The Impacts of High Masking Autism

High masking Autism refers to the ability to suppress, hide, or camouflage Autistic traits to blend into neurotypical expectations. While being able to mask comes with a certain level of privilege, it also comes at a significant cost. Especially when the mask is so deeply ingrained that we don’t know where we and it begin and end. 

As high masking Autistics, we’re often perceived as being “fine” on the outside, while inside we are overwhelmed, burnt out, and struggling. When our challenges are hidden, they are often dismissed and overlooked, by others and ourselves. 

Many Autistic adults don’t realize the impact of masking until we hit complete burnout - often after decades of suppression and hiding ourselves. The constant pressure to fit in, adjust to societal expectations, and monitor our way of being creates an exhausting cycle of burnout that at times can feel impossible to break free of.

Delayed Diagnosis & Misdiagnosis

High-masking individuals, especially those identifying female, non-binary, or LGBTQIA+, are often misdiagnosed, or remain undiagnosed well into adulthood. As we’ve spent years camouflaging our Autistic experience and figuring out ways to fit in to expectations, family, friends, teachers, and medical professionals can miss key indicators of Autism. This delay can foster confusion about our identities, making us question our behaviors and attributing challenges to personal failings rather than neurodivergence. 

Many late-diagnosed Autistics receive a diagnosis of an anxiety disorder, mood disorder, depression, OCD, or personality disorder along the way. While these conditions can coexist with Autism, they often develop as a result of masking and suppressing our authentic selves. And sometimes these diagnoses are just wrong - with Autistic signs being misperceived as symptoms of other conditions. For example, periods of hyperfocus and burnout are often confused for mania and depression. Misdiagnosis can be devastating -  leading to years of confusion, frustration, ineffective treatment, and self-blame. 

Chronic Burnout & Exhaustion

Masking isn’t just hiding stims or scripting conversations - it’s a constant, persistent, high-effort process of self-monitoring and adjusting. It drains our cognitive, physical, and emotional resources. The effort of continually monitoring our behaviors, suppressing our emotions, and conforming to neurotypical norms can lead to profound exhaustion, referred to as Autistic burnout. 

Different from general exhaustion, Autistic burnout involves deep cognitive, emotional, and physical depletion that can last for extended periods of time. During burnout, Autistic people might experience severe brain fog, difficulty making decisions, memory challenges, emotional shutdowns, heightened reactions and meltdowns, social withdrawal, and physical depletion like chronic pain, GI distress, and worsening of co-occurring conditions. 

Unlike typical burnout, Autistic burnout can last weeks, months, or even years, leading to periods of unemployment and extreme challenges with day-to-day activities. Many Autistics experience skill regression and heightened sensitivity during burnout, where Autistic experiences feel amplified. 

Identity Confusion & Loss of Self

After years of masking, many of us find it difficult to distinguish between our authentic selves and the persona we’ve been forced to adopt. We may start to question what’s us and what’s everyone else. For many of us, this is complicated by differences in interoception and how we experience emotions. As we begin to peel back the mask and discover who we are, it can feel like an identity crisis - prompting us to question who we are, what we value, and who is important to us. Unmasking, and re-exploring our interests, needs, passions, and relationships can be daunting and liberating. There can be immense joy in rediscovering childhood interests, making space to stim, and finding our natural communication methods. There can also be immense grief, as we reflect on lost time, past experiences, and uncertainty about life moving forward.

Social & Relationship Difficulties

While masking might make engaging with others seem easier, it often stays at the surface and prevents the formation of deeper, more authentic friendships and relationships. Many of us struggle with the fear of rejection, social exhaustion, a hyper awareness of social rules, and difficulty setting boundaries out of fear of being rude. The fear of being “too much” or “too weird” can drive us to maintain our mask even in personal relationships, leading to feelings of isolation and exhaustion. Constantly performing to fit in can make relationships feel burdensome and performative. One of the most healing parts of unmasking is building authentic connections (with both ourselves and others) by honoring our communication styles, setting boundaries, and allowing ourselves to take up space unapologetically.

Work & Career Challenges

Many high-masking autistic individuals seem to excel professionally. On the outside they seem confident and in charge. Internally, however, they may be battling sensory overload, executive dysfunction, and burnout. This disconnect between external competence and internal struggle can lead to perfectionism, overworking, people pleasing, difficulty advocating, masking through stress, and burnout. Many high maskers continuously push themselves past their limits, in an endless cycle of overcompensating, burning out, and needing recovery. Understanding one’s needs and having a ND-friendly work environment can make a huge difference in long-term career sustainability.  

Physical Health Consequences

Masking doesn’t just impact our mental health - it directly impacts the body. High maskers often push through discomfort, overriding body signals. This might include pushing through sensory pain, skipping meals or bathroom breaks, or suppressing stimming and the need for movement. Over time, neglecting our body’s signals can contribute to worsening health conditions and physical symptoms like headaches, GI distress, and chronic pain. Many Autistic people also develop dysautonomic conditions like POTS. 

Unmasking as a Healing Process

Masking comes at a significant cost, but recognizing its impact and becoming more aware of how you suppress your autistic experience is the first step toward change. Unmasking can feel overwhelming, vulnerable, and disorienting, but it also opens the door to self-discovery, compassion, and authenticity. It’s not just about letting go of the performance, it’s about uncovering who you truly are beneath it all. With time, patience, and support, unmasking can be a path toward self-acceptance and living a life that feels more aligned with your authentic self. 

If you’re ready to explore how online expressive arts, neurodivergent affirming therapy, or coaching can help, reach out today to get scheduled for a free 15-minute consult call or initial intake session.