Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample - Journal of Autism and Developmental Disorders
The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18–23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.
Research shows that self-reported autistic traits are associated with suicidal thoughts and behaviours (Cassidy et al. 2018c; Pelton and Cassidy 2017; Paquette-Smith et al. 2014; Takara and Kondo 2014; Cassidy et al. 2014), and 40% of adults who have attempted suicide meet the cut-off for clinical concern on a validated autism screening instrument (Richards et al. 2019).
Self-reported autistic traits in a non-clinical young adult sample were associated with suicidal thoughts and behaviours through thwarted belonging and perceived burdensomeness (Pelton and Cassidy 2017). This suggests that the IPTS could help explain why autistic people and those with high autistic traits are more likely to experience suicidal thoughts and suicidal behaviours.
One potentially relevant factor, and previously unexplored in suicide research, is camouflaging one’s autistic traits, in order to ‘fit in’ in social situations. Social camouflaging was originally described by autistic people, who report actively attempting to mask and compensate for their autistic traits in social situations, in an attempt to fit in better with others socially (Allely 2019; Livingston et al. 2019; Cage and Troxell-Whitman 2019; Lai et al. 2017; Hull et al. 2017). Hull et al. (2019) developed the Camouflaging Autistic Traits Questionnaire (CAT-Q), to capture the extent to which both autistic and non-autistic adults engage in three aspects of social camouflaging: (1) “compensation” for autism-related difficulties in social situations, such as using scripts and copying others from carefully watching other people; (2) “masking” one’s autistic characteristics, by constantly monitoring one’s own behaviours (e.g., eye contact, facial expression, gesture) to present a non-autistic persona to others; and (3) “assimilation”, which captures behavioural strategies used to fit in better with others (e.g., forcing oneself to interact by putting on a performance and pretending). Hull et al. (2019) found that social camouflaging was significantly associated with poor mental health and well-being, consistent with a range of previous research (Cage and Troxell-Whitman 2019; Livingston et al. 2019; Allely 2019; Leedham et al. 2019; Au-Yeung et al. 2018; Camm-Crosbie et al. 2018; Cassidy et al. 2018c; Bargiela et al. 2016; Rynkiewicz et al. 2016; Rutherford et al. 2016).
All variables—autistic traits, camouflaging, depression, anxiety, thwarted belongingness, and perceived burdensomeness—were significantly correlated with lifetime suicidal behaviour (Table 1).
There was a significant indirect effect of autistic traits on lifetime suicidal behaviour through camouflaging and thwarted belongingness (b = .0064 BCa CI [.001, .015]). The direct effect of autistic traits on suicidal behaviour remained significant once the mediators were added (b = .045, p = .04), indicating significant partial mediation.
The association between self-reported autistic traits with lifetime suicidal thoughts and behaviours was significantly mediated by camouflaging and thwarted belonging.
Results from the current study bring together these findings, showing that the path from autistic traits to suicidality is driven by camouflaging one’s autistic traits leading to feelings of thwarted belonging.
The association between autistic traits and lifetime suicidal thoughts and behaviours was also significantly mediated by assimilation and thwarted belonging, suggesting that those with high autistic traits, tend to try and assimilate into social situations, which results in feelings of thwarted belonging and subsequently lifetime suicidal thoughts and behaviours.
