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Is social camouflaging associated with anxiety and depression in autistic adults?
Open accessAbstract
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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“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
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“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
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Okada, S., Chida, W., English, M. C. W., Shibata, J., Onsen, M., Tsutsui, J., & Nakamura‐Taira, N. (2024) · Psychological Test Adaptation and Development · doi:10.1027/2698-1866/a000090 · Cited by 3
Santhanam, S. P., Bellon-Harn, M. L., Kashinath, S., Wilson, K. P., VanUitert, V. J., & Barnett, A. (2025) · American Journal of Speech-Language Pathology · doi:10.1044/2025_ajslp-24-00467 · Cited by 2
Effects of Neurotype and Neurotype Matching on Conversational Rapport and Masking.
Wolford, G. W. (2025) · American Journal of Speech-Language Pathology · doi:10.1044/2025_ajslp-24-00463 · Cited by 2
Autistic people’s perception of social camouflaging: qualitative analysis of a Web forum
Larochelle-Guy, J., Martinez, I. L., & Dufour, M. (2025) · Advances in Autism · doi:10.1108/aia-04-2025-0032 · Cited by 2
The Relationship Between Camouflaging and Lifetime Depression Among Adult Autistic Males and Females
Gesi, C., Pisani, R., Tamburini, N., & Dell’Osso, B. M. (2025) · Brain Sciences · doi:10.3390/brainsci15090920 · Cited by 3
Ávila, Á. P., Canales, C. E., Saavedra, C. S. F., Guillén, V., Huenupán, F., & González, O. H. (2025) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2025.2565639 · Cited by 2
Metadata
- 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
- Published
- 2021-02-16
- Volume
- 12
- Issue
- 1
- Pages
- 13-13
- ISSN
- 2040-2392 (ISSN-L)
- PMC
- PMC7885456
- OpenAlex
- W3132619758
- Cited by
- 337
- References
- 65
- Citations by year
- 2026: 69 · 2025: 74 · 2024: 81 · 2023: 59 · 2022: 34 · 2021: 19
- FWCI
- 25.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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