0:00 Thousands of women are discovering they're autistic in their 30s, 40s, 50s, and beyond. Not because autism suddenly appeared, but because nobody recognized what it looked like in them. For decades, the image of autism has been the socially withdrawn child who avoids eye contact, struggles to communicate, and is visibly having a hard time. And because many autistic women learn to mask their traits, an entire generation went unnoticed. A 2024 study confirmed what many clinicians and autistic women have been observing for years. Masking is associated with a later age of autism diagnosis in women. The longer that masking continues, the harder it becomes to recognize what's underneath. So, if you spent years collecting diagnoses, anxiety,
0:46 depression, maybe borderline personality disorder, and none of them have ever fully explained your experience, this video could help explain why. Early autism research was done almost entirely on boys. Why am I not surprised? And the criteria in the DSM reflect that. Clinicians were trained to look for a particular presentation, the child who doesn't make eye contact, who has obvious difficulty in social situations, who shows intense and narrow interests in ways that are visible and hard to miss. That presentation exists, right? It's real, and in boys it tends to surface early enough that the people around the child can't ignore it. The disruption is visible, the school flags it, the parents notice, the system, imperfect as it is, tends to
1:33 catch it. In girls, the picture often looks fundamentally different. Girls with autism are frequently much better at reading and imitating social behavior, even when they don't intuitively understand it. We watch the people around us with a kind of like focused attention that looks like social engagement, but is actually um I'd consider it more to be like field research. Like we learn the script, right? We figure out what the expected response is in a given situation, and then we produce it. We find one or two girls to attach to and mirror their behavior closely enough to pass. From the outside, we can look fine. We can look like we're being social. What doesn't show on the outside,
2:19 though, is the amount of processing that's required to look like we're being social. This is masking. And it's the reason autism in women often goes unidentified for so long. Masking is the learned, often largely unconscious, suppression and substitution of autistic traits to appear neurotypical. This could mean that we rehearse conversations before they happen, script responses to common social situations so they are ready when we need them. We watch how other people behave in an unfamiliar context, and then we mirror it back before anyone notices our uncertainty. We can even force eye contact, even when it feels physically uncomfortable,
3:05 because we've learned that people read the absence of it as rude, or that we aren't interested in what they have to say. We can also suppress stimming behaviors, the repetitive movements that regulate our nervous system, because they draw attention. We can pretend to be interested in social topics that feel genuinely baffling to us, laughing at the right moments, asking the follow-up questions that signal engagement. All of this is running simultaneously in real time in every social situation from childhood onward. And unfortunately, the diagnostic system that we have doesn't pick this up. A clinician, like a therapist, conducting a standard assessment would see the output of the masking, like how we present, not the effort behind it. They see a woman who makes eye contact,
3:52 who answers questions fluently, who presents as socially capable, and then they move on. Like, no autism traits here. But what they don't see is what happens after we leave the room. The exhaustion we might feel, the time we need alone to recover. The way we're replaying the entire interaction afterward, checking for any mistakes. Essentially, we're so good at masking that it conceals our symptoms of autism completely. And the longer we keep doing it, the longer it takes for us to get a proper diagnosis. Before we get our autism diagnosis, there are usually others. Often several, accumulated over years, sometimes over decades. Each diagnosis addressing a part of what we're
4:37 struggling with, but missing the whole picture. And anxiety is the most common. When we're constantly monitoring our own behavior, calculating social interactions in real time, managing our sensory overload, anxiety is the inevitable result, right? Our nervous system is kind of It's like it's running in a state of sustained vigilance. And the threat that we feel isn't imaginary. We can worry that we'll lose our friends and our sense of belonging. However, the workload of doing all of this is overwhelming. And that 2024 study that I've been referencing is important here, too, because it looked at roughly 6,000 autistic individuals and found that masking was directly linked to significantly higher rates of anxiety, depression, and stress, with
5:22 women experiencing those effects more intensely than men. Which means that masking isn't a neutral coping strategy. It can actually be detrimental to our well-being, while those around us probably don't even know that it's happening. A diagnosis of depression is also very common, and for similar reasons. The exhaustion of maintaining a masked life is intense in a way that it's it's like difficult to explain if you haven't experienced it. It It's like a full-time cognitive and emotional job running alongside whatever actual life is being lived. The job never stops. There's no like shift that ends. And the flatness, the loss of excitement in things that should matter, the persistent sense that something fundamental is missing and you
