Does camouflaging autistic traits increase stress?

A study by CiMUS at the University of Santiago de Compostela (USC) and the Health Research Institute of Santiago de Compostela (IDIS) shows that camouflaging autistic traits is associated with higher psychological and biological stress.
Unlike previous studies, which focused mainly on questionnaires, this research—published in the journal Molecular Autism—incorporates biomarkers for the first time to assess the physiological impact of camouflaging, using hair cortisol concentration as an objective indicator of accumulated stress.

Hiding autistic traits in social situations may come at a greater cost to health than previously thought. A study led by CiMUS at USC through the Genomics and Bioinformatics group and the Health Research Institute of Santiago de Compostela (IDIS), in collaboration with the Karolinska Institutet in Sweden, has revealed that these strategies are associated with markers of psychological and biological stress, offering a new perspective on how camouflaging affects the health of autistic people.
“This is the first study to find evidence that camouflaging autistic traits can act as a chronic stressor, influencing the HPA axis (hypothalamic–pituitary–adrenal axis, the body’s main stress-response system involving the hypothalamus, pituitary gland, and adrenal glands), leading to elevated accumulated cortisol. This research therefore provides key information to better understand autistic burnout—a phenomenon that is becoming increasingly widespread—mental health, and the identification of risk profiles,” explains CiMUS researcher and study co-author Sabela Conde-Pumpido Zubizarreta.
 

A study with 315 twin participants
The study analyzed 157 pairs of twins from the Swedish RATSS cohort (Roots of Autism and ADHD Twin Study in Sweden), among whom 69 participants were autistic individuals without intellectual disability.
Unlike earlier studies based primarily on questionnaires, this research incorporated an objective biomarker: hair cortisol concentration, a long-term stress marker that reflects accumulated stress over approximately five months. This approach made it possible to obtain a more objective picture of the impact of camouflaging on the body.
The results showed that, overall, individuals who more frequently used camouflaging strategies tended to have higher levels of accumulated cortisol. Among adults, camouflaging was associated both with symptoms related to psychological stress and with elevated cortisol levels, underscoring the impact of these strategies in adult life.
Genetics as a key factor
Thanks to the twin sample, the study was able to examine the role of genetic factors and the family environment in this relationship. The results indicate that these factors contribute significantly to how camouflaging and stress are linked.
“But the most striking finding emerged when precisely controlling for these family and genetic factors: in pairs in which both individuals were autistic and in adult pairs, more intense camouflaging was associated with lower levels of accumulated cortisol. One possible explanation is that the continued use of camouflaging exhausts the neuroendocrine system, reducing the body’s capacity to produce cortisol in a sustained manner,” concludes Conde-Pumpido Zubizarreta.