High masking autism in women: Signs That Get Misread as Anxiety (and What Evaluation Looks Like)
- Kiesa Kelly
- 2 days ago
- 9 min read
Last reviewed: 02/23/2026
Reviewed by: Dr. Kiesa Kelly
High masking autism in women can get mislabeled as “just anxiety,” especially when someone is bright, capable, and socially skilled on the surface. If you’ve done years of coping strategies, therapy, and self-help but still feel like daily life takes an outsized amount of effort, it may be worth looking at what’s driving the stress, not just how the stress shows up.
In this article, you’ll learn:
Why anxiety treatment sometimes helps, but not all the way
How masking fatigue can mimic social anxiety
The everyday “high-masking” profile (without stereotypes)
What AuDHD in women can look like
What an affirming adult autism assessment should include
Next steps for a private autism assessment in Tennessee
🧭 Key takeaway: Anxiety can be real and important, and autism can still be part of the picture. A good evaluation looks at both, without forcing you into a stereotype.
Why “anxiety treatment” sometimes doesn’t fully help
Many people with chronic anxiety benefit from approaches like CBT, ACT, exposure-based work, sleep interventions, or medication support. But if your nervous system is constantly working overtime to manage sensory and social demands, “anxiety tools” may feel like you’re learning to tolerate a fire alarm that never stops ringing.
Autistic masking (also called camouflaging) means using strategies to hide or compensate for autistic traits in order to fit in socially. Research suggests camouflaging is common in autistic adults and is linked with higher anxiety and depression symptoms in many samples. [1–3]
Another reason anxiety-only treatment can fall short: autistic stress isn’t always driven by fear-based thoughts. Sometimes it’s driven by overload, unpredictability, or the energy cost of performing “okay.”
The difference between social anxiety and masking fatigue
Social anxiety disorder is typically centered on fear of negative evaluation, embarrassment, or being judged. Masking fatigue is different: you may not be afraid of people, but you may be exhausted by the constant work of tracking social rules, performing the “right” facial expressions, and recovering afterward.
A practical example:
Social anxiety: “Everyone will think I’m awkward, so I avoid the party.”
Masking fatigue: “I can go to the party and even look ‘fine,’ but I’ll need the entire next day to recover, and I may feel irritable, numb, or wiped out afterward.”
Both experiences can coexist. Some people develop social anxiety on top of masking because the stakes feel high, mistakes feel costly, or past social experiences were painful. [2,4]
🧠 Key takeaway: A common clue is the “cost.” Social anxiety is often about fear before the event; masking fatigue is often about depletion after the event, even if it went well.
Chronic people-pleasing, shutdowns, burnout
High masking often includes chronic people-pleasing: saying yes automatically, mirroring others, over-explaining, or working hard to be “easy.” Over time, this can lead to a cycle of overfunctioning and collapse.
Two terms you might hear in autistic communities:
Shutdown: a drop in speech, motivation, and processing, often after overwhelm (people can look “fine” on the outside while going numb inside).
Autistic burnout: a state described by autistic adults as chronic exhaustion, reduced tolerance to stimuli, and loss of skills after prolonged stress and insufficient support.
The term “autistic burnout” is still an evolving area of research, but emerging work supports that many autistic adults experience a distinct, cumulative stress response tied to chronic demands and mismatch between expectations and supports. [5]
A practical example:
You keep up at work by over-preparing and being hyper-responsible. At home, you have nothing left. Dishes pile up, texts go unanswered, and small changes feel unbearable. Friends see a “high-functioning” person. You feel like you’re failing.
🧯 Key takeaway: If your life looks successful from the outside but feels unsustainable on the inside, that mismatch is clinically meaningful information, not a personal flaw.
High masking autism in women: the high-masking profile (in everyday language)
High masking autism is not “mild autism.” It’s often autism plus a strong ability (or pressure) to compensate. In everyday language, the profile may look like:
Being socially tuned-in, but through analysis rather than intuition
Rehearsing what to say, replaying conversations, or scripting ahead of time
Copying social styles (tone, expressions, slang) to blend in
Holding yourself to extremely high standards to avoid mistakes
Being intensely thoughtful, empathetic, or conscientious, but exhausted
It can also look like being misread as “just anxious,” “too sensitive,” “perfectionistic,” or “high-strung,” especially for autism in midlife women who have built decades of coping strategies.