6:07 can't name what it is, presents in clinical settings as depression. And therapists treat it as one because that's what we're trying to look for. Borderline personality disorder is another common misdiagnosis. Several of the symptoms that generate a BPD diagnosis are features of autism in women. Like emotional intensity that seems disproportionate to the situation. Difficulty in relationships, particularly with the push-pull dynamic that comes from, you know, wanting someone close and then also finding it overwhelming at the same time. Impulsive responses to emotional distress. Identity instability. It's like a persistent uncertainty about who you are and what you actually want. BPD and autism actually share enough
6:54 visible symptoms that a therapist who isn't specifically looking for autism can sometimes find BPD instead. And this happens because most of the assessment tools aren't designed to distinguish between them. Eating disorders also have a documented and significant overlap with autism in women. Trust me, I saw it in treatment centers. It's incredibly common. I mean, think about it. The ritualistic relationship with food, the rigidity we can have around eating patterns. The need for predictability and control when it comes to food and our life, to be honest. And there's also the sensory component, like particular textures, temperatures, and smells that are genuinely intolerable to us. The social complexity of eating with other people, that can come into play,
7:40 too. Like keeping up the conversation, the unpredictability, and the performance of enjoying it. Autistic women are significantly overrepresented in eating disorder treatment settings. And eating disorder treatment, which is already difficult enough, tends not to address the underlying neurodivergence at all. The accumulation of these diagnoses is not primarily the fault of clinicians who made them. They were working with a diagnostic framework that wasn't built to identify autism in women. They were doing what they could with what they had. But, big butt here, the effect on the women who accumulated these diagnoses is significant. Many of them arrive for therapy in their 30s and 40s with years of treatments that address some of the symptoms, but
8:27 not the source. Always feeling like like something's off or missing. Never understanding why they're always so exhausted or why none of the treatments they've received have ever really helped them. Since autism in women is so often overlooked and underdiagnosed, let's get into what it really looks like. First up, we have hyper empathy. This one is often a surprise cuz many of us think that someone with autism is someone who lacks empathy, who like can't read a room or can't feel what others feel or can't connect emotionally. However, hyper empathy or feeling other people's emotions with such intensity that it's destabilizing is one of the most consistently reported experiences among autistic women.
9:13 Not an absence of feeling, an excess of it. Like walking into a room and absorbing the emotional temperature before you've even talked to anyone. Or feeling a stranger's distress across a crowded space. Leaving social situations not just tired, but genuinely overwhelmed by the emotional weight of what other people were dealing with. This can look like extreme sensitivity, right? It could look like anxiety. It could look like being too much or too reactive or too affected by things that other people just seem to brush off or maybe not even acknowledge in at all. But what's actually happening is our brain processes emotions in a more
9:58 like unfiltered and a highly intense or immersive way, which can cause us to absorb the emotions of those around us. The annoying part of this particular symptom is that it directly contradicts the primary thing most people believe about autism. So, the women who experience it are not just undiagnosed, they're often actively misdirected away from the diagnosis by the very feature that most defines their experience. Moving right along, we have intense all or nothing friendships. Autistic women frequently form friendships with an intensity and depth that neurotypical relationships just don't tend to match. When we find someone we connect with, the connection
10:44 is deep, like we're all in. We want to know everything about this person, to spend as much time with them as possible, and to build a shared world with them. The friendship becomes our primary relationship. Everything else in our life is like organized around it. Now, this intensity is often not matched on the other side. Our friend can experience it as warm and flattering at first and then sometimes overwhelming. It's like too much contact or too much emotional investment. And for us on the other side as the autistic person, it can feel like too much hurt when the friendship naturally shifts or cools as friendships do, especially when we're growing up and we kind of grow apart, right? And these endings of friendships don't feel the same like the same way as a neurotypical
