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

Laura Hull, Lily Levy, Meng Chuan Lai, K. V. Petrides, Simon Baron-Cohen, Carrie Allison, Paula Smith, Will Mandy*

*Corresponding author for this work

    Research output: Contribution to journalArticle (Academic Journal)peer-review

    110 Citations (Scopus)
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    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.

    Original languageEnglish
    Article number13
    JournalMolecular Autism
    Issue number1
    Early online date16 Feb 2021
    Publication statusPublished - Dec 2021

    Bibliographical note

    Funding Information:
    The authors would like to thank Andrew Dunlop, Maya Bowri, and Emogen Campbell for their assistance in data collection, as well as everyone who took part in the study.

    Funding Information:
    SBC was funded by the Autism Research Trust, the Wellcome Trust, the Templeton World Charitable Foundation, and the NIHR Biomedical Research Centre in Cambridge, during the period of this work. The Medical Research Council (MRC; Grant Number RNAG/128 [Award Number RG46450]) and the Wellcome Trust (Grant Number RNAG/235 [Award Number RG58828]) funded the Cambridge Autism Research Database (CARD) that made this study possible. SBC also received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under Grant Agreement No. 777394. The JU receives support from the European Union’s Horizon 2020 Research and Innovation Programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. His research was also supported by the National Institute of Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) Programme. The views expressed are those of the authors, and not necessarily those of the NIHR, NHS, or Department of Health and Social Care.

    Publisher Copyright:
    © 2021, The Author(s).


    • Adults
    • Camouflaging
    • Gender
    • Mental health


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