Sensory load + social load + perfectionism
Masking is easiest to sustain when your environment is predictable and your sensory load is manageable. Add bright lights, unpredictable noise, fast social pacing, or constant multitasking, and the nervous system can hit a tipping point.
Common sensory and regulation clues (not a checklist):
Strong reactions to sound, light, textures, temperature, or crowded spaces
Needing “recovery rituals” after social time (silence, alone time, repetitive movement, deep pressure)
Feeling disproportionately wiped out by open offices, long meetings, or busy family routines
Getting irritable or tearful when plans change at the last minute
Perfectionism can function as camouflage. If you can’t predict people, you may try to predict outcomes: prepare more, work harder, double-check everything. That can look like anxiety, but the driver may be a need for clarity, control, and reduced uncertainty.
🧩 Key takeaway: Sensory overwhelm and social overwhelm can both create anxiety symptoms. The “cause” matters because the plan changes when the cause changes.
“I can do it…until I can’t”
This is one of the most common high-masking experiences: you can cope, you can push, you can perform.
Until you can’t.
When the system hits overload, people may experience:
A sudden drop in capacity (speech, focus, tolerance)
Emotional flooding (panic-like symptoms, tears, irritability)
Numbness or “going blank”
Needing to cancel plans, withdraw, or stay in bed to recover
Misconception #1: “If you can make eye contact, have friends, or do well at work, it can’t be autism.”
Reality: Many autistic adults learn compensatory skills. Looking skilled does not mean it is effortless. [1,2]
Autism, ADHD, and AuDHD overlap
Autism and ADHD frequently co-occur, and the overlap can complicate diagnosis, especially in adults who have learned to mask. [6]
Some people describe the combination as AuDHD. In AuDHD in women, it’s common to see “contradictory” needs, like craving routine but struggling to maintain it, or loving novelty but needing recovery time after sensory overload.
What overlap looks like (and why it confuses diagnosis)
Overlap can show up as:
Executive function challenges (starting tasks, switching tasks, prioritizing)
Sensory differences (seeking or avoiding stimulation)
Emotional intensity and difficulty “downshifting”
Sleep disruption, burnout cycles, or inconsistent energy
Where it gets confusing: anxiety can be the visible “front” symptom, while neurodevelopmental differences are the underlying pattern.
Misconception #2: “You can’t have both autism and ADHD.”
Reality: Co-occurrence is recognized clinically, and research continues to explore shared and distinct features across both conditions. [6]
Misconception #3: “If I’m anxious, then autism is the wrong direction.”
Reality: Anxiety is common in autistic adults, and it may be amplified by camouflaging, sensory overload, and chronic mismatch between demands and supports. [2,3]
🧠 Key takeaway: When autism and ADHD overlap, the goal isn’t a trendy label. It’s a clearer map for supports, therapy targets, and daily-life accommodations.
Why the right label can change the plan
A label is only helpful if it changes something for the better.
For many adults, an accurate profile changes the plan in concrete ways:
Therapy targets shift from “stop feeling anxious” to “reduce load, increase supports, and build self-advocacy.”
Skills work becomes more specific: sensory regulation, boundaries, recovery time, predictable routines, executive supports.
Self-talk changes: “I’m broken” becomes “my nervous system has a different operating system.”
If executive functioning is a major stressor, supports like executive function coaching can be a practical complement to therapy.
What an affirming adult autism assessment should include
An affirming adult autism assessment is structured, evidence-informed, and respectful. Clinical guidelines emphasize a comprehensive evaluation rather than a single test score. [7]
A quality adult autism assessment often includes:
A detailed clinical interview (current concerns, strengths, patterns across settings)
Developmental history (early social style, sensory patterns, interests, learning profile)
Collateral input when possible (partner, parent, close friend, school records)
Standardized measures to support clinical judgment (questionnaires and/or structured observations)
Screening and differential diagnosis for co-occurring conditions (ADHD, anxiety, depression, OCD, trauma, sleep issues)
If you’re exploring your own “autism assessment questions adults” list, it can help to bring them in writing so nothing important gets lost in the moment.