11:31 friendship drift is usually experienced. They feel closer to a breakup or a loss than just growing apart. The grief is real and also disproportionate by neurotypical standards. Yet, I want you to hear this. It's completely proportionate to what the friendship actually meant to the autistic person. This symptom can lead to a lot of loneliness because we can want those deep connections so badly and yet somehow always find it unstable or unavailable. And many of you have told me that this is the most one of the most painful parts of autism for you. Another sign is being mothered by our peers. From childhood onward, there's frequently a pattern of being taken under somebody's wing. Like you have a
12:17 friend who explains social situations to you afterward or a girl in the grade above you who like adopted you and taught you the unwritten rules. Or even maybe a small group that formed a kind of like a protective layer around you without you fully understanding why you needed it. These could be friends who checked in, who managed you, who translated you for other people, who run I don't know, like a gentle interference when you say something that people take the wrong way. When this is happening, it can feel like closeness, like we're being cared for or finally seen. And I want to be honest, there is some real affection in it, right? They actually do really care and they're doing this to care for you, but underneath the affection, as the autistic person, we can often get the
13:02 message that we need managing, right? That we couldn't quite be trusted to navigate social situations without support. That we were in some ways maybe more fragile or more oblivious or more likely to cause a problem than the people around us. And in adulthood, this pattern often continues in our romantic relationships. We can seek out partners who take on a coordinating or translating role, who handle all the social logistics, who smooth things over after a difficult interaction, who try to manage how we come across to the world. And we can be grateful for this because in some ways it's helpful, right? But it can also do a number on our sense of self, not to mention rob us of being able to feel like we're a capable and
13:47 independent adult. Women with autism can also have atypical repetitive behaviors. The clinical language used, like restricted and repetitive behaviors, is almost completely useless for identifying this in women because what it looks like in women isn't hand flapping or lining up objects. It looks like watching the same show four times through. Rereading a beloved book every couple months or every year. Eating the same lunch every day for months because it's one less decision to manage and one less sensory variable to navigate. Maybe it means we take the same route every time. We sit in the same seat. This could even be hair twirling or skin picking or shaking our legs. I read a
14:32 lot of on Reddit. We find comfort in repetition and can feel genuinely dysregulated when plans change without warning or when something that was supposed to be predictable turns out not to be. There's also a version of this that lives in our our language and in our thoughts, like returning to the same ideas, the same memories, the same questions. Kind of like we're stuck in a loop just going over and over and it I assume this happens cuz it's like our brain also finds comfort in familiar and predictable territory within it, like just within our thoughts, and it doesn't like anything new. Which is why many of us can watch the same movie and find it just as satisfying the 10th time as we did the first. Because the satisfaction was never about
15:17 the novelty, right? We're not talking about ADHD here. It was about the pleasure of the known, that consistency, what we can count on. Which even as I talk about this makes me think that this could be misdiagnosed as OCD, too. So, maybe I should have added that to the list of like possible misdiagnoses cuz if we have those repetitive loops, someone could someone could think it's OCD. Just throwing it out there. But in general, these repetitive behaviors or stimming is usually less visible and more internalized. Like rubbing a specific texture. And this makes me think I I don't think my great aunt was autistic, but she would always carry these little bits of fabric. They were like little knit booties. So random, you guys, but just flagged a memory. And she would keep them in her pockets of like her jackets
16:04 and in her jeans because she loved the feeling of her skin like catching the little threads. Shawn hates that feeling. It's just funny how texturally people can be so different. But she kept those with her all the time. So, I don't know if she thought it was soothing and she liked it. So, maybe she was autistic. Who knows? And this could also look like, you know, clicking a pen quietly under the table, chewing the inside of our cheek. I heard that a lot on Reddit. These are often like small, private regulating behaviors that we've suppressed or disguised for so long that we may not even register them as stimming behaviors. They're just things we do. So, maybe take a mental note. Did any of those resonate with you? And that moves us nicely into the next one, internalized symptoms. Everything we talked about before, the hyper empathy, the intensity of
