Autistic people’s experience of camouflaging and autistic burnout in relation to one another: A systematic review

An association between camouflaging and autistic burnout has been described qualitatively by autistic people but there have been limitations to empirically measuring this. This review aimed to synthesise qualitative data to understand how camouflaging and autistic burnout are experienced in relation to one another by autistic people. A systematic search of five databases and reference lists identified 14 studies to be included in the review. Each included study was appraised for quality using the Critical Appraisal Skills Programme (CASP). A narrative synthesis with thematic analysis was used to synthesise the qualitative data. Four themes with two subthemes were found: ‘the energy cost of camouflaging’; ‘burnout: camouflaging takes its toll’ with the subtheme ‘too drained to disguise’; ‘time and space to recharge’ with the subtheme ‘unmasking is a balancing act’; and ‘the autistic struggle’. Confidence in these findings was assessed using the GRADE-CERQual approach and relationships between the themes were explored using concept mapping. Implications for clinicians supporting autistic people and areas for further research are discussed. • This review emphasises the role of camouflaging in autistic burnout, with implications for clinicians working with autistic adults. • Camouflaging is experienced as energy draining and exhausting, potentially explaining its progression to autistic burnout without time and space to recharge. • The concept of unmasking was presented as both a proactive strategy to manage energy levels and a forced experience subsequent to the onset of autistic burnout, leading to conflicting outcomes. • Further research is needed to explore directly how camouflaging and autistic burnout are experienced in relation to one another by autistic people.