Social Camouflaging Among Autistic Adults Vs. Social Anxiety Disorder (2024)

Social camouflaging refers to strategies individuals use to mask or compensate for social differences in order to fit in with societal norms.
In autism, this masking may involve suppressing stimming behaviors, forcing eye contact, or using scripted responses in social situations.
For those with social anxiety, camouflaging might include hiding physical symptoms of anxiety, overcompensating in social interactions, or avoiding situations that trigger anxiety.
While camouflaging can help individuals navigate social environments, it often comes at a cost. Consequences may include increased stress, exhaustion, and burnout. It can lead to delayed or missed diagnoses, especially in autism.
Prolonged camouflaging may contribute to identity confusion, low self-esteem, and mental health issues such as depression and anxiety. Understanding these strategies and their impacts is crucial for improving support and interventions for both autism and social anxiety.

Social Camouflaging Among Autistic Adults Vs. Social Anxiety Disorder (1)

Pyszkowska, A. (2024). It is more anxiousness than role-playing: Social camouflaging conceptualization among adults on theautismspectrum compared to persons with social anxiety disorder.Journal ofAutismand Developmental Disorders.Advance online publication.https://doi.org/10.1007/s10803-024-06416-0

Key Points

The primary methods of studying social camouflaging in autism spectrum disorder (ASD) and social anxiety disorder (SAD) include comparative analysis, structural equation modeling, and network analysis.
Factors like autistic traits, social anxiety symptoms, public stigma, and camouflaging strategies significantly affect autistic burnout and overall well-being in individuals with ASD and SAD.
Camouflaging tendencies were found to be transdiagnostic, deriving from anxiousness and negative self-perception, rather than being exclusively linked to autism.
The research, while enlightening, has certain limitations such as a hom*ogeneous sample, cross-sectional design, and potential measurement issues.
This study highlights the universal relevance of understanding social adaptation strategies across different neurodevelopmental and psychiatric conditions, emphasizing the need for tailored support and interventions.

Rationale

Autism spectrum disorder (ASD) and social anxiety disorder (SAD) often co-occur, presenting challenges in differential diagnosis and understanding of social behaviors (Rosen et al., 2018).

Social camouflaging, a strategy used to navigate social situations by masking autistic traits or compensating for social difficulties, has been primarily studied in the context of ASD (Hull et al., 2017). However, its potential relevance to SAD and the interplay between these conditions remains underexplored.

Previous research has highlighted the impact of camouflaging on mental health and well-being (Cook et al., 2021), but the specific relationships between camouflaging, autistic traits, social anxiety symptoms, and public stigma across ASD and SAD populations are not well understood.

This study aims to address this gap by exploring and conceptualizing social camouflaging across ASD, SAD, and comorbid ASD+SAD groups, with a focus on how these factors contribute to autistic burnout.

Method

The study employed a quantitative, cross-sectional design using online surveys and standardized measures.

Participants were recruited through online autism groups, mental health facilities, and outpatient departments in Poland.

Procedure

Participants completed an online form via LimeSurvey, providing informed consent and demographic information.

They then completed several standardized questionnaires measuring camouflaging, autistic traits, autistic burnout, social anxiety symptoms, and perceived public stigma.

Sample

The study included 254 participants:

148 with ASD diagnosis
65 with SAD diagnosis
45 with both ASD and SAD diagnoses
186 females, 68 males/non-binary/other
Mean age: approximately 28 years old
Predominantly from urban areas in Poland

Measures

Camouflaging Autistic Traits Questionnaire (CAT-Q): A 25-item scale measuring three aspects of camouflaging: compensation, masking, and assimilation. It assesses strategies used to hide autistic traits or appear more neurotypical in social situations.
Autism Quotient-10 (AQ-10): A brief 10-item questionnaire designed to measure autistic traits in adults. It covers areas such as social skills, attention-switching, communication, and imagination.
AASPIRE’s Autistic Burnout Scale: A 27-item scale measuring symptoms of autistic burnout, including physical and emotional exhaustion, reduced tolerance to sensory input, and executive function difficulties.
Liebowitz Social Anxiety Scale (LSAS-SR): A 24-item self-report scale assessing fear and avoidance in various social situations. It provides separate scores for social fear and social avoidance.
Perceived Public Stigma Scale (PPSS): An 8-item scale measuring individuals’ perceptions of public attitudes and beliefs about autism or mental health conditions, assessing the level of perceived stigma in society.

Statistical measures

Kendall’s tau b correlation analysis
Analysis of Variance (ANOVA)
Partial Least Squares Structural Equation Modeling (PLS-SEM)
Network analysis using Qgraph package

Results

Hypothesis 1: There will be differences in social camouflaging features, autistic traits, autistic burnout, social anxiety symptoms, and public stigma among ASD, SAD, and ASD+SAD groups.

Results:

Total camouflaging scores did not differ significantly between groups.
Compensation was higher in ASD groups.
Masking was higher in the SAD group.
Assimilation was higher in SAD and ASD+SAD groups.
Autistic traits were highest in ASD and ASD+SAD groups.
Autistic burnout was highest in the ASD+SAD group.
Social anxiety symptoms were highest in SAD and ASD+SAD groups.
Public stigma did not differ significantly between groups.

