Background and Hypothesis: Autism Spectrum Disorder (ASD) is a developmental disorder affecting communication, social development, and unique behaviors. People with ASD struggle to understand societal cues and want to “fit in”. People with ASD often employ masking or camouflaging to hide autistic characteristics to “fit in” with societal expectations and standards. This is more common in those who identify as female or nonbinary (NB). Additionally, there is an increased prevalence of people with ASD identifying as LGBTQIA+ compared to the neurotypical population. I investigated how the act of masking/camouflaging in people with ASD might affect sexual and gender identity exploration.
Methods: My methods included conducting a literature review on PubMed for articles in English on ASD and Gender/Sexual Identity or ASD and Masking/Camouflaging. Articles that did not focus on the ASD population were excluded.
Results: Common themes elucidated that Masking/Camouflaging is more common in females and NB people and that the strong maintenance of a “non-autistic” persona did sometimes cause confusion about one’s identity as autistic. Common themes elucidated regarding Gender and Sexual Identity exploration in the ASD population showed that there is a high prevalence of Gender Dysphoria. Additionally, those with ASD who were assigned female at birth were more likely to report gender non-conforming feelings and attraction to same and opposite sex partners. Interestingly, one study found that having an ASD support group helped in exploration of gender and sexual identity in the context of having an ASD diagnosis.
Conclusion: However, there was not a single article identified that looked at both masking/camouflaging and sexual and gender identity exploration in the ASD population. A study done by Strang et. al. in 2021 stated that Autism/Neurodivergent factors likely affect gender exploration and should be understood and accommodated by physicians and healthcare providers. However, this study did not focus explicitly on masking/camouflaging. Additionally, in the articles that focused on each topic individually, only 3 studies were identified on masking/camouflaging and most of the studies on gender/sexual identity focused on the prevalence of gender dysphoria. This research is osteopathically relevant as it indicates the need for further research on how different aspects of a diagnosis affect a patient's self-exploration and the care they may need. It affirms the importance of the osteopathic principles of a holistic approach when counseling patients.
Acknowledgement of Research Study Sponsors and IRB: No study sponsors or grants were received. This research is a literature review and therefore was not submitted for IRB approval.
