What You Are Hiding Could Be Hurting You: Autistic Masking in Relation to Mental Health, Interpersonal Trauma, Authenticity, and Self-Esteem.

Background: Autistic masking refers to some autistic individuals' tendency to hide, suppress, or camouflage their autistic traits, autistic identity, or autism diagnosis. Autistic masking also may include unconscious or conscious attempts to mimic the behavioral, cognitive, or sensory styles of nonautistic neurotypical people and to suppress natural forms of autistic behavior, cognition, and reactions to sensory experiences. Since autistic people are a stigmatized minority in many neurotypical dominated societies, passing as nonautistic through autistic masking may be an attempt to avoid autism stigma and a reaction to previous interpersonal trauma. Increased autistic masking behaviors are associated with reports of increased depression, anxiety, burnout, and exhaustion in autistic people, and thus, exploring the roots and impact of autistic masking is an important mental health topic. Methods: This study investigated the relationships between autistic masking and depression, anxiety, gender identity, sexual orientation, interpersonal trauma, self-esteem, authenticity, and autistic community involvement. Participants were autistic adults (n = 342) recruited through autistic social media groups. Results: This study found that higher self-reported autistic masking behaviors were associated with higher reports of past interpersonal trauma, greater anxiety and depression symptoms, lower self-esteem, lower authenticity, and lower participation within the autistic community. Autistic masking was not associated with gender identity or sexual orientation. Conclusions: The results of this study highlight the relationship between autistic masking and past interpersonal trauma, finding that autistic masking behavior is associated with mental health, self-esteem, and authenticity risks for autistic adults. We call into question the teaching of autistic masking strategies in therapies and education programs for autistic people based on the negative associations with autistic masking presented in this study and other research in this field.

Why is this an important issue? Autistic masking refers to autistic people suppressing their natural autistic traits, responses, and behaviors, in an attempt, consciously or unconsciously, to hide or reduce the visibility of their autistic traits, autistic identity, or autism diagnosis. High levels of autistic masking are associated with negative mental health, authenticity challenges, and burnout for autistic people. Interpersonal pressuring, past traumatic social experiences, and autism stigma potentially fuel autistic masking. What is the purpose of this study? This study aimed to investigate relationship between autistic masking and depression, anxiety, interpersonal trauma, self-esteem, authenticity, autistic community involvement, gender identity, and sexual orientation. What did the researchers do? We recruited 342 autistic adult participants through autistic social media groups on Facebook to complete a 30-minute anonymous survey online comprising validated scales to measure autistic masking, depression, anxiety, interpersonal trauma, self-esteem, and authenticity. Additional questions were asked about demographic factors, such as gender identity and sexual orientation, and we asked open-ended questions about past social trauma and intersectional issues. What were the results of the study? We found that higher self-reported autistic masking behaviors were associated with higher reports of past interpersonal trauma, specifically being shamed and teased about autistic traits, and broader experiences of emotional and physical abuse. Masking was also associated with greater anxiety and more depression symptoms, lower self-esteem, lower authentic living, greater accepting of external influence, higher self-alienation, and lower participation within the autistic community. Autistic masking was not found to be associated with gender identity or sexual orientation. Participants who reported involvement in previous applied behavior analysis therapy reported higher past interpersonal trauma than participants involved in some other forms of therapy such as cognitive behavior therapy. What do the findings add to what was already known? This study supports previous research associating autistic masking with depression and anxiety symptoms, and lower reported authenticity, such as autistic people feeling they were not being true to themselves, or revealing their genuine selves to others. This study is the first to quantitatively investigate relationships between autistic masking and past interpersonal traumas, self-esteem, authenticity, and autistic community involvement. What are potential weaknesses in the study? Our sample is not representative of the U.S. population when it comes to race, educational level, gender, and sexual orientation. It was very White, highly educated, had few cisgender men, and sixty three percent were members of sexual minority groups. The majority of participants reported late diagnosis of autism. This sample potentially contained an overrepresentation of people with high levels of autistic masking or who more recently realized they were autistic masking in comparison with the general autistic population. We did not analyze differences between early-diagnosed and late-diagnosed cohorts. How will these findings help autistic adults now or in the future? This research calls into question the teaching of autistic masking strategies in parenting, education, and therapy programs for autistic people based on the negative associations of autistic masking. Our findings should be utilized as a strong call to action to push back against practices that encourage autistic masking and autistic trait shaming. Instead we advocate for promoting forms of parenting, education, and therapy that respect autistic people's traits, communication styles, sensory needs, and autistic identity.

