Unmasking Late: Why So Many Autistic Women Are Diagnosed in Adulthood, and Why It Matters
There’s a particular kind of grief that comes with finally understanding yourself after decades of feeling different. For many women, receiving an autism diagnosis in adulthood brings clarity but also sorrow. It’s a quiet kind of mourning, not just for the years lost to confusion or shame, but for the child who went unseen.
In my work, both clinical and personal, I’ve observed how many autistic women navigate the world with a mask. Women who are often described as “quiet,” “high-achieving,” or “empathetic.” Traits that camouflage distress, traits that help them blend into a neurotypical world so well that even they don’t realise they are performing.
Missed and Misunderstood
Autistic women are often diagnosed years, if not decades, after their male counterparts, or not at all. The original diagnostic criteria for autism were based on studies of boys, meaning that many women do not meet the stereotypical presentation (Lai & Baron-Cohen, 2015). While boys may externalise distress through behaviour, many autistic girls and women internalise it, manifesting as anxiety, depression, eating disorders, or burnout (Bargiela, Steward & Mandy, 2016).
Many autistic women learn to “mask”. Masking is when someone mimics neurotypical social behaviours so effectively that they go unnoticed. This may involve copying facial expressions, rehearsing social scripts, or suppressing natural behaviours like stimming. These strategies are often unconscious and can become so habitual that they feel like personality rather than protection (Hull et al., 2017).
This is part of what makes late diagnosis so emotionally charged. The discovery that you are autistic doesn’t just give you a new framework; it often asks you to deconstruct an identity you built for survival, dig down to find your true self.
The Cost of Camouflage
The psychological toll of masking is well documented. Women who camouflage extensively report higher levels of exhaustion, identity confusion, and mental health issues (Dean et al., 2017). Some describe losing touch with who they are beneath the performance.
It reminds me of Winnicott’s (1960) concept of the false self — a self that forms to meet the perceived demands of the environment. Many autistic women create a false self early in life, built on praise for being “easy,” “good,” or “independent.” These defences may allow them to function, or often even excel, but at the cost of our authenticity and mental health.
Eventually, though, the mask becomes too heavy. Burnout, often mistaken for depression, is one of the most common triggers for seeking a diagnosis. Often, women may seek a diagnosis after the diagnosis of a child, which leads many mothers to realise that the patterns they see in their child also live in them.
Why It Matters
There is no cure for autism, and many people with autism aren’t seeking a cure anyway. So why is receiving an autism diagnosis as an adult helpful? For some, it can feel like a new beginning. It offers a new language for understanding oneself. It helps explain why certain things have always felt harder, why exhaustion feels bone-deep after a social gathering, or why injustice feels physically intolerable. It can help some people have more compassion for their younger selves.
It can also come with grief. Many clients I’ve worked with speak about the sorrow of not being understood, the years spent adapting, the friendships lost to misattunement. There is often anger at the systems that failed them, at the people who told them they were “too much,” and at the self for not realizing sooner.
Yet within that grief is often a quiet liberation. Carl Rogers, the humanistic psychologist, believed that psychological well-being comes from living in congruence—when our outer lives match our inner truth. For many late-diagnosed autistic adults, the diagnosis is the key that allows this alignment to finally happen. No longer forced to maintain a socially acceptable façade, they can begin to live with greater authenticity, self-acceptance, and self-compassion. As one client told me, “It’s like I’ve been translating myself my whole life, and I finally found the original language.”
The Intersection with Gender
It’s important to note that this diagnostic delay is not just about autism — it’s also about gender. From an early age, many girls are socialised to be compliant, relational, and emotionally attuned. Autistic traits like blunt honesty, emotional intensity, and sensory sensitivity may be pathologised as mood disorders, or written off as “just being sensitive.”
Autistic girls who are quiet are called “shy.” Those who are overwhelmed are called “dramatic.” Those who question rules are “defiant.” None of these labels get to the heart of what’s really going on.
Our cultural scripts around gender can be a barrier to diagnosis. As Mandy and Tchanturia (2015) argue, clinicians often fail to look beyond stereotypical male presentations, meaning many women are misdiagnosed or dismissed. The result is a diagnostic system that continues to fail an entire group of people.
Towards Recognition and Repair
We need to listen differently. Not just as clinicians or therapists, but as communities. We need to believe women when they say, “This is hard for me.” We need to expand our understanding of what autism looks like, not just in the classroom, but in the workplace, the friendship group, and the family system.
Late-diagnosed women don’t need fixing. They need recognition. They need space to unmask. And they need support, not to become neurotypical, but to build lives that accommodate and celebrate their neurodivergence.
As therapists, we have a responsibility to see what has not yet been seen and create spaces that are spacious enough for the unmasking to begin. This means attuning to what is said and what is not. It means recognising the weight of performance, the exhaustion of survival, and the courage it takes to ask, “Who am I underneath this?”
Final Thoughts
Getting diagnosed late in life doesn’t undo the past, but it does allow for a different future. One grounded in authenticity, not adaptation. One that honours not just survival, but selfhood.
There is immense strength in the act of reclaiming your story — even if the beginning was miswritten.
If you’re struggling with a new diagnosis, going through the long process, or deciding whether or not to pursue one, I can help. I understand what you’re going through and how difficult these stages can be.
References
Bargiela, S., Steward, R., & Mandy, W. (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8
Dean, M., Harwood, R., & Kasari, C. (2017). The Art of Camouflage: Gender Differences in the Social Behaviors of Girls and Boys with Autism Spectrum Disorder. Autism, 21(6), 678–689. https://doi.org/10.1177/1362361316671845
Hull, L., Mandy, W., & Petrides, K. V. (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
Lai, M.-C., & Baron-Cohen, S. (2015). Identifying the Lost Generation of Adults with Autism Spectrum Conditions. The Lancet Psychiatry, 2(11), 1013–1027. https://doi.org/10.1016/S2215-0366(15)00277-1
Mandy, W., & Tchanturia, K. (2015). Do Women with Autism Spectrum Conditions Experience Higher Levels of Eating Disorder Psychopathology than Men? British Journal of Clinical Psychology, 54(3), 310–317. https://doi.org/10.1111/bjc.12065
Winnicott, D.W. (1960). Ego Distortion in Terms of True and False Self. In The Maturational Processes and the Facilitating Environment. London: Karnac Books.
