Autism in women: masking, camouflaging and late diagnosis

Research suggests that on average autistic girls and women may have strong social motivation, copy peers and develop scripts for interaction. Special interests may be socially typical, such as books, animals or celebrities, so they may be less noticeable. Difficulties may emerge when social demands increase in adolescence or adulthood. Because assessors may look for male-typical features, some women are told they cannot be autistic because they make eye contact or have friends.

• Rehearsing conversations and copying the expressions of others.

• Forcing eye contact or suppressing stimming such as rocking or fidgeting.

• Hiding sensory distress in public, then needing hours of recovery.

• Following social rules without intuitively understanding them.

• Appearing confident at work yet feeling drained at home.

• Fear of being found out and a sense of not belonging.

Sustained masking is associated with exhaustion, anxiety, depression and burnout. Some women reach a crisis point after a life event, such as having a child, a bereavement or a change in work, when coping strategies no longer hold. Autistic burnout can involve loss of skills, extreme fatigue and withdrawal. Recognition can be a turning point because it allows adjustments instead of pushing harder.

Autistic women are often treated for anxiety, depression, eating disorders, borderline personality disorder or obsessive-compulsive disorder before autism is recognised. Autism commonly co-occurs with ADHD, hypermobility, gut and sleep problems, and sensory sensitivities. A good assessment looks at the whole picture, rather than treating each in isolation.

Tell your GP clearly why you suspect autism and what difficulties you experience. Take notes with specific examples. Ask whether the assessing service has experience with women and with masking. If you are refused a referral, you can ask for the reasoning in writing and consider a second opinion. NICE guidance (CG142) recommends a full assessment by trained professionals, and advises that diagnosis should consider the person's history across life.

Many women describe relief and grief, along with reinterpreting past experiences. Support may include psychoeducation, adjustments at work, peer groups, sensory strategies and mental health care tailored to autism. Charities and community groups led by autistic women can help. A diagnosis does not change who you are, but it can help you understand and meet your needs.

Think about how you would answer questions such as how you cope in groups, what you do to prepare for social events, how you feel afterwards and what happens when routines change. Mention any history of eating difficulties, burnout, selective mutism in childhood or intense friendships that ended painfully. Share anything that others have noticed about you across your life. If an assessor seems to rely on a single observation, such as your eye contact, politely explain how much effort it takes and ask how that has been considered.