The reading room · Exploration debates

Does masking cost your health, or protect it?

Why this debate

Masking, or camouflaging, means working to hide the traits that mark you as different: scripting conversations, suppressing responses, performing ease you do not feel. If you have asked whether the performance is costing you, the research has asked the same question and split on the answer.

One line of evidence ties camouflaging to serious harm. A newer line of evidence, using the design the first line lacked, found the opposite direction of travel. The disagreement is not about whether masking is exhausting. It is about cause and consequence.

One side

Camouflaging as a risk factor

Cassidy and colleagues found camouflaging associated with suicidality in autistic adults, an association that held after accounting for depression and anxiety, and replicated the link in later samples using two different models of suicide risk. On this side, camouflaging is a risk marker in its own right: the cost of not being accepted for one's actual self.

Cassidy et al. (2018), Molecular Autism, 9 · Cassidy et al. (2020), Journal of Autism and Developmental Disorders, 50(10), 3638-3648 · Cassidy et al. (2023), Suicide and Life-Threatening Behavior, 53(4), 572-585

Evidence tier: consistent associations across several studies, all cross-sectional. Association, not demonstrated direction.

The other

The longitudinal complication

van der Putten and colleagues followed 332 autistic adults across roughly two years, the first longitudinal test of the question, preregistered. Higher initial camouflaging predicted a small decrease in mental health difficulties over time; lower initial camouflaging predicted a slight increase. The authors conclude the assumed causal story, masking produces harm, is not supported in this data, and that for some people camouflaging may be protective. Whether distress drives masking or masking drives distress remains unresolved.

van der Putten, Mol, Radhoe, Torenvliet, Agelink van Rentergem, Groenman & Geurts (2025), Autism, 29(10), 2604-2617

Evidence tier: one longitudinal study, two timepoints, small effect. It complicates the first side; it does not overturn it.

What can be learned

Both sides of this debate accept your experience as real. The exhaustion, the intensity, the doubt: no paper on either side disputes that these happen. What the sides contest is the frame. Which name the experience carries, which cause it points to, and whether the thing that needs to change is you or the environment around you.

And the debate does not settle in the abstract. Decades in, it remains open because it can only resolve in the particulars of an individual case: this person, this history, this room.

If you want your own particulars laid out, that is what the map is for.

Begin the Map →

Last updated 2026-07-27