Anxiety Sat in the Middle

What the research found

A team led by Sara Conde-Pumpido-Zubizarreta set out to understand a difficult pattern. Autistic women often work hard to hide their autistic traits in social settings. This effort is called camouflaging. The researchers wanted to know whether that effort was connected to suicidal thoughts, and whether anxiety helped explain the connection.

They surveyed 471 women in Spain between February 2023 and March 2024. Of these, 72 were autistic and 399 were not. The women ranged in age from 18 to 66. Everyone completed the same online questionnaires: one measuring camouflaging, one measuring anxiety, and one measuring depression that included a single question about suicidal thoughts. This was a cross-sectional study, meaning it captured one moment in time rather than following people across years.

The group differences were large. Autistic women scored much higher on camouflaging than non-autistic women. The average total camouflaging score was 134.81 for autistic women and 93.16 for non-autistic women. The gaps on the individual measures were wide by the usual standards researchers use, with effect sizes running from 0.82 to 1.58. An effect size above 0.8 is generally called large. So these were not subtle differences.

The figures on suicidal thinking were the most sobering. Among autistic women, 68.1 per cent reported some suicidal ideation, meaning 49 of the 72. Among non-autistic women, the figure was 26.07 per cent. That is a striking difference, and it echoes concerns raised in other research about suicide risk in autistic adults, particularly women.

The camouflaging measure has three parts. Compensation is actively working around social difficulties. Masking is hiding autistic traits. Assimilation is changing yourself to blend into a group, copying the attitudes and behaviours of those around you. Of these three, assimilation was the strategy most closely tied to suicidal ideation. Having a depression diagnosis and higher anxiety were also linked to it.

Then came the central question. The researchers tested whether anxiety sat between camouflaging and suicidal thoughts. It did, in part. Camouflaging predicted anxiety strongly (a coefficient of 0.45). Anxiety in turn predicted suicidal ideation. The indirect path running through anxiety was statistically significant (a coefficient of 0.14). But this was a partial mediation, not a full one. Camouflaging still had a direct link to suicidal ideation even after anxiety was accounted for. Anxiety explained some of the story, not all of it.

What it means for you and your child

If you are the parent of an autistic girl, the honest headline here is that the effort of blending in may carry a hidden cost. The women in this study who worked hardest to appear non-autistic tended to be more anxious, and anxiety was linked to darker thoughts. That is worth taking seriously. It fits what many autistic women describe: that constant self-monitoring in social settings is exhausting and lonely, even when it looks like success from the outside.

But it is important to be precise about what this study can and cannot tell you. It is a snapshot of one moment. It cannot prove that camouflaging causes anxiety, or that anxiety causes suicidal thoughts. The arrows could point the other way. An anxious young woman may camouflage more because she is anxious. A woman already struggling may find masking harder to sustain. Cross-sectional data cannot separate these possibilities. The authors are careful about this, and so should we be.

There are other limits worth holding in mind. The sample was uneven, with far more non-autistic than autistic women, and it was recruited online, which tends to draw people with more education and higher cognitive ability. Suicidal thinking was measured with a single question rather than a full assessment, and that question was not designed or validated for autistic adults. It can also blur the line between a passing thought and genuine risk. None of this makes the findings worthless. It means they are a signal to investigate, not a settled fact.

For a family, the practical takeaway is not to tell a daughter to stop masking. Masking is often a survival skill, and dropping it in an unwelcoming environment can make life harder, not easier. The more useful response is to reduce the need for it. That means building settings, at school and at home, where an autistic girl does not have to perform constantly to be accepted. It means noticing anxiety early, because anxiety appears here as the pressure point that connects effort to distress.

It also means watching for the quieter strategy the study flagged: assimilation, the loss of yourself into the group. A girl who seems to have no strong preferences of her own, who mirrors whoever she is with, who reports feeling like a different person in every room, may be paying a cost that grades and friendships will not reveal. That is a conversation to have gently and often.

Finally, if any child expresses thoughts of suicide, this study is not the place to weigh the risk. Contact your GP, a mental health professional, or an urgent helpline. A research finding describes a group. Your child is one person, and one person deserves direct care.