Introduction

According to the World Health Organization, women are more likely to experience PTSD than men. This may come as a surprise considering many physical and combat-based positions are filled by men across widespread industries. Approximately 70% of the global population has experienced at least one traumatic incident in their lifetime.

Addressing trauma and its power is crucial to overcoming it and ultimately, thriving.

It's also estimated that 370 million girls and women around the globe (1 in 8) were sexually abused or assaulted before the age of 18. These stats are devastating, and make it challenging for many adolescent and adult women to distinguish between being impacted by trauma or dealing with later-onset signs of neurodivergence, more specifically, ADHD and autism.

There is a common misconception in modern society that trauma is the sole source of behavioral and/or emotional struggles (survival mode), particularly among women.

However, it's important to note that undiagnosed ADHD and autism often mimics and even overlaps typical trauma symptoms. For women, this is an even more common issue, as women are biologically more inclined to have social prowess and an inclination towards social scenarios, learning to mask from an early age. In fact, most women do not realize when they are "masking," or attempting to connect with others. They may even write it off as simply trying to "fit in with the group," or get along with someone new.

The Hidden Struggles of Masking

What is Masking?

Masking is a phrase that represents concealing or suppressing the identity of one's true self. This may come as no surprise if you're a woman in corporate settings or if you've ever felt extreme anxiety before a gathering, party, or outing, (especially if you're meeting with new acquaintances). For women in particular, we often feel increased pressure to meet societal standards, which subconsciously adds to our external "masking," or presenting what we feel is acceptable to those around us.

The overlap of masking and trauma-related responses is already prevalent if we take "masking" at its base definition. Many women believe their past trauma has caused them to act awkwardly around others, keep strangers at a distance, or avoid socializing altogether. Living in "survival" mode may feel "normal" for someone who grew up in abusive, unconventional, or unsecure households.

However, this makes it more challenging for many women to be taken seriously when seeking a proper medical diagnosis, even when working with a therapist or psychiatrist. ADHD and autistic traits in men are considered easily identifiable compared to women, due to a woman's natural ability to "mask," or act as a chameleon in a variety of social settings, from a doctor's office to a business meeting.

As society pushes to label goofy, eccentric, different girls and women as "quirky," we're only doing a disservice to those who may have a genuine need for a proper diagnosis. When women have been socialized to meet external expectations, reaching out for help may seem frivolous or unnecessary, especially if they have past trauma that seems to align with some of their behaviors, emotional responses, and habits.

Motivations of Masking

Masking is defined medically and socially. For women, in particular, masking is often driven by the fear of being rejected, judged, shamed, or misunderstood. Social pressures and attempts to fit in without feeling stigmatized, discriminated against, or set aside as an outcast can be draining. This can result in emotional burnout, emotional irregulation, and feeling disconnected from expressing one's true self and identity.

Common Signs and Symptoms Associated With Masking

Women in social settings who mask are more likely to exhibit the following behaviors and actions:

• Copying speech patterns: Mirroring speech patterns of others may help an individual subconsciously feel connected with others. Imitation may include adjusting your volume and tone to ease your way into a conversation or fit in with an entire group.
• Body language: In addition to mirroring speech patterns, it's not uncommon for women who mask to mimic the body language of those around them. This can include both conscious and unconscious expressions to appear socially "normal." Ultimately, the entire practice of masking can be draining, leading to a less productive day or lifestyle (especially in women who are unaware of their masking).
• Eye contact issues: Faking eye contact, or feeling as if you're forcing yourself to make eye contact can be another sign of masking in undiagnosed women with ADHD and/or autism. For those who are neurodivergent, looking around while speaking isn't uncommon. For women, however, the additional effort to maintain eye contact will likely feel more unnatural.
• Politeness: Are you constantly apologizing to others? Are you agreeable to a fault? Do you excessively work to accommodate the needs of others? While women may chalk these traits up to survival mode from past trauma, they can also be indicators of ADHD and autism.
• Overthinking: We live in a hyperactive, fast-paced, demanding society. Naturally, we may have been led to believe that overthinking is just par for the course. This is not the case. Overthinking in women may be due to their attempt to meet the needs and expectations of others, even in simple conversations.
• Emotional suppression: Suppression emotions and avoiding conflict are also prevalent in women who are neurodivergent. This can result in an inability to set boundaries, converse properly, negotiate, or make intimate, genuine connections with friends, loved ones, and partners.
• Burnout and exhaustion: We have a terrible habit of painting our society in a perpetual state of burnout. This is not healthy. However, it may not be due to simply living in a "wild world," and instead, may be directly linked to the neurobiological makeup of the brains of those affected (especially in women). Feeling emotionally drained after an event or constant mental fatigue in social settings may be a sign of neurodivergence.
• Communication and self-expression: Difficulty expressing true feelings, thoughts and interests in general social settings can also indicate neurodivergence in women with ADHD and/or autism. Feeling as if you're unable to share your true self can lead to a crisis of personal identity, adding to compound stress and feelings of depression you experience.
• Withdrawal and isolation: Women may begin avoiding gatherings and social situations if they feel overwhelmed by the thought (due to masking). This can limit genuine and deep connections with others, both personally and professionally.