The effects of body-positive Instagram posts on body image in adult women.

While recent studies have examined the effects of viewing body-positive social media content on body appreciation and satisfaction in young adult women, research has yet to include older adult women. The current study assessed the effects of viewing body-positive Instagram content on body image in 205 adult women (18-76 years old) who were randomly assigned to view either body-positive, thin-ideal, or appearance-neutral Instagram content. Our findings demonstrated that exposure to body-positive Instagram content resulted in greater levels of body appreciation and body satisfaction compared to exposure to thin-ideal and neutral Instagram content, while no significant differences were found between any of the conditions on self-objectification. Finally, age was only a significant moderator for one variable (self objectification) and condition (thin ideal), indicating that exposure to body-positive social media content may improve levels of body appreciation and satisfaction in adult women, regardless of age.

The Development and Validation of the Comprehensive Intellectual Humility Scale.

A series of studies was conducted to create the 22-item Comprehensive Intellectual Humility Scale on the basis of theoretical descriptions of intellectual humility, expert reviews, pilot studies, and exploratory and confirmatory factor analyses. The scale measures 4 distinct but intercorrelated aspects of intellectual humility, including independence of intellect and ego, openness to revising one's viewpoint, respect for others' viewpoints, and lack of intellectual overconfidence. Internal consistency and test-retest analyses provided reliable scale and subscale scores within numerous independent samples. Validation data were obtained from multiple, independent samples, supporting appropriate levels of convergent, discriminant, and predictive validity. The analyses suggest that the scale has utility as a self-report measure for future research.

Universal worth: construct and scale development.

Although research has demonstrated that narcissistic, contingent, and unsubstantiated forms of self-esteem correlate with undesirable behavior patterns, other researchers have searched for prosocial forms of belief in one's worth. Universal worth is proposed as the belief that (a) one is valued by a deity; (b) one's value is not contingent on success or failure; and (c) one is not valued by a deity more or less than others are valued. The Universal Worth Scale (UWS) was developed to measure this set of beliefs. Psychometric analyses showed that UWS scores were both internally consistent and temporally stable. Although scores on this scale were correlated with measures of constructs that were expected to be associated, the pattern of correlations suggests that UWS scores measure a distinct construct. Future research is suggested to explore universal worth in relation to sociometer theory and terror management theory, and within the continued search for prosocial foundations of self-worth.

What do the MMPI-2 restructured clinical scales reliably measure? Answers from multiple research settings.

The Restructured Clinical (RC; Tellegen et al., 2003) scales were developed to improve measurement of the core constructs of the MMPI-2 (Butcher et al., 2001) Clinical scales by removing "demoralization," hypothesized to affect these scales adversely. Using 25 samples with MMPI-2 responses from 78,159 subjects across diverse clinical settings, we found that each RC scale was highly correlated with a Supplementary, Content, or Personality Psychopathology 5 (PSY-5; Harkness, McNulty, & Ben-Porath, 1995) scale: higher, in fact, than the correlation between the RC scale and its parent scale. Furthermore, for over half the RC scales (i.e., RC1, RC3, RC7, RC8, and RCd), the correlations were strong enough to conclude that the RC scales replicate MMPI-2 scales with rich empirical foundations; the remaining RC scales were not redundant. Next, we examined reliability estimates using alpha coefficients and interitem correlations and did not reveal superior reliability for most of the RC scales over existing MMPI-2 scales.

Using reliability generalization methods to explore measurement error: an illustration using the MMPI-2 PSY-5 scales.

