Who Am I: The Balance Between Masking and Identity

AbstractBackground: Autistic people experience worse mental health outcomes than non-autistic people. Masking (concealing autistic traits) is found to relate to poor mental health. Research shows autistic people indicate relationships between masking and difficulties creating or maintaining a sense of identity. Personal identity is rarely studied within autism research. This study aims to bridge this gap by exploring the connection between identity formation difficulties (both social and personal) and its impact on poor mental health in autistic people. It examines levels of identity conflict and distress in autistic and non-autistic people and whether identity distress mediates and identity conflict moderates the relationship between masking and psychological distress. Method: Data were collected for autistic (n = 139) and non-autistic people (n = 133) using an online survey. Results: Autistic people were found to experience higher levels of identity distress, conflict, and psychological distress. Identity distress represents a full mediation of the relationship between masking and psychological distress in the autistic cohort but a partial mediation in the non-autistic cohort. Identity conflict did not moderate any relationships within the model for either cohort. However, it did have a significant direct relationship with each variable. Conclusions: These findings suggest that autistic people may experience worse mental health outcomes due to difficulties with cohesive identity formation. Additional research into the role of autism in identity development may identify other areas in which identity difficulties negatively impact autistic people, such as long-term planning and suicidality. Community BriefWhy is this an important issue?Research shows autistic people experience poorer mental health than non-autistic people. Autistic people have reported feeling they must mask or hide that they are autistic is connected to poorer mental health. Autistic people also state that masking can make it difficult for them to feel comfortable being themselves. This study explores if negative mental health issues may be because masking makes it harder for autistic people to have or form a steady and comfortable identity. What was the purpose of the study?This study aims to learn whether autistic people or non-autistic people had more fear or confusion around their identity and whether they felt able to be themselves. It explores how negative emotions around identity may increase the number of autistic people who face mental health issues. What did the researcher do?The researcher used an online survey that asked people about masking, identity distress, identity conflict, and mental health. One hundred and thirty-nine autistic people and one hundred and thirty-three non-autistic people completed the survey. The researcher used three kinds of analysis: ANCOVA analysis to learn which group had more identity distress, conflict and poorer mental health; mediation analysis to see if identity distress explains the relationship between masking and mental health; and moderation analysis to see if identity conflict increases or decreases the relationship between masking and mental health.What were the results of the study?The researcher found that autistic people had more distress and conflict around their identity and poorer mental health than non-autistic people. In autistic people masking only had a relationship with poorer mental health through its relationship with identity distress. In non-autistic people, identity distress and masking both led to poorer mental health independently. Finally, identity conflict relates to more identity distress, more masking, and worse mental health, but it does not make the connections between them stronger.What do these findings add to what was already known?These findings show that identity has a big impact on the lives of autistic people and that increased issues with identity may be causing mental health challenges. Autistic people are not always able to stop masking because it is often used to protect themselves from stigma and discrimination, as a result learning more about the relationship between masking and identity may help us better support autistic people. What are potential weaknesses in the study?The participants in both groups were mainly white, meaning some findings may not represent the experiences of people of colour, and the impact of race and ethnicity on identity. It would be helpful to have more diverse participants and a larger number of participants. How will these findings help autistic adults now or in the future?This study shows that identity is very important in helping to understand mental well-being in autistic people. This study supports moving away from teaching autistic individuals to hide their autistic characteristics and towards humanizing approaches that encourage them to explore their identity as autistic people.