Review Links Autistic Masking in Women With Anxiety, Depression and Suicidality

CN: Discussion of masking exhaustion, mental health and suicidality.

1. What is happening?

A new systematic review published in the Journal of Autism and Developmental Disorders examined whether autistic masking in adult women is associated with anxiety, depression, autistic burnout and suicidality. The review was published by E. Cuni and M. Cantero-García on 2026-10-16 and is available through the Journal of Autism and Developmental Disorders.

The authors reviewed nine studies published from 2018 to 2025, with a combined analytic sample of more than 1,500 formally diagnosed autistic women across seven countries. The review reports that masking was consistently associated with anxiety and depression, and that masking was also an independent predictor of suicidality.

The source brief reports an odds ratio of 5.04 for suicidality compared with the general population. It also notes that CAT-Q assimilation, a masking pattern linked with trying to fit in socially, predicted suicidal ideation in women through anxiety. A stated limitation was that no included study assessed autistic burnout with validated instruments, so the burnout findings should be read carefully.

2. The Somatic & Systemic Context

Masking, also called camouflaging, means hiding, suppressing or disguising autistic traits to fit into non-autistic social environments. The National Autistic Society describes examples such as suppressing stimming, copying non-verbal behaviour and using social scripts. These strategies can help someone get through work, school, family life or public spaces, but the article also describes masking as exhausting and linked with anxiety, depression and suicidal behaviours.

For many neurodivergent people, masking is not simply a “social skill.” It can become a full-body regulation demand: monitoring facial expression, voice, movement, eye contact, timing and reactions while also trying to understand the room. Over time, that effort can leave a person depleted, especially when their natural traits are treated as something to hide rather than something to accommodate.

A 2023 mixed methods systematic review in Clinical Psychology Review adds a wider psychosocial frame. It synthesized 58 studies and found that camouflaging is shaped by social norms, acceptance or rejection, self-esteem and identity. It was linked with adverse outcomes including being overlooked, under-supported, burnt out, having low self-esteem and experiencing identity confusion. In plain terms, autism high masking burnout is not just about being tired after social contact. It can reflect years of trying to stay acceptable in environments that do not make enough room for neurodivergent ways of sensing, moving and communicating.

3. The Dual Perspective

What this means for daily life

If you recognize yourself in this topic, masking exhaustion may feel like coming home from ordinary interactions with no capacity left. You may replay conversations, feel pressure to perform friendliness, hide stimming, force eye contact or use scripts that help you get through the day but leave you flattened afterward.

This review does not mean every person who masks will experience the same mental health outcomes. It does suggest that masking deserves to be taken seriously, especially when it is connected with anxiety, low mood, shutdown, loss of identity or thoughts of not wanting to live. If suicidality or intense distress is present, support from qualified mental health or crisis professionals matters.

A gentle daily-life question is not “How can I look more neurotypical?” but “Where can I reduce the amount of pretending?” That might include asking for clearer communication, using sensory tools, resting after demanding contact, allowing safe forms of movement or spending more time with people who do not require constant performance.

What this means for your practice as a coach, facilitator or bodyworker

For somatic coaches, massage therapists, movement teachers, relationship coaches and bodyworkers, this review is a reminder not to reward clients only when they appear calm, still, expressive or socially fluent in familiar neurotypical ways. A client may look composed while using enormous effort to manage facial expression, tone, movement and compliance.

In sessions, this suggests building accommodation into the container from the start. Offer clear choices, predictable structure, permission to move or pause, sensory adjustments and explicit consent around touch, sound, lighting and pacing. Avoid framing stimming, direct communication, reduced eye contact or a need for quiet as resistance or lack of engagement.

Scope of practice is also central. The review reports links with anxiety, depression and suicidality, which means practitioners outside licensed mental health care should have referral options and crisis protocols appropriate to their region. Your role may include supporting body awareness, choice, rest and safer expression of neurodivergent traits, while not promising to treat mental health conditions or replace clinical care.

4. Key Takeaways

• This systematic review reports consistent links between autistic masking in adult women and anxiety, depression and suicidality.
• Masking can be understood as a regulation load, not just a social habit or personality style.
• Practitioners can support neurodivergent clients by reducing performance pressure and building consent-based accommodation into sessions.

Sources & References:

1. Original News – Journal of Autism and Developmental Disorders systematic review
2. Context – Autistic people and masking
3. Reference – Psychosocial factors associated with camouflaging in autistic people and its relationship with mental health and well-being

Recommended Video Resource: Autism and Masking webinar
Why we recommend this: It offers an accessible way to deepen understanding of masking alongside the research summary.

Further Reading on The Conscious Channel: For more on neurodivergent regulation, accommodation and body-based practice, visit our Neurodiversity & Somatics section.

This article summarizes published news and research for educational purposes. It is not medical, psychological or legal advice.

#AutisticMasking #AutisticWomen #NeurodiversitySomatics #SomaticMaskingRecovery #AutismAcceptance #HighMasking