The impact of camouflaging autistic traits on psychological and physiological stress: a co-twin control study
Camouflaging autistic traits may not inherently raise long-term biological stress once shared genetics and environment are controlled.
01Research in Context
What this study did
Zubizarreta et al. (2025) asked if hiding autistic traits raises long-term stress.
They studied hair cortisol in twins. One twin often masks traits more than the other.
By comparing twins to each other, they removed shared genes and home life.
What they found
Across all twins, more camouflaging went with higher cortisol.
Yet inside each twin pair, the link vanished.
In adult autistic pairs, the heavier masker even showed lower cortisol.
Family background, not masking itself, likely drives the stress signal.
How this fits with other research
Isaksson et al. (2019) used the same twin trick. Mind-reading problems also disappeared within pairs, showing family confounding is common.
Kupzyk et al. (2011) found clumsiness and autistic traits share 63 % of their genes. This supports the idea that many autism-linked patterns ride on inherited biology, not direct causation.
Dubey et al. (2024) showed autistic traits alone did not hurt self-promotion; social anxiety did. Like the present study, context matters more than the trait count.
Why it matters
Stop telling clients that masking always burns their body out. Check family stress load and social anxiety first. If a client’s cortisol is high, target sleep, diet, and life events before you try to reduce camouflaging. Use self-advocacy training to lower the need for masking, but do not assume the act itself is toxic.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add family-stress and social-anxiety questions to your intake; treat those before you target masking reduction.
02At a glance
03Original abstract
Camouflaging autistic traits is suggested to increase stress and the risk of autistic burnout. However, the relationship with psychological and biological markers of stress and the influence of familial factors on this relationship remain unclear. In a neurodiverse twin sample (N = 315; 69 diagnosed with autism), we examined associations between camouflaging behaviors (operationalized as the discrepancy between the Autism Diagnostic Observation Schedule 2nd edition [ADOS-2] and the Autism Quotient [AQ]), rated stress-related symptoms, and biological long-term stress measured via hair cortisol concentration (HCC). Associations were analyzed across the full sample, accounting for age, sex, and HCC confounders, as well as within-twin pairs, implicitly adjusting for genetic and environmental confounding. Across individuals, camouflaging was associated with increased HCC, particularly in autistic and adult subsamples, while associations with stress-related symptoms were only evident in adults. Within-pair analyses revealed no associations in the full sample, suggesting familial confounding. Interestingly, in adjusted within-pair models in autistic and adult twin-pairs, camouflaging was linked to lower HCC. Only the adult participants provided self-reports of autistic traits (AQ) and stress-related symptoms, while parent-reports were used for the younger participants. This difference in reporting sources may have reduced the accuracy of data for the younger subgroups in our sample. The findings indicate that camouflaging is associated with increased biological long-term stress at the population level but that familial factors may influence this relationship. Future research is needed to explore these complex dynamics and their implications for mental health and adaptive functioning in autistic individuals. The online version contains supplementary material available at 10.1186/s13229-025-00695-9.
Molecular Autism, 2025 · doi:10.1186/s13229-025-00695-9