Examples include forced eye contact, mimicking others’ social behaviors, and suppressing repetitive movements.
While camouflaging may help autistic people navigate social situations, it often comes at a cost to their mental health and sense of authenticity.
Camouflaging is thought to be more common in autistic females and may contribute to missed or late diagnosis.
Understanding camouflaging is important for improving recognition and support for autistic individuals’ needs.
Key Points
This mixed methods systematic review synthesizedqualitative and quantitative researchon psychosocial factors associated with camouflaging and its relationship with mental well-being inautisticand non-autistic people.
Seven main themes were identified relating to psychosocial correlates and consequences of camouflaging:
More research with diverse participants is needed to better understand psychosocial influences on camouflaging. The findings call for a whole society approach to increase acceptance of autistic people.
Rationale
Camouflaging involvesautistic individuals hiding their autistic characteristics in social situations, often to fit in and avoid stigma (Hull et al., 2017).
While a rapidly growing area of research, most studies have focused on the experiences of a narrow demographic – White, female, late-diagnosed autistic adults with average to above average abilities (Cook et al., 2021; Libsack et al., 2021).
Though camouflaging enables some to achieve social and functional goals (Hull et al., 2017; Livingston et al., 2019), it has been consistently associated with poorer mental health (Beck et al., 2020; Cassidy et al., 2018).
Qualitative accounts suggest various psychosocial factors may motivate camouflaging and explain its mental health impact, such as societal stigma and the desire for belonging (Cage & Troxell-Whitman, 2019; Cook et al., 2021). However, no review has systematically examined psychosocial influences on camouflaging and well-being.
This mixed-methods systematic review aimed to critically synthesize qualitative and quantitative research on psychosocial factors associated with camouflaging and its relationship with mental well-being in autistic and non-autistic people.
Understanding psychosocial motivations for camouflaging could inform support to promote more adaptive camouflaging and authentic self-expression, contributing to better mental health for autistic people.
Method
Procedure
Thismeta-synthesisfollowed PRISMA guidelines. Six databases were searched, and backward citation searching and expert consultations were conducted.
Athematic synthesiswas conducted, where data were categorized and pooled together based on similar meanings.
Codes and themes were iteratively discussed among the research team, which included academics and two autistic advisors who provided input on the data synthesis and interpretation.
Sample
58 studies (40 qualitative, 13 quantitative, 5 mixed methods) were included, encompassing 4808 autistic and 1780 non-autistic participants.
Participants were predominantly White (85.9%), female (61.8%), and late-diagnosed (mean age of diagnosis 30.47 years) autistic adults with likely average to above average intellectual/verbal abilities.
Results
Seven themes relating to psychosocial correlates and consequences of camouflaging were identified:
The themes highlight the bidirectional influences between the individual and environment in camouflaging.
Camouflaging emerged as a largely socially-motivated yet self-reinforcing response that comes with serious costs to authenticity and mental well-being.
Insight
This review provides a novel and comprehensive synthesis of psychosocial factors implicated in camouflaging.
The findings indicate that camouflaging arises from the dynamic interplay between the individual and their social environment, challenging purely individual-focused explanations.
Furthermore, internalizing stigmatizing narratives motivated individuals to mask their differences.
However, camouflaging often had the unintended effect of leaving stigma unchallenged while increasing internalized stigma. It also resulted in autistic people’s needs being overlooked and unmet.
Additionally, while the desire for social connections drove camouflaging, participants felt that the relationships formed through it were inauthentic. These “double binds” made it difficult for individuals to break out of the camouflaging cycle.
The findings call for a shift from changing the individual to fostering more inclusive environments.
A whole-society approach is needed to increase understanding and acceptance of autism, thus reducing pressures on autistic people to camouflage.
Future studies should empirically test the conceptual model presented and prioritize diverse participant representation.
Additionally, research examining the influence of everyday psychosocial experiences on camouflaging can provide insight into how autistic individuals navigate camouflaging in daily life.
Strengths
This study had several methodological strengths, including:
Limitations
Despite its strengths, there are several limitations of this study, including:
Implications
The findings have important implications for increasing awareness, acceptance, and support for autistic people:
However, as most included studies involved a narrow participant demographic, more research is needed to understand the relevance of findings for underrepresented groups, including racial/ethnic minorities, males, gender diverse individuals, those with intellectual disability, and people from non-Western cultures.
Additionally, prospective studies are required to establish directional relationships.
References
Primary reference
Zhuang, S., Tan, D. W., Reddrop, S., Dean, L., Maybery, M., & Magiati, I. (2023). Psychosocial factors associated with camouflaging in autistic people and its relationship with mental health and well-being: A mixed methods systematic review.Clinical Psychology Review, 105,1–16.https://doi.org/10.1016/j.cpr.2023.102335
Other references
Beck, J. S., Lundwall, R. A., Gabrielsen, T., Cox, J. C., & South, M. (2020). Looking good but feeling bad: “Camouflaging” behaviors and mental health in women with autistic traits.Autism, 24(4), 809–821.https://doi.org/10.1177/1362361320912147
Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults.Journal of Autism and Developmental Disorders, 49(5), 1899–1911. .https://doi.org/10.1007/s10803-018-03878-x
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults.Molecular Autism, 9(1), 42.https://doi.org/10.1186/s13229-018-0226-4
Cook, J., Crane, L., Bourne, L., Hull, L., & Mandy, W. (2021). Camouflaging in an everyday social context: An interpersonal recall study.Autism, 25(5), 1444–1456.https://doi.org/10.1177/1362361321992641
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534.https://doi.org/10.1007/s10803-017-3166-5
Libsack, E. J., Keenan, E. G., Freden, C. E., Mirmina, J., Iskhakov, N., Krishnathasan, D., & Lerner, M. D. (2021). A systematic review of passing as non-autistic in autism spectrum disorder. Clinical Child and Family Psychology Review, 24(4), 783–812.https://doi.org/10.1007/s10567-021-00365-1
Livingston, L. A., Shah, P., & Happé, F. (2019). Compensatory strategies below the behavioral surface in autism: A qualitative study. The Lancet Psychiatry, 6(9), 766–777.https://doi.org/10.1016/s2215-0366(19)30224-x
Keep Learning
Here are some reflective questions related to this study that could prompt further discussion:
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
