The relationship between autistic camouflaging mental health: a scoping review

Background Autistic camouflaging, also referred to as “masking” or “adaptive morphing”, refers to the conscious and unconscious use of strategies to socially fit in, mimic neurotypical behavior, or suppress or “mask” ASD traits. Some studies suggested a relationship between camouflaging and poor mental health. Objective The goal of this review is to answer the question: “What is the current state of literature regarding the relation between autistic camouflaging and mental health?” Methods We reviewed qualitative, quantitative, and mixed-method peer-reviewed publications regarding autistic camouflaging and mental health from four databases (Google Scholar, Psychinfo, PubMed, and JSTOR). Studies needed to involve autistic participants, be an experimental or observational study, and be in English. Results of said studies relating to camouflaging and depression, anxiety, stress, mental wellbeing, or burnout were summarized with effect sizes being reported when available. Data were charted using an adapted and modified Cochrane review checklist. Results Forty-eight studies were selected based on eligibility criteria. Results indicated a positive relationship between camouflaging and poor mental health with effect sizes ranging from small to large. Mental health issues appeared to relate more with assimilation (attempting to fit in during social settings) than with compensation (mimicking and practiced skills) or masking (actively attempting to suppress ASD traits). Results for qualitative studies indicated that the relationship between camouflaging and mental health appeared to be bidirectional. Non-autistic individuals had similar relationships between camouflaging and mental health as autistic participants. Conclusions Given the finding that camouflaging is associated with poor mental health outcomes, and qualitative findings that it may contribute to poor mental health, caution should be taken regarding the encouraging of camouflaging behaviors, especially assimilation behaviors, by interventions. Future research is needed into these relationships, especially as said relationship was present in non-autistic samples as well.