16:50 connection, the social confusion, the sensory load, the need for sameness, produces symptoms. But in women, those symptoms tend to go inward rather than outward. Boys with autism often externalize. So, the behavior becomes visible quickly. Their parents or teachers like can't ignore it. It's happening right in front of them. And their symptoms are just often more obvious. Now, girls with unidentified autism internalize. The anxiety we feel lives inside of us. The self-criticism is relentless, but nobody else hears it. The symptoms of depression are constant, so much so that people in our life can just think that that's just who we are or that's how we are, right? Not to mention the eating
17:35 disorder behaviors can develop as a way to control a life that feels constantly unmanageable. And if there's any self-harm happens privately. Any suicidal ideation we deal with on our own. The internalizing we do is also what makes getting a proper diagnosis so difficult. We aren't disruptive. We're trying so hard. We're doing what's expected of us at home and work, and no one outside of ourselves sees just how difficult and exhausting this is. And so we move through childhood, adolescence, and often most of adulthood collecting the diagnoses that treat some of our symptoms while the underlying autism goes unidentified. If any of this resonated, let's get into
18:21 what we can do next. Starting off strong, and prob- sure you saw this coming, get a proper evaluation. This is the most important step, and it's worth being specific about what proper means here and why I said it that way. A general psychological assessment conducted by a clinician who primarily works with children will not reliably catch autism in adult women, especially those of us who've been masking for decades. The standard tools weren't designed for us. So, they will often be looking for signs or symptoms that we don't present. Ask specifically. It's okay to ask before you book anything. Don't spend any money if you don't know. We want to know about the clinician's experience with adult autism and giving that diagnosis. We want to
19:07 ask specifically about their experience with women. Ask whether the evaluation will include a detailed developmental history. That's really important because understanding how the traits presented in childhood before the masking was fully developed, right? We're like pros now. What about when we weren't pro? That's going to be one of the most reliable paths to an accurate assessment. So, ask whether they have a process for specifically exploring masking because a clinician who doesn't ask about it probably isn't going to see through it. And when you go to your assessment, moving on to number two, I want you to bring your full history including every diagnosis that you've ever had. Everything that's accumulated before this point is relevant data. This isn't a reason for embarrassment or shame or
19:54 judgment, okay? It's actually incredibly helpful. The anxiety, the depression, the eating disorder, the BPD diagnosis, whatever you've collected throughout the years is all like all is part of this picture that a good evaluator will need to see. A clinician who knows what they're looking for will want to understand whether those previous diagnoses were primary conditions meaning like the main thing going on or whether they were downstream of something like autism. And that reframing process is part of what makes a late autism assessment so significant for many women. We aren't starting over, don't worry. But we are looking for the piece that hopefully makes everything else make more sense. Be as honest as you can in the evaluation about the things that don't
20:41 work. Not just the things that you found ways to manage or deal with, okay? Let them know about how you feel after socializing or even how deeply things hurt you or even the repetitive behaviors you maybe just now today as you watch this video realized you've been doing your entire life. Let them know. They're there to help, not judge. Next up, work on separating the mask from who you are. Now, I know this is obviously much deeper work. I know you're like, "How do you flop into that one, Katie?" It's important, okay? And this is one that I would encourage you to do with your therapist. But maybe even today, you know, consider like, "What do I actually want? Or what do I think or or feel or prefer
21:26 when I stop running the calculation about what the appropriate response would be?" Think about it, and take your time. You know, the mask has been in place for so long that removing it can feel uncomfortable or disorienting. Many late-diagnosed women describe a period after the diagnosis where they feel less certain about themselves, not more. Because the certainty they had before was built on masking. And now, you know, masking can start to feel optional maybe in a way it never has before. And that disorientation is kind of part of the process. So, offer yourself some compassion during this period of adjustment okay? And start small with this. You know, pay attention. Try to be a detective about it, right? We're going to pay attention to the moments where your immediate, unfiltered
22:14 reaction is different from the response that you end up having. And that gap between what you actually thought or felt and what you decided to show, that's like where the work happens. And we're not trying to eliminate the gap entirely. Let's be honest, some degree of social management is part of everyone's life. Like, I do it, too, right? We know what's appropriate or not in certain situations or around certain people. But what we're trying to do is we're just trying to understand it and make it a chosen thing. So, like, I'm choosing to act this way cuz I'm at work and it's not okay versus it being automatic, something that we're doing like 100% of the time. Okay? And finally, number four, find community. You're here. Talk in the comments. Now, this is the
