What is camouflaging?
‘Camouflaging’ refers to the masking of, or compensating for, autistic traits during social interactions. This is done using strategies or behaviours that allow the individual to effectively conceal any social difficulties and present as socially competent (Hull et al., 2017; Hull et al., 2019). Strategies used vary but may involve hiding certain behaviours e.g. learning not to stand too close to people or talk about certain subjects, or making conscious efforts to display particular socially ‘normative’ behaviours e.g. directly imitating others’ behaviour in social situations, observing and learning jokes, phrases or how to respond in conversations, attempting to recreate speech sounds or patterns used most frequently by other non-autistic people and learning existing social scripts to follow (Lai et al., 2017; Parish-Morris et al., 2017).

What is the reason for camouflaging?
Camouflaging may be intentional or unintentional however for many autistic individuals it is considered a necessity rather than a choice, often motivated by feelings of isolation or threat, showing an attempt to prevent discrimination, exclusion or bullying. It highlights the difficulty that autistic individuals face day-to-day in a social environment that is better adapted and suited to non-autistic individuals (Mandy, 2019). In addition to this, autistic individuals might attempt to camouflage to ‘fit in’ or ‘succeed’ socially, perhaps to achieve educational or employment opportunities or establish relationships (Hull et al., 2019; Hull et al., 2017; Mandy, 2019).

What are the consequences of camouflaging?
Camouflaging can be extremely cognitively exhausting and can lead to feelings of loss of identity, various mental health issues including anxiety or depression, suicidal thoughts, reduced access to support services and unmet needs (Hull et al., 2019; Hull et al., 2017). Camouflaging is also suggested to be more often used by females and therefore proposed as an explanation for missed or late diagnoses of autism spectrum conditions (ASC) in females due to the unique presentation of autistic traits, or phenotype, of autism in some females compared to males. This then continues to contribute to the under-representation/acknowledgement of what are considered typically more ‘female’ autistic traits and therefore the exacerbation of gender stereotyped characterisations of autism, increasing the potential for autistic females to be misdiagnosed or not be diagnosed at all (Lai et al., 2017; Hull et al., 2017).

Gender and camouflaging
Camouflaging may be attempted by any individual of any gender, however there is some suggestion that it is more prevalent among autistic females and part of the proposed ‘female phenotype’ of autism (Lai et al., 2017). There are several factors that have been suggested to contribute to the observed gender differences in camouflaging, for example biological or developmental differences giving females greater cognitive ability related to camouflaging, the expectation of females to have higher standards of social skills, or females receiving greater stigmatisation for being autistic. These may all contribute to the greater ability or perceived need for camouflaging in females (Hull et al., 2019). Additionally, female social environments lend themselves more readily to camouflaging. Autistic females can more readily mask the appearance of their social difficulties by staying close in proximity to peers and by weaving in and out of social activities, allowing social challenges to go unnoticed, where autistic males tend to spend more time alone (Dean, Harwood & Kasari, 2016).

Autism, camouflaging and eating disorders
Autism is suggested to be overrepresented in eating disorder populations however due to the underdiagnosis of autism among females, for some it may be the case that their autism is only brought to clinical attention for the first time once in treatment for an eating disorder. Research suggests that autistic females are at higher risk of developing an eating disorder than those without autism and are more likely than males to have had previous diagnoses of other mental health difficulties including eating disorders (Mandy & Tchanturia, 2015; Baron-Cohen et al., 2013). Furthermore, it has been suggested that the presence of autistic traits may contribute to poorer treatment outcomes for eating disorders. This highlights the importance of ensuring individuals with both an eating disorder and autistic traits are not left unrecognised so that appropriate and effective adaptations can be made to treatment approaches and care pathways (Westwood & Tchanturia, 2017).
Additionally, given the many struggles autistic people often face in social situations, the risk of developing an eating disorder may be increased further considering research that evidences the role that social difficulties play in the development of anorexia (Westwood, Lawrence, Fleming & Tchanturia, 2016). It is important to recognise that social connections and relationships are equally important to autistic people, who are just as interested in and capable of meaningful friendships and relationships, as non-autistic people (Sedgewick, Leppanen & Tchanturia, 2019).

Information and support links:
https://www.spectrumnews.org/features/deep-dive/costs-camouflaging-autism/
https://kids.frontiersin.org/article/10.3389/frym.2019.00129
https://www.spectrumnews.org/features/deep-dive/the-invisible-link-between-autism-and-anorexia/
https://www.autism.org.uk/about/what-is/gender.aspx

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References

1) Baron-Cohen, S., Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular Autism, 4, Article 4.

2) Dean, M., Harwood, R., & Kasari, C. (2016). The art of camouflage: Gender differences in the social behaviours or girls and boys with autism spectrum disorder. Autism, 21(6), 678-689.

3) Hull, L., Lai, M-C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K. V., & Mandy, W. (2020). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism, 24(2), 352-363.

4) 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.

5) Lai, M-C., Lombardo, M. V., Ruigrok, A. N. V., Chakrabarti, B., Auyeung, B., Szatmari, P., Happe, F., & Baron-Cohen, S. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690-702.

6) Mandy, W. (2019). Social camouflaging in autism: is it time to lose the mask? Autism, 23(8), 1879-1881.

7) Mandy, W. & Tchanturia, K. (2015). Do women with eating disorders who have social and flexibility difficulties really have autism? Molecular Autism, 6, Article 6.

8) Parish-Morris, J., Liberman, M. Y., Cieri, C., Herrington, J. D., Yerys, B. E., Bateman, L., Donaher, J., Ferguson, E., Pandey, J., & Schultz, R. T. (2017). Linguistic camouflage in girls with autism dpectrum disorder. Molecular Autism, 8, Article 48.

9) Sedgewick, F., Leppanen, J., & Tchanturia, K. (2019). The Friendship Questionnaire, autism, and gender differences: a study revised. Molecular Autism, 10, Article 40.

10) Westwood, H., Lawrence, V., Fleming, C., & Tchanturia, K. (2016). Exploration of friendship experiences, before and after illness onset in females with Anorexia Nervosa: A qualitative study. PLoS One, 11(9).

11) Westwood, H., & Tchanturia, K. (2017). Autism Spectrum Disorder in Anorexia Nervosa: An updated literature review. Current Psychiatry Reports, 19(41).

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