Social Anxiety or Autism? Understanding the Differences in Adult Women

Autism or Social Anxiety? Why So Many Adult Women Are Misdiagnosed

For many women, receiving an autism diagnosis in adulthood comes after years or sometimes decades of feeling misunderstood and alone.

Often, the first explanation offered is anxiety, especially social anxiety (3). On the surface, the overlap makes sense: avoiding social situations, replaying conversations afterward, feeling uncomfortable around others, or needing time alone to recover. Both autism and social anxiety can involve social avoidance, distress, and rumination after interaction (2). But while these experiences can look similar from the outside, what is happening underneath can be very different.

Understanding the distinction matters. Not just for diagnosis, but for treatment, self-understanding, and reducing shame (1,4).

Why autism in women is so often missed?

For a long time, autism research focused mostly on boys, which shaped diagnostic criteria around traits that tend to be more externally visible in males (1).

Many women present differently and are more motivated to try to fit in or at least look like they are fitting in (2).

Autistic women often become highly skilled at adapting socially through observation and imitation, a process often referred to as masking or camouflaging (1). From a young age, they may study social interactions closely, learning how to blend in by copying others.

This can look like rehearsing conversations ahead of time, forcing eye contact, mimicking facial expressions, or mirroring the personalities of peers (2).

To others, they may appear socially capable.

Internally, though, it can feel exhausting.

This is one reason many women are first diagnosed with:

Social Anxiety Disorder, Generalized Anxiety Disorder, Depression, ADHD, Borderline Personality Disorder, eating disorders, chronic stress or burnout (2,3).

These conditions can co-occur with autism and may overshadow the underlying neurodevelopmental profile (1).

From my point of view in a nutshetllthe main difference is fear versus difference in processing.

One of the clearest ways to understand the difference between autism and social anxiety is to look at why social situations feel hard.

With social anxiety, the struggle is often rooted in fear particularly fear of being judged, embarrassed, or rejected. Social anxiety is characterized by fear of negative evaluation and social scrutiny (2). This can happen to people with Autism Spectrum Disorder over time but it is not the most obvious challenge for them (2).

A woman with social anxiety may think for example: What if I say the wrong thing or they probably think I’m awkward. She might think that everyone noticed how nervous she was.

The social rules usually make sense. The distress is about how she will be perceived (2).

With autism, social difficulty is more often linked to differences in social communication, processing speed, and sensory regulation (2,3). In autistic women these issues would have been present across the lifespan (1) as with any neurodevelopmental disorder and not have a clear starting point as with some women who have social anxiety (1,2).

In my experience an autistic woman may think things along the lines of: I’m not sure what’s expected of me here or this conversation feels confusing. She might feel like there’s too much happening at once and she's trying really hard to seem normal.

The distress often comes less from fear and more from confusion, overload, and the mental effort it takes to keep up. However, it is good to keep in mind that some women with autism have high coping strategies that make these situations tolerable and even okay for them. No one individual is the same and these challenges should not be assumed for all women on the autism spectrum.

Social skills aren’t the same as social energy

Many women with social anxiety understand social interaction, even if anxiety interferes (1).

Autistic women may also deeply want connection, but socializing can require more conscious effort because social information may need to be actively processed rather than intuitively understood (1,2).Examples are interpreting indirect communication, reading tone and body language, knowing when it’s their turn to speak, understanding hidden expectations and keeping up with the flow of conversation (1,2,3).

Sustained social interaction can lead to significant fatigue and emotional depletion, particularly when masking is involved (1).

Masking is the part most people don’t see.

Masking is one of the biggest reasons autism can go unnoticed in women (1).

It can involve:

Copying facial expressions, memorizing social scripts, forcing eye contact, hiding stimming, or constantly monitoring body language, tone, and timing

These adaptive behaviours can reduce outward signs of autism while increasing internal stress and anxiety (1).

Social anxiety also involves self-monitoring, but autistic masking tends to be broader and more persistent because it is often rooted in adapting to neurological differences rather than solely fear of judgment (1,3).

That difference matters.

Sensory clues are often overlooked (1).

Sensory differences can be one of the strongest indicators that something more than social anxiety is happening.

Many autistic women report: feeling overwhelmed by noise or crowds, sensitivity to light, smells, or textures. Difficulty filtering background noise or needing long recovery time after stimulation (3). If these needs and triggers are ignored many report shutting down or melting down which can look different for each person. These are usually consistent over time and have patterns unlike triggers in people with social anxiety that would be likely situational and may vary overtime (1). It is important to remember that on the outside they might just look shy or disinterested. This is not the case for many autistic women.

Sensory sensitivities and sensory overload are core experiences in autism and can significantly shape social functioning (1,3).

While anxiety can heighten sensitivity in stressful situations, it does not usually create the same persistent sensory pattern (2,3,4).

Special interests don’t always look autistic.

Autistic women often have deep, focused interests that provide regulation, structure, and comfort (1).

These interests may not fit common stereotypes and can look like an interest in

psychology, literature, animals, human behaviour, health and wellness, music, fictional worlds or even creative hobbies.

Because these interests can appear socially typical, they are often overlooked in assessment (1,2,4).

Sometimes it’s both

Autism and social anxiety frequently coexist. Anxiety disorders are highly prevalent among autistic individuals, often emerging through repeated experiences of misunderstanding, exclusion, or social difficulty (2).

In other words, an autistic woman may develop social anxiety because of autism not instead of it (2,3). The environment is not always welcoming towards differences.

This is why treating anxiety alone can sometimes feel incomplete (2).

Why getting it right matters

When autism is mistaken for anxiety, women can spend years feeling like they’re failing at therapy, relationships, or life (1,2).

Traditional anxiety treatments can be helpful, but may not fully address autistic needs when autism is part of the clinical picture (4).

Support may also need to include sensory accommodations, burnout prevention, communication support, and identity exploration, alongside learning how to reduce masking in ways that feel safe and sustainable (1,2,3,4). For many women, this process also involves building self-acceptance and working with neurodivergent-informed therapy that recognizes autism not as something to “fix,” but as an important part of understanding themselves (1). For many people receiving an autism diagnosis later in life is often less about discovering something new and more about finally having language for experiences that have been present all along.

The overlap between autism and social anxiety in women is real, but the reasons underneath the behaviour can be profoundly different (1).

One is often rooted in fear of judgment.

The other reflects a different way of processing the world socially, emotionally, and sensorily (1,2,4).

For women who have spent years feeling too much, too sensitive, or too different, understanding that distinction can be deeply validating.

And sometimes, that understanding is the beginning of healing. This is part of my work as a psychologist and how I strive to support late diagnosed adults. Although this is about autistic women I believe that this information can also apply to men and non-binary individuals in some cases.

*Please note this blog is written by a human, so please forgive its imperfections. I intend to convey interesting research findings, my clinical experience and my human experience in a way that might be helpful to others.

References

1 Cook, J., Hull, L., & Mandy, W. (2024). Improving Diagnostic Procedures in Autism for Girls and Women: A Narrative Review. Neuropsychiatric Disease and Treatment, 20, 505–514. https://doi.org/10.2147/NDT.S372723

2 Kerns, C., Kendall, P. (2014). Autism and Anxiety: Overlap, Similarities, and Differences. In: Davis III, T., White, S., Ollendick, T. (eds) Handbook of Autism and Anxiety. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-319-06796-4_6

3 Lai MC, Kassee C, Besney R, et al. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry. 2019;6(10):819–829. doi:10.1016/S2215-0366(19)30289-5

4 National Institute for Health and Care Excellence. Autism spectrum disorder in adults: diagnosis and management [Clinical guideline 142]; 2021.