Masking is a term frequently encountered in discussions about neurodiversity, but what does it really mean? It's not a formal psychiatric term, but it is helpful for anybody working with neurodivergent people to be aware of, which, let's face it, is every health clinician working with the public.
What is Masking?
Masking, also known as camouflaging, refers to the strategies neurodivergent individuals use to blend into a neurotypical world. Masking is not exclusive to neurodivergent people—most individuals will adjust their behaviour in different situations to fit social norms. This is a normal and adaptive thing to do. Imagine doing whatever you wanted to do at work, like telling your boss they're an idiot, wearing pyjamas, and starting at 10 am instead of 8 am. You wouldn't last long in that job. So, what we call masking we might also call learning, adapting, or accommodating. A lot of my ADHD and/or autistic clients use the term masking to describe their deliberate attempts to change behaviour to fit in.
When we talk about masking in conjunction with neurodivergence, a popular belief is that masking can be a pathway to poor mental health. So what data do we have about this? The Camouflaging Autistic Traits Questionnaire (CAT-Q), a scale designed to measure social masking in autistic people, has revealed significant gender differences. Both autistic and non-autistic women mask more frequently than their male counterparts. Additionally, autistic women mask more than non-autistic women, while autistic men mask less than non-autistic men. Data from the questionnaire shows that a higher total camouflaging score in autistic people correlated negatively with well-being and also with higher scores for depression and anxiety symptoms. This suggests, that at least for autistic people, camouflaging/masking might be something useful to think about during therapy if the person believes they do a lot of it and that it is at least partly detrimental.
When it comes to neurodivergent-specific masking, we can think of behaviours like mimicking social cues, hiding stimming or fidgeting behaviors, adopting a 'socially acceptable' persona, or wanting to appear unimpeachable through the rigid application of perfectionism. For instance, an autistic person might force themselves to make eye contact or suppress their need to stim (repetitive movements or sounds) to avoid standing out.
Some of this masking will be adaptive and will indeed help people achieve their goals of fitting in. Some masking may be problematic and lead to expending significant energy that a person may wish to conserve for other pursuits. Thinking about what is helpful and what is not would be the first step in deciding whether a person wishes to "unmask", and what specific behaviours seem to be a problem. Also considering whom it is safe to unmask around is important.
The Potential Costs of Masking
While masking can help neurodivergent individuals navigate a neurotypical world, it can sometimes come at a significant personal cost. The constant effort to maintain a façade can lead to:
Mental Health Issues: Prolonged masking may increase anxiety, depression, burnout, and perfectionistic tendencies. The strain of suppressing one's true self for fear of imminent rejection may erode self-esteem and lead to feelings of isolation.
Exhaustion: The energy required to constantly monitor and adjust one's behaviour can be immense.
Loss of Identity: Over time, extensive masking may blur the line between one's authentic self and the persona adopted to fit in. This can create a disconnection from one's true identity and values. Some of my clients talk about not knowing who they actually are. Some have talked about hiding their emotional distress from their family out of a sense of shame and guilt. Some have been able to mask their symptoms so well that even those closest to them cannot see their suffering (which makes performing an ADHD assessment a bit harder when it comes to gathering collateral information about symptoms).
Related blog post: "Spoon Theory" as Applied to ADHD
Related blog post: Understanding and Managing Burnout in Neurodivergent Adults
Breaking the Mask: Embracing Authenticity
For some neurodivergent adults, the journey towards authenticity may involve some unmasking in certain safe situations or around safe people. This process can be empowering but also challenging, particularly in environments that are not supportive or understanding of neurodiversity. I have some clients who allow themselves to use fidget toys at work, or in the therapy room (I have a bowl of fidgets in my therapy room for this purpose).
Here are some steps that can help with altering unhelpful masking:
Self-Acceptance: Recognising and accepting one's neurodivergent traits can be important in deciding what behaviours are OK to show to selected others. This involves understanding that these traits are a fundamental part of who the neurodivergent person is, and that perhaps they might not lead to the rejection or abandonment that a person fears.
Seeking Support: Connecting with other neurodivergent individuals or communities in person or using social media can provide invaluable support and validation.
Educating Others: Sharing information about neurodiversity with friends, family, and colleagues can foster a more supportive and inclusive environment. Education can help dispel myths and reduce the stigma associated with neurodivergent behaviours.
Advocating for Accommodations: Whether in the workplace, educational settings, or social environments, advocating for accommodations can make it easier to function in tasks with reduced masking. This might involve requesting sensory-friendly accommodations, flexible work arrangements, or clear communication styles.
Related blog post: To Disclose or Not to Disclose: Navigating ADHD Diagnosis Disclosure at Work
Related blog post: The Dual Nature of Advocacy in Living with Adult ADHD
Conclusion
Masking is a complex social phenomenon that comprises both helpful and effortful changes in how a neurodivergent person may present themselves to others. Simply dropping the mask and living your authentic self is not realistic or desirable for most people; I wouldn't want to do it! But, there may be steps toward revealing aspects of a person's self slowly to trusted people that could be useful in dropping the more harmful aspects of masking.
Clinical psychologist Dr Sharon Saline writes about unhealthy masking and how to go about changing it in Why ADHD Masking Is a Form of Self-Sabotage
ADHD expert and psychologist Dr Russell Barkley puts forward the case that masking may not be as detrimental nor exclusive to ADHD as it is suggested to be, and then posts a clarification video following comments on his original video.
This article from ADDitude includes anecdotes about unmasking from people with ADHD: “We Are Who We Are. There’s No Shame in That.”
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