For a few sessions, my therapist had been referring to me as \u201cneurodivergent.\u201d <\/p>\n\n\n\n
I have OCD, which is often considered to be under that umbrella, so I didn’t flinch. But one day, I asked her what she meant by it exactly, and she suggested that I have some traits consistent with an autism diagnosis. While I haven’t undergone the very costly formal process to find out whether I am in fact autistic, her assessment made sense to me: I find social interactions taxing and confusing; I have a deep emotional attachment to stuffed animals; I sometimes feel like covering my ears when there are too many things happening at once.<\/p>\n\n\n\n
\n“There is more and more evidence out there these days that women are chronically underdiagnosed with autism.”<\/p>\n<\/blockquote>\n\n\n\n
I\u2019ve often wondered whether I might be autistic as a byproduct of self-diagnosis TikToks, but this was the first time anyone else had suggested it. The thing is, there is more and more evidence out there these days that women are chronically underdiagnosed with autism. <\/p>\n\n\n\n
There are a number of reasons for this, particularly that autism in those who are raised or identify as girls and women often presents very differently than it does in boys and men. This is a problem because, while a diagnosis isn\u2019t the be-all and end-all, it can help people understand themselves better, learn coping strategies, and find community with like-minded others. I spoke to three autism experts to find out more about how autism presents in girls and women, and why it\u2019s still so misunderstood.<\/p>\n\n\n\n
\n\n\n\nWhat is autism?<\/h4>\n\n\n\n
We\u2019ve all heard about autism, but not many of us could define it, so let\u2019s start there. <\/p>\n\n\n\n
\u201cAutism is a neurodevelopmental condition that shows up as differences in social interaction, communication, sensory processing, and behavior patterns,\u201d says Gayle Clark<\/a>, LCSW, a trauma therapist who works with neurodivergent women. \u201cSimply put, it means that the brain processes the world differently \u2014 it is not a mental illness or a disorder, just different wiring.\u201d Autism often affects the way people process sensory input and experience social interactions, and can lead to feelings of overwhelm.<\/p>\n\n\n\n
\n“Autism often affects the way people process sensory input and experience social interactions, and can lead to feelings of overwhelm.”<\/p>\n<\/blockquote>\n\n\n\n
Autism is mostly understood to be genetic, but our experiences of life \u2014 including a history of trauma \u2014 also shape how it shows up in individuals. \u201cFor many autistic women, trauma and masking can layer over each other, making it harder to recognize,\u201d says Vanessa Palomera, LMFT, a therapist and founder of Serene Butterfly Counseling<\/a>, who is neurodivergent and a Certified Autism Spectrum Disorder Clinical Specialist. \u201cIt\u2019s not that trauma causes autism, but it can complicate how symptoms present and make it harder to identify.\u201d<\/p>\n\n\n\n
\n\n\n\nHow does autism present differently in women than in men?<\/h4>\n\n\n\n
Autism looks different in every individual, but there are some commonalities in how it presents in men and boys vs. women and girls, which often means the latter get missed. <\/p>\n\n\n\n
One particular difference is that women and girls are more prone to \u201cmasking,\u201d i.e., emulating social norms to a greater degree and hiding some of their autistic traits, which could potentially lead to social isolation. This means that autistic women and girls may find it more difficult to advocate for their needs. <\/p>\n\n\n\n
\n“Women and girls are more prone to \u201cmasking,\u201d i.e., emulating social norms to a greater degree and hiding some of their autistic traits.”<\/p>\n<\/blockquote>\n\n\n\n
Additionally, autistic people often have special interests that take up a lot of their attention, but \u201cwomen and girls are much more likely to choose socially acceptable special interests (animals, books, music, art), so are less likely to be noticed,\u201d says Clark.<\/p>\n\n\n\n
These are some signs of autism in women, according to Clark and Becky Grace Irwing<\/a>, a psychotherapist in the UK who is autistic herself:<\/p>\n\n\n\n
\n
- Feeling out of step with others despite appearing competent<\/li>\n\n\n\n
- Mimicking others to fit in<\/li>\n\n\n\n