Reliability generalization (RG) is a meta-analytic technique that allows for the systematic examination of variation in score reliability for different samples of test takers; this procedure is based on the recognition that reliability is not a stable property of a test but is sample dependent. As a demonstration of an RG analysis, I obtained 63 reliability coefficients for each of the MMPI-2 (Butcher et al., 2001) Personality Psychopathology 5 (Harkness, McNulty, & Ben-Porath, 1995) scales. The overall variability of alpha coefficients supports the argument that reliability is sample dependent and underscores the need for researchers to calculate reliability estimates based on their research samples rather than simply citing published alpha coefficients as evidence of score reliability. I observed statistically significant mean reliability differences for scores across the 5 scales, with the highest level of reliability observed for scores on the measure of Negative Emotionality and the lowest levels of reliability observed for scores on the measures of Aggression and Disconstraint. There was no evidence that the sex-composition of a sample was systematically related to score reliability, and there were no statistically significant differences in reliability between scores obtained with the English version of the test and those obtained with translated forms. However, reliability was consistently lower for scores on some scales when the data were obtained in nonclinical settings as opposed to clinical ones. Sample size was not significantly correlated with reliability estimates. RG methods have the potential for deepening the level of understanding about the role of reliability in the evaluation and use of personality tests.

The deconstruction of the Hy Scale of MMPI-2: failure of RC3 in measuring somatic symptom expression.

The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Clinical Scales have a long history in psychological assessment. Recently, Tellegen et al. (2003) conducted a series of analyses to restructure the scales to reduce what they considered to be problems that limit scale functioning. In a critique of the Restructured Clinical (RC) Scales published in this issue, Nichols (2006/this issue) questions a number of aspects of the approach Tellegen et al. took including their theoretical assumptions, methods of analysis, and failures to report important information needed for scale evaluation such as relationships with existing scales. We concur with many points raised by Nichols. In our analysis of the performance of the RC3 scale, we found that it has "drifted" so far from the original Hy scale as to be a completely different measure- a scale of cynical attitudes that is already well represented in existing MMPI-2 measures. In this article, we take these concerns a step further and examine the history and construct validity of the Hy scale in evaluating the somatic expression of problems that the original authors (McKinley & Hathaway, 1944) intended. We also include new information from a medical setting, an application not represented in Tellegen et al.'s RC Scale monograph. In agreement with Rogers et al. (2006/this issue), it is our conclusion that some RC Scales do not represent the measurement domain of the original scales and should not be relied on for or used to refine traditional interpretation, particularly in medical or forensic situations (such as personal injury cases) because of their confusing and conflicting results.

Predictive and treatment validity of life satisfaction and the quality of life inventory.

The clinical and positive psychology usefulness of quality of life, well-being, and life satisfaction assessments depends on their ability to predict important outcomes and to detect intervention-related change. These issues were explored in the context of a program of instrument validation for the Quality of Life Inventory (QOLI) involving 3,927 clients from various clinical settings. Clinical norms were also generated that supplement existing nationwide norms. The predictive validity of the QOLI and life satisfaction in a university counseling center was supported in terms of its ability to predict academic retention both by itself and in conjunction with cumulative grade point average 1 to 3 years in advance. The QOLI was also found to be sensitive to treatment-related change in two naturalistic clinical settings and samples. The interpretation and intervention utility of measures of quality of life, well-being, and life satisfaction are discussed with respect to clinical and positive psychology research.

The MMPI-2 in sexual harassment and discrimination litigants.

In order to understand patterns of respondents on validity and clinical scales, this study analyzed archival Minnesota Multiphasic Personality Inventory 2s (MMPI-2s) produced by 192 women and 14 men who initiated legal claims of ongoing emotional harm related to workplace sexual harassment and discrimination. The MMPI-2s were administered as a part of a comprehensive psychiatric forensic evaluation of the claimants' current psychological condition. All validity and clinical scale scores were manually entered into the computer, and codetype and cluster analyses were obtained. Among the women, 28% produced a "normal limits" profile, providing no MMPI-2 support for their claims of ongoing emotional distress. Cluster analysis of the validity scales of the remaining profiles produced four distinctive clusters of profiles representing different approaches to the test items.