What Is Masking? And What’s the Harm?

We all wear a mask sometimes.

How you present yourself at work can be different from how you are at home.

When you’re coaching pee-wee football, you’re probably a different version of yourself than when you’re out with your friends.

But for autistic people, masking can go beyond situational shifts. And the day-in-day-out pretending can be a big burden to shoulder.

We talked about masking with developmental pediatrician Carrie Cuffman, MD.

But first, a quick note about language use. We use the term “autistic” throughout this piece to reflect the preferences of the autistic community, which largely prefers identity-first language.

What is masking?

Masking is a way of representing yourself to be more like how others expect you to be. It’s a way of hiding yourself (or parts of yourself) that you don’t want to present to the world. Not in a nefarious way. More like a “meeting societal expectations” kind of way.

“When we’re masking, we’re disguising our true feelings or our true abilities,” Dr. Cuffman explains. “People may mask what they perceive to be their deficiencies. Or they can use masking to fit in better or meet other people’s expectations.”

In a way, masking is something that everyone does.

When you had that job interview, you put on your most professional attire and worked to project an air of confidence and capability you didn’t necessarily entirely feel.

When you met your significant other’s parents for the first time, you smiled more than usual and watched your potty mouth.

“All of us moderate or modify our behaviors in order to fit in better in the situation we’re in,” she adds. “If I’m not a very chatty person, I still might make an effort to talk more than usual when I’m at a social function. Sometimes, those can be really positive and helpful behaviors — when they’re not used to the extreme.”

Masking and autism

We all mask sometimes. But it can be an especially common tool used by neurodivergent communities, including among autistic people.

“Masking can be a way that autistic people work to fit in or avoid judgment,” Dr. Cuffman shares. “That’s particularly true among people who feel that they can’t make strong social connections by being themselves.”

If you’re autistic, you may mask your condition by doing things like hiding self-stimulatory behaviors (stims). You may work to purposefully make and maintain eye contact. Or pretend to be interested in the topics or hobbies of other people in the group.

You may mask to blend in. Because that’s what society seems to expect. But over the long term, camouflaging can take a real toll.

Consider these impacts of masking.

Loss of identity

Masking can become a way of life. Rather than a tool to get through an uncomfortable situation, masking becomes the norm. And the real you gets pushed down deeper and deeper.

Masking is conforming. It’s downplaying the sides of you that are different, powerful and special.

But people respond well to your camouflage. They want to be your friend when you mask. They think you’re smart. They think you’re fun.

So, you keep it up.

Masking can become automatic. Less of a purposeful act and more like a default switch. It can be hard to tell where the mask ends and where the rest of you begins.

Does that mean your masked self is now your real self? Or is your true identity — your interests, preferences and values — still somewhere under the surface? And when do they get to come out?

There’s no easy answer. And untangling that web can be overwhelming.

Mental health issues

It’s a heavy lift to keep up a mask. And the more you wear it, the more burdensome the mask can become. For a neurotypical person, it would be like keeping up their chipper and professional interview self all day, every day.

It can wear you down. And cause significant inner turmoil.

“It can be exhausting and emotionally draining to keep it up,” Dr. Cuffman shares. “Some studies have shown connections between using masking often and higher rates of anxiety, depression and even suicide.”

Those studies showed that mental health conditions were related to masking. Not that masking caused deteriorating mental health.

In other words, it could be that masking leads to things like anxiety disorders. Or it may be that people who live with high levels of anxiety are more likely to mask.

More information is needed to understand the connection. But the fact that they’re related is reason enough to recognize that frequent masking can do significant harm.

Relationship damage

Masking around a small cohort of colleagues or at the occasional party is one thing. But if you’re masking even around people in your innermost circle, problems are likely to abound.

“One of the themes that comes up in camouflaging research is that people who mask can feel like they’re lying about who they are and not being true to themselves,” Dr. Cuffman notes. “And that can extend to having long-term relationships built on camouflaging.”

If masking leads to a relationship where your partner doesn’t know the full you, it’s tough to sustain the act. And tougher, too, to lift that mask the longer you keep it on.

Diagnosis and care

Masking can also keep autistic people from getting diagnosed or from getting the support that could benefit them.

“There’s some thought that masking may be part of the reason that females are less likely to be diagnosed with autism,” Dr. Cuffman points out. “We know that autistic women and girls may be more likely to mask. And if they’re hiding their symptoms, they aren’t likely to get a proper diagnosis.”

It’s a domino effect. You mask to “fit in” with the neurotypical crowd. You’re accepted as such. You “pass” for not having autism.

You don’t get diagnosed. You don’t get the support that can help you to thrive. You’re on your own. And so you continue to mask. Potentially even to the point of your own detriment.

“I see this in my pediatric patients — they work so hard to hold it together through the school day, and then they fall apart at home,” she adds. “If they were diagnosed and receiving support through the school day, they might not be so exhausted at the end of the day.”

Seeking support

Masking can be tiresome and a significant risk to your well-being. But that doesn’t mean it’s easy to unmask.

“It’s not an individual problem. There’s a societal shift that needs to happen so that people feel comfortable unmasked,” Dr. Cuffman advocates. “We want autistic individuals to feel like they're accepted in the world as they are.”

Masking is a tool that can help you navigate a world that doesn’t always feel safe for you. And until society welcomes you — all of you — it’s understandable why you’d keep masking. But it’s important to know that masking can come with a hefty price. One that you shouldn’t have to pay.

Support is available for people with autism to help them live their best lives. Talk with your healthcare provider. Seek mental health services. Join discussion boards and forums. Take down your mask when you feel comfortable doing so. And know that the real you is amazing and worthy of love and respect.