- Exhaustion after socializing or performing \u201cnormal\u201d<\/li>\n\n\n\n
- Struggles with small talk, social rules, or interpreting tone<\/li>\n\n\n\n
- Intense internal worlds and rich imaginative lives<\/li>\n\n\n\n
- Deep emotional sensitivity or sensory sensitivity<\/li>\n\n\n\n
- Sensory discomforts to lights, sounds, textures, foods, being masked as \u201cpickiness\u201d or \u201csensitivity\u201d<\/li>\n\n\n\n
- Shutdowns or meltdowns when overwhelmed<\/li>\n\n\n\n
- Literal thinking and difficulty with abstractions<\/li>\n\n\n\n
- Need for routine and predictability<\/li>\n\n\n\n
- Chronic anxiety, burnout, perfectionism, or identity confusion<\/li>\n<\/ul>\n\n\n\n
\n\n\n\nWhy does it take so long for women to be diagnosed with autism?<\/h4>\n\n\n\n
Research<\/a> from Swansea University in 2022 found that it took girls six years longer than boys on average to receive an autism diagnosis, with further research<\/a> corroborating the delay (though it\u2019s difficult to pinpoint exactly how much longer it might take women to get diagnosed than men). <\/p>\n\n\n\n
\u201cA young girl who is using social camouflage may not act out in ways that make their parents concerned, and so a diagnosis is never sought out,\u201d says Clark. \u201cAs she grows up, continuing to mask and to just push through her discomfort, she does not seek out diagnosis in adulthood. If she does decide to investigate further, she is much more likely to be misdiagnosed with mental health conditions such as borderline personality disorder, anxiety, or PTSD.\u201d<\/p>\n\n\n\n
\n\u201cA young girl who is using social camouflage may not act out in ways that make their parents concerned, and so a diagnosis is never sought out.\u201d<\/p>\n\u2013 Gayle Clark, LCSW<\/cite><\/blockquote>\n\n\n\n
Many women aren\u2019t diagnosed until adulthood<\/a>, if they\u2019re diagnosed at all. \u201cIt is often some major event, such as the diagnosis of a child leading to some self-reflection, or a mental health crisis, or a health provider that asks the right questions that ultimately leads to the diagnosis,\u201d says Clark.<\/p>\n\n\n\n
There are unfortunately several reasons for this delay in diagnosis. \u201cMost diagnostic criteria were developed by studying boys who were white and had highly externalized traits or symptoms,\u201d says Palomera. \u201cUnfortunately, most of the tools and checklists used often miss the way autism shows up in women and people of color.\u201d Because of this huge and bias-based oversight, there has also been a historical assumption that boys and men are more likely to be autistic than girls and women.<\/p>\n\n\n\n
One of the most salient reasons that girls and women are diagnosed with autism so late is their socialization, which is very different from that of boys and men. \u201cGirls and women are often socialized to care for others, hold the mental load, and please people, so masking is extremely common,\u201d says Irwing. \u201cIn my practice, I see a lot of fawning behaviours: Saying \u2018yes\u2019 when they mean \u2018no,\u2019 overfunctioning in relationships, people-pleasing to the point of burnout.\u201d Autism can look very different from person to person, \u201cbut many autistic women are deep thinkers, empaths, and often mislabeled with anxiety or borderline traits,\u201d Irwing adds.<\/p>\n\n\n\n
\n“Autism can look very different from person to person.”<\/p>\n<\/blockquote>\n\n\n\n
By contrast, boys and men by and large don\u2019t feel so compelled to mask or people-please, so the traits and behaviors consistent with their autism are often more obvious \u2014 and more likely to correspond to the existing diagnostic criteria. \u201cAutistic boys and men tend not to care as much about what people think, possibly because their autistic behaviors are generally more accepted by society than autistic women,\u201d says Palomera. \u201cInstead of externalizing behaviors, which are often seen in boys and men, women and girls internalize and struggle behind closed doors. Autistic women are often the \u2018quiet good girl\u2019 or the \u2018sensitive one.\u2019\u201d<\/p>\n\n\n\n
\n\n\n\nWhy does getting diagnosed matter?<\/h4>\n\n\n\n
