When Masking Leads to Mental Health Misdiagnoses. #TakeTheMaskOff

Some people mask so well that nobody knows they’re autistic, not even themselves. And they manage just fine….until the cracks begin to appear. They still don’t “look autistic” but there is something definitely “off” about them. And their lives are often a mess.

So, off they go to their local psychiatrist, who normally doesn’t know too much about autism, especially when it’s being covered up with a mask. And they emerge with a diagnosis of schizophrenia, bipolar disorder, major depressive disorder, psychotic disorder or personality disorder (usually borderline personality disorder).

I read with interest this study that outlines how this may happen. It includes a handy chart of “Postulated pathways for patterns of maladjustment and the process to misdiagnosis in adults with autism spectrum disorder.” Which I have included as an image for your perusal. It shows how typical autistic behaviours can be misinterpreted as things such as impulsivity or even schizophrenia.

These people may indeed have the psychiatric conditions they are diagnosed with, as co-morbid to their autism. Or their autistic traits may be mistaken for symptoms of conditions that they actually don’t have. Either way, their autism doesn’t get picked up on and they suffer as a result.

The blame lies solely on the shoulders of the psychiatrists and psychologists. They need to learn to see beyond the mask, or even just recognize that the mask exists at all. They need better training on the “subtle” signs of autism that peek out from behind the mask. They need to probe into the autistic person’s childhood, as a lot of psychiatric conditions don’t manifest in childhood, while autism does.

Until then too many of us will be diagnosed with conditions we don’t have, while the actual cause of our problems – living unsupported as masked autistics in a non-autistic world- goes unrecognized.


  1. The chart is interesting. Those perceived as women are, of course, still much more likely to be misdiagnosed with a host of things. In my case, the only thing they tried to treat was depression. I’m not sure it ever really was that. Autistic burnout combined with cPTSD seems more likely. But I really did camouflage both so well, confusing the emotional flashbacks associated with cPTSD with the emotional dysregulation associated with meltdowns and furiously using all the techniques I had developed to try to manage and control both. And I mostly kept them hidden from others and even from myself.

    I’m not sure I would say I ever managed just fine, though. I survived.


  2. I can’t see the chart but very much, loud, and angrily agree with the many bs misdiagnoses especially for autistic persons with femaleness. but unless we can improve the shrinks and other so called professionals, and the nt culture around, the masks will exist

    Liked by 1 person

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