To mask or not to mask: The role of concealment behavior, stigma experience, and community connectedness in autistic people's mental health

Abstract

Psychological theory and results from previous empirical studies paradoxically suggest that concealing and revealing one's autism can each result in reduced mental well-being. On one hand, autistic people who reveal their autistic identity experience considerable anti-autism stigma, which can lead to worse mental health outcomes compared to autistic people who conceal their autistic identity. On the other hand, autistic people who conceal their autistic identity are not afforded the benefits of autistic community connectedness, potentially undermining mental health outcomes compared to autistic people who reveal their autistic identity. The present study explores the relationships between autism concealment behaviors, autistic community connectedness, stigma experience, and mental well-being in autistic people. In an analytic sample of 409 autistic people, we found that concealing one's autistic identity was related to worse depressive symptoms, and that this relationship was related to experiencing greater stigma, and not to differences in community connectedness. These findings reinforce the need for combatting stigma against autistic people. Lay Abstract Many autistic people try to hide their autistic traits or appear more in line with typical social norms through changing their behavior, even when it is uncomfortable, which is known as camouflaging. Previous studies have shown that autistic people often attribute mental health difficulties, such as anxiety and depression, to concealing their autism through camouflaging. In part, this might be because concealing one's autism is related the loss of a sense of community with other autistic people, which is a protective factor for autistic people's mental health. However, allowing one's autistic identity to be public by forgoing camouflaging can make autistic people more likely to face judgement, stigmatization, and unfair treatment due to society's negative view of autism, which can also lead to poor mental health. Autistic people may thus be in a double bind between engaging in camouflaging but possibly experiencing related mental health difficulties and camouflaging less but encountering more stigmatization. In this study, we explored what contributes to this seemingly contradictory relationship between autism concealment and depressive symptoms. We collected data from 409 autistic people in an online survey. The results showed that participants who concealed their autism more were more likely to show depressive symptoms. This increase in depression symptoms was explained by experiencing stigma rather than feeling connected to the autistic community. These findings suggest negative effects of camouflaging and stigma on autistic people's mental health and support the call for increased autism acceptance.