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Cited by 339Autism Spectrum Disorder ResearchFamily and Disability Support ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Is social camouflaging associated with anxiety and depression in autistic adults?

Open access
Hull, Laura, Levy, Lily, Lai, Meng-Chuan, Petrides, K. V., Baron-Cohen, Simon, Allison, Carrie, Smith, Paula, Mandy, Will·2021·Molecular Autism
DOI 10.1186/s13229-021-00421-1PMC PMC7885456
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Abstract

BACKGROUND: There is inconsistent evidence for a clear pattern of association between 'camouflaging' (strategies used to mask and/or compensate for autism characteristics during social interactions) and mental health. METHODS: This study explored the relationship between self-reported camouflaging and generalised anxiety, depression, and social anxiety in a large sample of autistic adults and, for the first time, explored the moderating effect of gender, in an online survey. RESULTS: Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression. No interaction between camouflaging and gender was found. LIMITATIONS: These results cannot be generalised to autistic people with intellectual disability, or autistic children and young people. The sample did not include sufficient numbers of non-binary people to run separate analyses; therefore, it is possible that camouflaging impacts mental health differently in this population. CONCLUSIONS: The findings suggest that camouflaging is a risk factor for mental health problems in autistic adults without intellectual disability, regardless of gender. We also identified levels of camouflaging at which risk of mental health problems is highest, suggesting clinicians should be particularly aware of mental health problems in those who score at or above these levels.

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  • Social camouflaging is a common coping mechanism among autistic individuals and is closely linked to the development of various comorbid symptoms.

    “One relevant psychopathogenic mechanism of such comorbidities is social camouflaging, which is a common coping mechanism among autistic individuals that has been closely linked to the development of various comorbid symptoms (Hull et al., 2021).”

    From Rethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach. (2025) · cites this paper as Hull et al., 2021

    The Background calls camouflaging widespread among autistic people, and the Results associate greater camouflaging with greater generalised anxiety, depression, and social anxiety in autistic adults. But the claim’s description of a psychopathogenic mechanism linked to the development of various comorbid symptoms is stronger and broader than the findings: the Limitations say confounding is possible and that longitudinal or experimental studies are needed to address causation. (LLM, conf=0.88)

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  • Social camouflaging is linked to negative mental health outcomes, including depression and anxiety.

    “While camouflaging may create an appearance of adaptation, it has been strongly linked to negative mental health outcomes, including heightened rates of depression and anxiety (Bernardin et al., 2021;Hull et al., 2021).”

    From Rethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach. (2025) · cites this paper as Hull et al., 2021

    The Abstract’s Results report that camouflaging was associated with greater anxiety and depression symptoms in autistic adults. But the association was small beyond the contribution of age and autistic traits, and the paper cautions that its depression result warrants careful interpretation. This supports a link, not the citing sentence’s description of a strong link or a general claim about heightened rates. (LLM, conf=0.88)

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Authors
Hull, L., Levy, L., Lai, M.-C., Petrides, K. V., Baron-Cohen, S., Allison, C., Smith, P., & Mandy, W.
Affiliations
  • University College London (GB)
  • Homerton University Hospital NHS Foundation Trust (GB)
  • Centre for Addiction and Mental Health (CA)
  • University of Cambridge (GB)
ORCID
Venue
Molecular Autism
Publisher
Springer Science and Business Media LLC
Published
2021-02-16
Volume
12
Issue
1
Pages
13-13
ISSN
2040-2392 (ISSN-L)
DOI
10.1186/s13229-021-00421-1
PMC
PMC7885456
OpenAlex
W3132619758
Cited by
337
References
65
Citations by year
2026: 69 · 2025: 74 · 2024: 81 · 2023: 59 · 2022: 34 · 2021: 19 · 2020: 1
FWCI
25.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Molecular Autism (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion, cc-by)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
  • Medical Research Council (RG46450)
  • Wellcome Trust (RG58828)
  • Innovative Medicines Initiative 2 Joint Undertaking (777394)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
social camouflaging, autism spectrum disorder, autistic adults, anxiety, depression, social anxiety, mental health, gender differences, autistic traits, masking, intellectual disability
MeSH terms
Adolescent, Adult, Aged, Anxiety, Autistic Disorder, Depression, Disease Susceptibility, Female, Humans, Male, Mental Health, Middle Aged, Surveys and Questionnaires, Social Behavior, Young Adult, Self Report, Public Health Surveillance

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