22:59 recommendation that late-diagnosed autistic women gave most consistently when asked what actually helped. Trust me, I went down quite the rabbit rabbit hole on this one. They didn't say you needed to get a new therapist or get a better treatment team, and they didn't mention another workbook that you just got to purchase. It's the best. Oh my god. They all said to find community. Finding other late diagnosed women. Being in spaces where the masking isn't required, where the sensory needs are understood, where you don't have to explain the exhaustion or justify your recovery time or perform on a level of social engagement that you don't have the capacity for. The comfort that they talked about, you guys, that can come from being in a room, virtual or in person, with people who understand exactly what you mean
23:47 without requiring translation. It it's like it's its own form of healing. It doesn't replace professional support, but it does give you a space where you can just be yourself. And if you've never been able to do that, it can be incredibly powerful, not to mention healing. For a lot of women, the autism diagnosis arrives after years of treatments that touched the symptoms, but not the source, right? Didn't get to the root. After years of trying harder and still feeling like something fundamental was off, after years of being told in various ways that the problem was them rather than the framework being used to assess their issues. And when the diagnosis arrives, the most common response isn't grief, though grief often comes too, but it's
24:32 recognition. Like a retroactive understanding of a life that suddenly makes more sense. It's like we can look back on our whole life and be like, "Oh my god." The amount of people for any person who gets diagnosed late in life with autism, ADHD anything. You can look back and be like, "Wow. That's why that was so hard." There's all of a sudden this like I I know, like a light bulb goes off. It kind of reminds me of like Inside Out. I know I mention this all the time, but it's a beautiful movie. When sadness touches all the memories and they turn into like nostalgic like they're sad, but it's like nostalgia like aw, I I was such a great time. It's almost like that like you look back, you can touch it with this this new awareness and you're like oh my god, all those memories are different. Oh my god, I was having a tough time because of this like it's like
25:18 like it can blow your mind and it's not because anything changed, but it's because the frame or like the lens that we're looking at looking through changed. Now going back to that 2024 study, it's a great one. I'll link it in the description if you want to read yourself. They tracked over 10,000 diagnostic records across two decades and found that the gap between male and female diagnosis rates has been narrowing. Q yay, right? Q the confetti or whatever. Progress is happening. That's what that really means. That's what I took away from it at least. But females are still being diagnosed later, particularly those who have been masking effectively. So those of us that are older that have been doing it longer. So the system is improving, but it
26:05 hasn't quite caught up, which is part of why conversations like this one are so important. So if you feel compelled, share this video. We want people to be more aware, right? We want this to not be something that continues to happen. We want our younger generations to get diagnosed earlier so they don't have to look back on their whole life and be like oh my god, it would have been so much better if I knew this, right? I want you to know if any of this resonated you are not strange. You're not too sensitive. You're not too intense or too much or too hard to read. You're wired differently in a world that doesn't have the framework to understand you. We're getting there, but we're not quite there. And you built over years and decades an extraordinary set of skills to help you navigate that gap. You got to give yourself some credit for your resilience and your grit.
26:50 Give yourself a little pat on the back, right? And if the section about masking hit home for you, the next video that I would send you to is the one that we did last month on people-pleasing. I know, it's very similar. I think a lot of what looks like people-pleasing in autistic women has the same root, like learning early that your natural way of being wasn't safe to show. Right? The strategies are very similar, and understanding both together, I think, is more useful than like understanding them separately or like either of them just alone. So, I'll pop that link in the description as well. And if this is your first time on the channel, welcome. Each week I try to help us better understand where our patterns came from, why they made sense at the time, and how we can slowly stop organizing our life around them. If that's up your alley, make sure you're subscribed so that you don't miss out. Have a wonderful week. Thank you so much
27:37 for watching, and I will see you next time.