Trauma vs. Neurodivergence

Women who have experienced any form of trauma (sexual, emotional, or physical abuse) may experience social anxiety, emotional irregulation, and hypervigilance.

These responses are extremely prevalent among women (and men) who have experienced a range of trauma, abuse, or even PTSD. However, these symptoms also overlap behavior patterns and expressions in women with undiagnosed ADHD and autism.

Trauma, ADHD, and Autistic Traits (Overlap)

Trauma response: Women with trauma in their histories may struggle with emotional regulation, mood swings, outbursts, and challenges with managing anger or intense feelings after feeling triggered or upset.

ADHD / Autism: Emotional dysregulation is common among women with ADHD and autism, leading to poor impulse control, sensory overload, and frustration in environments that are out of their control or predictable routine.

The Overlap: The overlap between neurodivergent and trauma behaviors is clear in women, but often overlooked. Heightened sensitivity to emotional stimuli can make it difficult to manage anxiety, stress, sadness, and anger, especially when feeling overstimulated in a particular environment.

Common signs of emotional dysregulation and dysfunction include challenges calming down once upset, outbursts of emotions (frustration, anger, and crying), and intense feelings of irritability and/or sadness (even without identifiable triggers).

Hypervigilance

Hypervigilance is another response that's commonly associated and linked with trauma, especially in girls and women. When women experience sexual assault or childhood abuse (along with domestic abuse), they may only receive recommendations or medical guidance that aligns with trauma-informed therapy. Discounting a potential underlying condition, such as ADHD or autism, can be damaging long-term for women seeking to truly heal.

Being hypervigilant is common in women who have experienced any form of abuse. This may include scanning environments, predicting scenarios and social events in advance, and remaining "on alert" at all times whenever they are somewhere new or outside of their comfort zone.

ADHD and Autism hypervigilance: In women who have been diagnosed with autism and/or ADHD, hypervigilance is also noticeable. Heightened levels of anxiety and feeling overstimulated in unfamiliar atmospheres can cause feelings of unease and stress. Loud parties, extensive social gatherings, and even bright lights can lead to hypervigilant behaviors.

Avoidant Behavior and Flashbacks

Trauma response: Women who have significant pain or trauma from the past may avoid specific activities, conversation topics, people or even visiting particular locations. Flashbacks (along with dissociation) may occur due to the reminder of the trauma event.

ADHD: Difficulties concentrating, remembering, and even avoiding tasks is commonplace among women (and men) with ADHD. In the case of an ADHD diagnosis, this is typically linked to cognitive overload (rather than simply emotional trauma flashbacks).

Autism: For women with diagnosed or undiagnosed autism, specific sensory environments and routines are essential for inner peace and balance. If routines and environments are changed or disrupted, they're more likely to experience sensory overload and distress. This can lead to avoidance, rather than trauma-related triggers and/or avoidance.

Overlap: Because ADHD, autism, and trauma-linked behaviors all include forms of avoidance of triggers, it can be difficult to determine when a woman is experiencing trauma-related outbursts, sensory overload, or a combination of both. Social isolation, withdrawal, refusal to engage in activities, and even emotional shutdowns may occur with all three conditions.

Compulsive and Repetitive Behaviors

Trauma response: In women who have a traumatic past, self-soothing and emotional regulation is often expressed in an array of behaviors. From compulsive cleaning to overeating or "bed rotting," compulsive and repetitive behaviors may indicate an individual's need to seek comfort and control of the emotional pain they're masking or not yet healed from, especially if they've yet to identify the root cause of their struggles.

ADHD: Women who have ADHD may indulge in repetitive and impulsive behaviors. These can include procrastination, pacing, and fidgeting to cope with restlessness and even feeling overwhelming boredom.

Autism: In women with autism, hand-flapping, rocking, and self-regulating behaviors help soothe sensory overload and stress.

Overlap: Both neurodivergence and trauma play a role in compulsive and repetitive behaviors. This makes it difficult to identify whether sensory overload, trauma histories, or self-regulating behaviors are present to help with comfort or provide a sense of self-control due to cognitive overload.

Communication, Trust, and Relationships

Trauma response: For trauma survivors, trust can be a word that's no longer in your daily vocabulary. You may feel as though it's difficult to open up to others or be vulnerable in any situation, especially one that's new and unfamiliar. Past losses and betrayals may trigger emotional detachment, avoidant behavior, and a fear of abandonment.

ADHD: Women with ADHD may find it challenging to maintain relationships due to forgetfulness, impulsivity, and the inability to connect empathetically with others. For those with ADHD, communication and trust issues may stem from emotional or cognitive processing challenges, as opposed to being rooted in fear.