An autistic person can absolutely lead a full life without ever receiving a diagnosis, but for many women, getting diagnosed can make things a lot easier. \u201cFor many autistic women, a diagnosis feels like permission to stop pretending to be something they\u2019re not,\u201d says Palomera. \u201cIt gives clarity on why they\u2019ve struggled and felt different. It can help an autistic woman implement much-needed accommodations as well as self-compassion.\u201d From there, it becomes much easier to set boundaries, tend to your needs, and practice self-love, all of which make relationships flow more easily, too \u2014 not to mention a diagnosis opens up opportunities to find community in autistic circles as well.<\/p>\n\n\n\n
\n\u201cFor many autistic women, a diagnosis feels like permission to stop pretending to be something they\u2019re not.\u201d<\/p>\n\u2013 Vanessa Palomera, LMFT<\/cite><\/blockquote>\n\n\n\n
On the flipside, being undiagnosed long into your adult life can come with a lot of difficulties. \u201cWithout understanding your neurotype, you might live on autopilot, trying to meet expectations that were never made for you,\u201d says Irwing. \u201cUndiagnosed autism can result in repeated burnout, chronic stress and inflammation, misdiagnoses (borderline personality disorder, OCD, anxiety, eating disorders), identity confusion and low self-trust and difficulty advocating for yourself or setting boundaries.\u201d Irwing also notes that all of this struggle can lead to physical health issues as well, like \u201cfatigue, digestive issues, and hormonal dysregulation, partly because of the toll of long-term masking and hypervigilance.\u201d<\/p>\n\n\n\n
In order to get diagnosed, search for a psychologist, psychiatrist, or social worker in your area who specializes in autism spectrum disorders. They should be able to carry out an evaluation to determine whether you qualify for an autism diagnosis. Just keep in mind that, depending on your insurance plan, getting diagnosed could be pretty costly.<\/p>\n\n\n\n
\n\n\n\nIf you\u2019re diagnosed as autistic, do you need therapy?<\/h4>\n\n\n\n
Though there\u2019s some debate, these days many experts on autism consider it to be a difference rather than a disorder. \u201cFrom a medical<\/em> lens, autism is classified as a disorder,\u201d says Irwing. \u201cFrom a social<\/em> or neurodiversity-affirming lens, it\u2019s a difference, a valid and natural way of being.\u201d <\/p>\n\n\n\n
\n“These days many experts on autism consider it to be a difference rather than a disorder.”<\/p>\n<\/blockquote>\n\n\n\n
Meanwhile, Clark and Palomera see autism as a difference or simply a neurotype, not a mental illness, which means that in and of itself, autism doesn\u2019t require that the individual be followed by a therapist.<\/p>\n\n\n\n
But that\u2019s not to say that therapy can\u2019t be a great tool for autistic women \u2014 and particularly for those who are late-diagnosed. \u201cMany autistic women carry trauma from years of masking, being misunderstood, and pushing themselves past their limits,\u201d says Palomera. \u201cTherapy can be helpful, but it has to be neurodiversity-affirming. That means not trying to \u2018fix\u2019 the autism, teaching social skills, or forcing exposure to things without considering their unique needs and nervous system.\u201d Some modalities that can be supportive include integrative therapy, autistic-affirming CBT, somatic work, or attachment-focused EMDR.<\/p>\n\n\n\n
Another reason that autistic women might greatly benefit from therapy is that they are \u201cstatistically more vulnerable to relational trauma, including emotional abuse, coercion, and neglect,\u201d says Clark, citing a 2014 survey<\/a>. For anyone with a history of relational trauma, therapy is highly recommended.<\/p>\n\n\n\n
\n\n\n\nHow can autistic women and girls lead easier lives?<\/h4>\n\n\n\n
For those who have been diagnosed (at last!) or who suspect they fall somewhere on the autism spectrum, there are many steps they can take to make their experience of life a lot smoother and happier. \u201cFor many, self-help looks like learning to unmask, developing self-compassionate techniques to decrease discomfort \u2014 whether that is developing better routines, seeking out sensory-friendly environments, and learning to say no \u2014 and working on a stronger and self-compassionate identity,\u201d says Clark. \u201cTesting out and implementing seemingly small things, such as using noise-canceling headphones or fidgets, avoiding busy places, or scripting conversations, can really reduce a lot of the everyday stress.\u201d<\/p>\n\n\n\n