Hypothesis 2: Associations and determinants of camouflaging will be based on symptomatology and social contexts rather than mere diagnosis.

Results:

Structural equation models showed acceptable fit for the proposed conceptualization of camouflaging and autistic burnout.
Public stigma predicted social anxiety and avoidance.
Camouflaging significantly predicted autistic burnout.
Autistic traits had minimal effect on public stigma.
Network analysis revealed different patterns of relationships between variables across the three groups.

Insight

This study provides valuable insights into the complex relationships between social camouflaging, autistic traits, social anxiety, and public stigma across ASD and SAD populations.

The finding that total camouflaging scores did not differ significantly between groups suggests that camouflaging may be a transdiagnostic phenomenon, driven more by anxiety and negative self-perception than by autism-specific traits.

This challenges the notion that camouflaging is unique to autism and highlights the importance of considering these strategies in a broader context of social adaptation.

The study extends previous research by examining camouflaging in both ASD and SAD populations, revealing nuanced differences in how these groups employ various camouflaging strategies.

For instance, the higher levels of compensation in ASD groups and higher levels of masking in SAD groups suggest that different underlying mechanisms may be at play in each condition.

The significant relationship between camouflaging and autistic burnout across groups emphasizes the potential negative consequences of these adaptive strategies, regardless of diagnosis. This finding has important implications for understanding the long-term effects of social camouflaging on mental health and well-being.

Future research could focus on longitudinal studies to examine the causal relationships between camouflaging, social anxiety, and burnout over time.

Additionally, investigating the effectiveness of interventions targeting specific camouflaging strategies in reducing burnout and improving social functioning across different diagnostic groups would be valuable.

Strengths

This study had several methodological strengths, including:

Comparative design, including ASD, SAD, and comorbid groups
Use of validated measures for key constructs
Employment of advanced statistical techniques (SEM and network analysis)
Consideration of multiple factors influencing camouflaging (autistic traits, social anxiety, public stigma)
Integration of quantitative data with theoretical conceptualization

Limitations

This study also had some methodological limitations, including:

hom*ogeneous sample (predominantly white, employed/student, Polish)
Cross-sectional design limiting causal inferences
Reliance on self-report measures
Potential cultural specificity of results (Polish context)
Unbalanced sample sizes across groups
Use of AQ-10, which may have limited reliability in non-autistic populations

These limitations impact the generalizability of the findings to other cultural contexts and demographic groups. The cross-sectional nature of the study prevents drawing conclusions about the direction of relationships between variables over time.

Implications

The results of this study have significant implications for clinical practice and understanding of social adaptation strategies in ASD and SAD.

The finding that camouflaging is not unique to autism suggests that clinicians should consider these strategies when working with individuals with social anxiety, potentially leading to more accurate diagnoses and targeted interventions.

The strong relationship between camouflaging and autistic burnout highlights the need for interventions that address the potential negative consequences of these adaptive strategies. Clinicians may need to help individuals balance the perceived benefits of camouflaging with its potential costs to mental health and well-being.

The varied patterns of camouflaging across groups (e.g., higher compensation in ASD, higher masking in SAD) suggest that interventions may need to be tailored to address specific types of camouflaging strategies depending on an individual’s diagnosis and presentation.

The role of public stigma in predicting social anxiety and avoidance emphasizes the importance of addressing societal attitudes and misconceptions about neurodevelopmental and psychiatric conditions.

Public education and anti-stigma campaigns may be crucial in reducing the perceived need for camouflaging and improving overall outcomes for individuals with ASD and SAD.

Variables that influence the results include cultural context, gender (with a predominantly female sample), and the presence of comorbid conditions. Future research should explore how these factors moderate the relationships between camouflaging, social anxiety, and burnout.

References

Primary reference

Pyszkowska, A. (2024). It is more anxiousness than role-playing: Social camouflaging conceptualization among adults on theautismspectrum compared to persons with social anxiety disorder.Journal ofAutismand Developmental Disorders.Advance online publication.https://doi.org/10.1007/s10803-024-06416-0

Other references

Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: A systematic review.Clinical psychology review,89, 102080. https://doi.org/10.1016/j.cpr.2021.102080

Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions.Journal of autism and developmental disorders,47, 2519-2534. https://doi.org/10.1007/s10803-017-3166-5

Rosen, T. E., Mazefsky, C. A., Vasa, R. A., & Lerner, M. D. (2018). Co-occurring psychiatric conditions in autism spectrum disorder.International review of psychiatry,30(1), 40-61. https://doi.org/10.1080/09540261.2018.1450229

Keep Learning

Socratic questions for a college class discussion:

How might the concept of social camouflaging challenge our understanding of the boundaries between different psychological disorders?
In what ways could the cultural context of this study (conducted in Poland) influence the results, and how might they differ in other cultural settings?
Given the finding that camouflaging is associated with burnout, how can we balance the potential short-term benefits of social adaptation with long-term well-being?
How might the predominantly female sample in this study affect our interpretation of the results, and what implications does this have for understanding gender differences in camouflaging?
Considering the transdiagnostic nature of camouflaging found in this study, how might this impact diagnostic criteria and processes for ASD and SAD?
What ethical considerations arise when studying and potentially intervening in camouflaging behaviors, given that they may serve as adaptive strategies for some individuals?