{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T23:01:51Z","timestamp":1794006111088,"version":"4.8.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction across multiple contexts. Social camouflaging was first shown to be a characteristic of autistic persons, who actively try to disguise and compensate for their autism features in social contexts in an effort to socially blend in better. Recently, an increasing, though still insufficient, number of studies has been conducted on the concept of camouflage; however, different aspect of it, from psychopathology and etiology to its complications and consequences, are not clearly defined. We aimed to systematically review the existing literature on camouflage in autistic adults to describe the correlates of camouflage, motivations for exhibiting camouflage behavior, and the potential impacts of camouflage on the mental health of autistic individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guidelines to conduct a systematic review. The databases of PubMed and Scopus, and PsycInfo were searched for eligible studies. Studies were published between January 1st, 1980, to April 1st, 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 16 articles, of which four studies were qualitative and 11 were quantitative. One study used a mix method. The assessment tools used for camouflage, the correlates of camouflage including autism severity, gender, age, cognitive profile and neuroanatomical correlates, reasons for camouflage and the impacts of camouflaging behavior on mental health are discussed in this review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In synthesizing the literature, we conclude that camouflage seems to be more common among females who report more autistic symptoms themselves. There may also be some differences between men and women in reasons of exhibiting it and its neuroanatomical correlates. Further research is needed as to why this phenomenon is more prevalent in females with implications for gender related cognitive and neuroanatomical differences. Effects of camouflage on mental health and daily life measures of individuals such as employment, university graduation, relationship, financial status, and quality of life should be studied with more details in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1108110","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:45:18Z","timestamp":1678927518000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":118,"title":["Camouflage and masking behavior in adult autism"],"prefix":"10.3389","volume":"14","author":[{"given":"Javad","family":"Alaghband-rad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arman","family":"Hajikarim-Hamedani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahtab","family":"Motamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"ref1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR","year":"2013"},{"key":"ref2","volume-title":"The Psychiatric Management of Autism in Adults (CR228)","year":"2020"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6706a1","article-title":"Prevalence of autism spectrum disorder among children aged 8 years\u2014autism and developmental disabilities monitoring network, 11 sites, United States, 2014","volume":"67","author":"Baio","year":"2018","journal-title":"MMWR Surveill Summ"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1038\/s41390-021-01465-y","article-title":"Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood","volume":"91","author":"Malik-Soni","year":"2022","journal-title":"Pediatr Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e20835","DOI":"10.1371\/journal.pone.0020835","article-title":"A behavioral comparison of male and female adults with high functioning autism spectrum conditions","volume":"6","author":"Lai","year":"2011","journal-title":"PLoS One"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2190","DOI":"10.1007\/s10803-020-04695-x","article-title":"Social camouflaging in females with autism Spectrum disorder: a systematic review","volume":"51","author":"Tubio-Fungueirino","year":"2021","journal-title":"J Autism Dev Disord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1108\/AIA-09-2018-0036","article-title":"Understanding and recognizing the female phenotype of autism spectrum disorder and the \u201ccamouflage\u201d hypothesis: a systematic PRISMA review","volume":"5","author":"Allely","year":"2018","journal-title":"Adv Autism"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.jaac.2014.10.003","article-title":"Sex\/gender differences and autism: setting the scene for future research","volume":"54","author":"Lai","year":"2015","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1177\/1362361317702561","article-title":"A qualitative study of the service experiences of women with autism spectrum disorder","volume":"22","author":"Tint","year":"2018","journal-title":"Autism"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1177\/1362361316671845","article-title":"The art of camouflage: gender differences in the social behaviors of girls and boys with autism spectrum disorder","volume":"21","author":"Dean","year":"2017","journal-title":"Autism"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.dhjo.2009.07.001","article-title":"Sex differences in the evaluation and diagnosis of autism spectrum disorders among children","volume":"3","author":"Giarelli","year":"2010","journal-title":"Disabil Health J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1007\/s10803-012-1656-z","article-title":"Sex differences in the timing of identification among children and adults with autism spectrum disorders","volume":"43","author":"Begeer","year":"2013","journal-title":"J Autism Dev Disord"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1698","DOI":"10.1007\/s10803-017-3413-9","article-title":"What about the girls? Sex-based differences in autistic traits and adaptive skills","volume":"48","author":"Ratto","year":"2018","journal-title":"J Autism Dev Disord"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1007\/s10803-020-04615-z","article-title":"Sex\/gender differences in camouflaging in children and adolescents with autism","volume":"51","author":"Wood-Downie","year":"2021","journal-title":"J Autism Dev Disord"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.jaac.2017.03.013","article-title":"What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis","volume":"56","author":"Loomes","year":"2017","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s13293-016-0112-8","article-title":"The role of sex-differential biology in risk for autism spectrum disorder","volume":"7","author":"Werling","year":"2016","journal-title":"Biol Sex Differ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1007\/s10803-018-3792-6","article-title":"Development and validation of the camouflaging autistic traits questionnaire (CAT-Q)","volume":"49","author":"Hull","year":"2019","journal-title":"J Autism Dev Disord"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/S2215-0366(15)00277-1","article-title":"Identifying the lost generation of adults with autism spectrum conditions","volume":"2","author":"Lai","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1177\/1362361315590805","article-title":"The experiences and needs of female adults with high-functioning autism spectrum disorder","volume":"20","author":"Baldwin","year":"2016","journal-title":"Autism"},{"key":"ref20","first-page":"1879","volume-title":"Social Camouflaging in Autism: Is It Time to Lose the Mask?","author":"Mandy","year":"2019"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1007\/s10803-011-1356-0","article-title":"Sex differences in autism spectrum disorder: evidence from a large sample of children and adolescents","volume":"42","author":"Mandy","year":"2012","journal-title":"J Autism Dev Disord"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s40489-020-00197-9","article-title":"The female autism phenotype and camouflaging: a narrative review","volume":"7","author":"Hull","year":"2020","journal-title":"Rev J Autism Dev Disord"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"102080","DOI":"10.1016\/j.cpr.2021.102080","article-title":"Camouflaging in autism: a systematic review","volume":"89","author":"Cook","year":"2021","journal-title":"Clin Psychol Rev"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst Rev"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1017\/S1092852921000808","article-title":"Autistic traits and camouflaging behaviors: a cross-sectional investigation in a university student population","volume":"27","author":"Dell'Osso","year":"2021","journal-title":"CNS Spectr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13229-021-00421-1","article-title":"Is social camouflaging associated with anxiety and depression in autistic adults?","volume":"12","author":"Hull","year":"2021","journal-title":"Mol Autism"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"3413","DOI":"10.1007\/s10803-021-05221-3","article-title":"Camouflaging intent, first impressions, and age of ASC diagnosis in autistic men and women","volume":"52","author":"Belcher","year":"2022","journal-title":"J Autism Dev Disord"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1177\/1362361320912147","article-title":"Looking good but feeling bad: \"camouflaging\" behaviors and mental health in women with autistic traits","volume":"24","author":"Beck","year":"2020","journal-title":"Autism"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1177\/1362361319864804","article-title":"Gender differences in self-reported camouflaging in autistic and non-autistic adults","volume":"24","author":"Hull","year":"2020","journal-title":"Autism"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3638","DOI":"10.1007\/s10803-019-04323-3","article-title":"Is camouflaging autistic traits associated with suicidal thoughts and behaviours? 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