilege. We must be mindful of this and pay due regard as to how safe it is for someone to drop their mask. It may put them at risk of both emotional and physical harm.

Taking these issues into consideration, it is very important that standard answers to autism assessment questions are not taken at superficial level, and instead, an open, explorative approach is adapted to explore what has been ‘learned’ and to differentiate this from what just ‘is’. An Autistic person may describe themselves as good at making friends, but we must then tease out what that means for them, how they go about this and their history of friendship making. This often results in narratives describing early difficulties making friends, not knowing how, and figuring out how to mirror popular peers in school and getting into groups, although mainly on the edge and not actively participating. Other patterns include always having one single person as a friend at a time, that friendship being very intense, and then, when the other person makes a new friend, the Autistic person cannot manage this change and the friendship invariably dissolves. In relation to friendships ending, Autistic people often report histories of friendships ending but never knowing why – they often hear things like ‘You know what you did or said’ when in fact they do not. When they do find out, it is usually that they have told a secret or shared personal information about a friend, which itself is often the result of not readily reading the non-verbal cues that would tell a neurotypical person that what they are hearing is confidential. Other patterns include making friends in context, that is, school, college and work, but never maintaining these friendships when out of that specific context. This itself speaks to the use of masking and the often-transient nature of friendship making for Autistic people.