How clinicians identify masking without stereotyping
A neurodiversity-affirming clinician doesn’t look for “movie autism.” They look for patterns and costs.
Some examples of masking-aware questions:
“What do you do to get through social situations?”
“How much recovery time do you need afterward?”
“Do you feel like you’re ‘performing’ a version of yourself?”
“Do you have sensory triggers that you hide or push through?”
“What happens when you’re depleted: do you shut down, get irritable, or go numb?”
Tools like the Camouflaging Autistic Traits Questionnaire (CAT-Q) can help describe masking experiences, but no questionnaire is a diagnosis by itself. [1]
🧾 Key takeaway: A strong high masking autism assessment integrates multiple sources of data and pays attention to what you’ve had to do to “pass,” not just what others can see.
Practical outcomes: accommodations, self-understanding, therapy targets
A good assessment should end with clear, usable recommendations.
Depending on your needs, practical outcomes might include:
Work accommodations (predictable schedules, written instructions, reduced sensory load)
Communication supports (clear expectations, fewer rapid-fire meetings, permission to pause)
Home-life adjustments (batching errands, recovery time, simplifying routines)
Therapy targets (self-advocacy, boundary-setting, shame reduction, emotion regulation)
It may also include guidance on next steps for anxiety support that fits your neurotype, such as adapting CBT/ACT strategies to account for sensory overload and masking fatigue. [2,8]
If you want to explore screening tools while you wait for a full evaluation, ScienceWorks offers self-guided resources like the AQ-10 autism screener, the ASRS adult ADHD screener, and the GAD-7 anxiety screener. Screeners are not diagnostic, but they can help you organize symptoms and questions.
Getting assessed in Tennessee (what to do next)
If you’re in Tennessee and considering a private autism assessment, you don’t have to “prove” you’re autistic to deserve clarity. Your job is to show up with your real experience. The clinician’s job is to evaluate it carefully.
If you’re not sure where to begin, start by learning what a full evaluation looks like on our Psychological Assessments page.
How to start with ScienceWorks (CTA)
Here’s a simple way to take the next step:
Review our assessment options to see what fits your goals
Write down your top 5 concerns and your top 5 “costs” (what drains you most)
Reach out through our Contact page to request an appointment or a free consultation
If you’d like to get a feel for our approach, you can also meet our team and see who may be a good fit.
What to bring to your appointment
You don’t need a perfect file folder, but having a few notes can make your appointment easier.
Consider bringing:
A timeline of patterns (childhood, teens, college/work, current)
School reports, prior testing, or therapy notes (if you have them)
Examples of masking (scripts you use, rules you follow, “after” effects)
Sensory triggers and recovery needs
Family history of ADHD/autism or related traits
A list of “autism assessment questions adults” you want answered
If you suspect AuDHD, it can also help to write down what feels ADHD-like (starting, switching, time blindness) versus autism-like (sensory load, social decoding, need for predictability). Many people have both.
Conclusion
If you’ve been treated for anxiety for years and still feel like life takes too much effort, it may be time to zoom out and look at the whole pattern. High masking autism can be easy to miss, especially in women who learned early to be agreeable, capable, and “low maintenance.”
An affirming evaluation doesn’t reduce you to a checklist. It helps you name what’s happening, understand why certain environments are draining, and build a plan that supports your nervous system instead of fighting it.
If you’re ready for next steps, we’re here to help you explore options with clarity and respect.
About the Author
Dr. Kiesa Kelly is a clinical psychologist (PhD) with a concentration in neuropsychology and more than 20 years of experience in psychological assessment. She has completed clinical training at the University of Chicago, the University of Wisconsin, the University of Florida, and Vanderbilt University.
At ScienceWorks Behavioral Healthcare, Dr. Kelly provides neurodiversity-affirming assessments and specializes in helping previously undiagnosed adults, particularly women and non-binary folks, better understand ADHD and autism profiles. Learn more about Dr. Kiesa Kelly.
References
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Disclaimer
This article is for informational and educational purposes only and is not a substitute for professional diagnosis, treatment, or medical advice. If you are in crisis or think you may have an emergency, call 911 or go to the nearest emergency room.
