Unmasking in small steps

Meta-analysis found significant moderate positive associations between camouflaging and anxiety, depression and social anxiety, and a significant small negative association with mental wellbeing. Establishes that masking correlates with worse mental health — the harm the method aims to reduce — but is correlational, not a test of unmasking.

Co-twin control design (stronger causal inference than standard observational data) examining whether camouflaging causes reduced quality of life. Supports the causal direction underlying the method's rationale but does not test a gradual-unmasking protocol.

Camouflaging (especially assimilation/'putting on an act') mediated the link between autistic traits and lower wellbeing; positive autistic identity moderated the relationship. Directly supports the mechanism (reduce assimilation, build identity) but is cross-sectional, not an intervention trial.

Greater time since diagnosis related to less dissatisfaction with autistic identity; autism pride predicted higher self-esteem, dissatisfaction predicted lower self-esteem. Supports the 'it takes time' framing and the self-esteem/shame target, but is observational.

Narrative/systematic review concluding clinicians should discuss whether camouflaging harms wellbeing and support individuals to identify strategies to reduce it — clinical consensus consistent with the method, but explicitly notes camouflaging is not always harmful and provides no controlled test of an unmasking protocol.