Autism: Women who are autistic may find it overwhelming to connect with others in a genuine manner. Because of communication differences and sensory sensitivities, those who have autism may struggle to express themselves or form long-term connections.

Overlap: Both past traumas and neurodivergence can contribute to difficulties forming healthy and trusting bonds, platonically and romantically. While neurodivergent women typically struggle with comprehending and understanding social cues, women who have experienced trauma may avoid intimacy altogether to prevent being hurt by others again. This may occur at a subconscious level, making it even more complex to find a proper diagnosis for women.

Self-esteem and self-worth

Trauma response: Women who have experienced trauma may feel shame, self-blame, and feelings of unworthiness. Neglect, violence, and abuse can lead to a distorted sense of self-esteem. This can cause women to feel truly unworthy of care and love (from themselves and others).

ADHD: Those who have ADHD may struggle with self-esteem if they struggle with time management, organization, and focus. This can cause women with ADHD to feel as if they're "never good enough" in social or work environments.

Autism: Women with autism may feel poorly about themselves due to struggling with traditional social expectations. They may feel inadequate due to social differences. They're also more likely to internalize negative feedback and even healthy criticism from others, taking it as a personal attack, rather than constructive or helpful.

Overlap: Self-criticism, constant negative self-talk, difficulty accepting praise and/or compliments, and even feeling general unworthiness in social and work environments can all be linked to traumatic experiences or undiagnosed ADHD and/or autism.

The Impact of Misdiagnosis

Navigating the intersection of trauma and neurodivergence is crucial to finding a proper pathway to truly healing and overcoming social and emotional barriers. Fostering emotional regulation, supportive relationships, and radical self-acceptance is key for a healthy, growth mindset and thriving lifestyle.

Understanding the complexity of behavioral patterns, trauma-informed care, and ADHD/autism-specific strategies specifically for women is essential to promote balance, healing, and ultimately, resilience for women who have trauma histories and/or neurodivergence.

The Risk of Overlooking ADHD/Autism in Trauma Recovery

Traditional trauma therapies for women may overlook the possibility of ADHD and autism, particularly in women who excel at masking or putting the needs and emotional responses of others first. This can lead to ineffective and incomplete treatments, resulting in cycles of frustration, stagnation, self-blame, and emotional irregulation or dysfunction.

Whether you're a woman who has a traumatic past or you're often overstimulated, find yourself wiped out after a social event, or you're simply unable to connect with others, seeking a proper diagnosis is imperative. Seeking professional evaluations and vocalizing your needs upfront may be necessary to be taken seriously, especially as the field of women and neurodivergence is only now expanding.

Reviewing specific behavioral patterns and traits that are not only associated with trauma, but also ADHD and autism can help you gain insight into your inner, true self. This can also lead you to find a diagnosis that aligns with how your brain, mind, and emotions actually function. Remember, you are unique, and you deserve a diagnosis that aligns with your particular needs, not a blanket based on outdated research. Even women who have experienced trauma in the past may be clear of the trauma, but not recognize their behaviors as links to autism or ADHD. This can lead to further delays in diagnosis and successful treatments or therapy.

Healing in life is not always straightforward. The saying "time heals all wounds," may be true in a sense. However, healing is a complex, multi-layered process that requires a thorough review of your feelings and how you interact in the world. Because of how ADHD, trauma, and autism intersect, especially in women, acknowledging your actual identity can lead to a more fulfilling sense of self-awareness and ultimately, feeling whole as your authentic self.

References

1. Emotional Dysregulation & ADHD and Autism
   National Institute of Mental Health (NIMH). (2019). Emotional dysregulation and mental health. Retrieved from https://www.nimh.nih.gov
2. Hypervigilance in Trauma and Neurodivergence
   American Psychological Association (APA). (2022). Hypervigilance and trauma. Retrieved from https://www.apa.org
3. Avoidance of Triggers or Flashbacks
   Post-Traumatic Stress Disorder (PTSD) and Trauma Resources. (2021). Understanding avoidance and trauma responses. National PTSD Program, U.S. Department of Veterans Affairs. Retrieved from https://www.ptsd.va.gov
4. Repetitive or Compulsive Behaviors
   Journal of Autism and Developmental Disorders. (2020). Repetitive behaviors and autism: Clinical perspectives. Retrieved from https://link.springer.com/journal/10803
5. Trust and Relationships in Trauma and Neurodivergence
   Neurodivergence and Attachment Theory. (2020). Exploring attachment styles in autism and trauma survivors. Retrieved from https://neurodivergentinsights.com
6. Low Self-Esteem in Trauma and Neurodivergence
   Social Science & Medicine. (2021). The impact of trauma and neurodivergence on self-esteem. Retrieved from https://www.journals.elsevier.com/social-science-and-medicine

Resources

If you can relate to this experience, I encourage you to check out the following resources:

• Women and ADHD: National Resource Center on ADHD
• Autism in Women and Girls
• The International Society for the Study
• Autism Tests - Embrace Autism