Traditional anxiety intervention falling short for highly masked autistic women
Many highly masked autistic women are diagnosed with anxiety early and often. They’re described as insightful, articulate, emotionally attuned, yet internally tense, vigilant, and rarely at ease. Even in familiar or low-stakes environments, their bodies feel braced, as if something important could be missed.
What’s often misunderstood is this:
This anxiety isn’t primarily about worry. It’s about what it takes to stay oriented and safe in a world that requires constant translation.
This distinct form of anxiety in autism is the tension that builds when an autistic nervous system has to stay continuously aware and regulated in environments that require translation, masking, and adjustment. (Check out the study on this different type of anxiety here.)
Anxiety as a product of the masking system
If you have been masking, it is not a personality trait. It has been an unconscious strategy designed to prevent misunderstandings, rejections, or ruptures.
Common parts in a highly masked autistic woman’s system often include:
The Social Translator
Converts internal experience into socially acceptable language, tone, and expression.The Hyper-Vigilant Monitor
Tracks facial expressions, conversational pacing, emotional shifts, and unspoken rules.The Anticipatory Planner
Rehearses conversations, predicts outcomes, and prepares for mistakes before they happen.The Mask (Meta-Protector)
Organizes the entire system to ensure competence, likability, and safety.
When these parts are running constantly, anxiety emerges, not because something is “wrong,” but because the system is working in real time without rest.
This is not anxiety about social situations.
It is anxiety within them.
Why this anxiety doesn’t fit traditional anxiety models of therapy
This form of anxiety is often misread because it doesn’t originate in distorted thinking. It comes from accurate perception paired with sustained responsibility.
Maybe consider that you…
Aren’t catastrophizing, you’re anticipating realistically
Aren’t avoidant, you’re enduring
Aren’t lacking insight; you’re carrying too much of the load
As a result, traditional anxiety interventions often fall short.
Reassurance doesn’t reduce anxiety when the environment still requires performance. Cognitive reframing doesn’t calm the body when vigilance remains necessary. Even coping skills can unintentionally increase self-monitoring.
When anxiety persists despite insight and effort, women often assume they’re failing. More often, the system is simply responding to unchanged demands.
Anxiety and the cost of belonging
For many highly masked autistic women, anxiety is the cost of belonging.
Belonging has often required being acceptable, likable, or easy to be around. It has meant tracking how one is perceived and adjusting in order to remain included. Over time, anxiety becomes the internal signal that helps maintain connection.
This isn’t anxiety rooted in imagined rejection. It’s shaped by lived experience, by moments when being misunderstood or “off” had real consequences. The system learned that safety depended on accuracy and restraint.
As a result, you may feel socially connected yet internally unseen. Relationships exist, but something essential is held back. What’s missing isn’t connection, it’s safety without performance.
In this context, anxiety functions as a form of relational vigilance. It tends to soften only in spaces where no translation is required. And those relationships are like taking a breath of fresh air!
The cost of misnaming this experience
When this anxiety is framed solely as a disorder, you have likely turned inward instead of contextualizing.
Common consequences include:
Chronic self-doubt
Shame around needing rest or accommodation
Over-pathologizing normal autistic responses
A quiet grief for ease that never came
The problem isn’t that you are broken. It’s that your system has been asked to do far more than anyone realized.
A reframe that restores dignity
If this resonates, you’re not alone, and you’re not imagining it. The anxiety so many highly masked autistic women live with is not a sign of fragility. It is a sign of adaptation.
It reflects a system that learned, early and accurately, that safety required attention, attunement, and restraint.
Before that system can soften, it needs to be understood rather than pathologized.
Start working with a neurodivergent affirming therapist in Highland Park and Los Angeles
If you’re curious about exploring this with support, neurodiversity-affirming, system-informed therapy can offer a different kind of relief.
Reach out to schedule a free 15-minute consultation with a neurodivergent affirming therapist who understands the unique realities of late-discovered or diagnosed autistic experience.
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Gabriella Elise Giorgio is a Registered Associate Marriage and Family Therapist (AMFT 140682), supervised by Sharon Yu. I am a late-discovered autistic person, shaped by years of masking for safety and belonging. The process of being truly understood, by ourselves first, is an act of radical self-compassion. Reach out to learn more about our experienced therapists.