Camouflaging, internalized stigma, and mental health in the general population

Abstract

Background: Camouflaging, the strategies that some autistic people use to hide their differences, has been hypothesized to trigger mental health ramifications. Camouflaging might reflect ubiquitous impression management experiences that are not unique to autistic people and similarly impact the mental health of non-autistic people.

Aims: We first examined whether individuals in the general population camouflage and manage impressions while experiencing mental health repercussions, and how gender and neurodivergent traits modified these associations. We then assessed how camouflaging and impression management arose from internalized stigma, and their inter-relationships in shaping mental health outcomes.

Methods: Data were collected from 972 adults from a representative U.S. general population sample, with measures pertaining to camouflaging, impression management, mental health, internalized stigma, and neurodivergent traits. Multivariate hierarchical regression and moderated mediation analyses were used to address the two research aims.

Results: Both camouflaging and self-presentation (a key component of impression management) were associated with mental health presentations in the general population, which overlapped with those previously reported in autistic people. These associations were more pronounced in women compared with men and were of different directions for individuals with higher autistic traits versus higher ADHD traits. Internalized stigma might be a key stressor that could elicit camouflaging and impression management through social anxiety, which in turn might lead to adverse mental health outcomes.

Conclusions: These findings advance the conceptual clarity and clinical relevance of camouflaging and impression management across social and neurodiverse groups in the general population. The ramifications of camouflaging and impression management underscore the need to alleviate internalized stigma for better mental health across human groups.

Keywords: Camouflaging; impression management; internalized stigma; mental health; neurodivergence.

Figure 1.

Conceptual mapping of the hypothesized relationships among internalized stigma, social anxiety, camouflaging/IM, and mental health repercussions. Note. Internalized stigma is hypothesized to drive camouflaging/IM directly and also through social anxiety. Internalized stigma and camouflaging/IM are both hypothesized to lead directly to poor mental health, and internalized stigma might further indirectly evoke poor mental health through increasing camouflaging/IM. Furthermore, it is hypothesized that all mediation effects and the direct effect of camouflaging/IM on mental health could be moderated by gender, autistic traits, and ADHD traits.

Figure 2.

Mental health correlates of camouflaging and self-presentation as moderated by gender and neurodivergent traits. The step 3 hierarchical multivariate regression showed significant moderating effects of gender and neurodivergent traits on the relationships between camouflaging/self-presentation and mental health. (a) Women, in comparison to men, who indicated higher levels of camouflaging demonstrated worse mental health consequences. People with greater autistic traits, compared with those with lower traits, who engage in more camouflaging reported poorer mental health. Conversely, the mental health outcomes of people with greater ADHD traits, compared with those with lower traits, who engage in more camouflaging were more positive. (b) The same directionality of interaction effects was found when replacing camouflaging with self-presentation as the predictor. Note. self-reg. fatigue = self-regulatory fatigue; SPT = self-presentation tactics; ADHD = attention-deficit/hyperactivity disorder.

Figure 3.

Summarized results of the simple mediation and moderated mediation analyses. (a) A summary of the simple mediation analyses for the hypothesized relationships among internalized stigma, social anxiety, impression management (IM), and mental health. Effect parameter labels of white font in gray background represent non-significant paths; ‘Direct’ refers to direct effects and ‘Indirect’ refers to indirect effects; β refers to standardized regression coefficients; confidence intervals represent 95% bootstrapped confidence intervals. (b) Strength of the conditional indirect effects from internalized stigma to IM through social anxiety at different levels of autistic traits. The indirect effect was stronger for individuals with lower compared with higher autistic traits. ‘Conditional Indirect Effect’ refers to the standardized Beta value of the indirect path from internalized stigma to IM through social anxiety. Abbreviations: impression management (IM), mental wellbeing (Mental WB), self-regulatory fatigue (SelfReg Fatigue).