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The popular perception of autism is a very male version — girls and women with autism spectrum disorders (ASD) can have very different symptoms than males. This not only leads to many girls and women never being diagnosed, but it also creates a life filled with confusion, mystery, and frustration over an inability to function like most people. In fact, a recent study showed that people who were diagnosed with autism in their 50s spent their lives thinking they were bad people because of how their brains worked.

ASD appears to affect primarily males, however, many girls are not receiving diagnoses because their symptoms have not been studied to the same degree. As it turns out, girls have very different than boys. In fact, girls with autism often behave more like neurotypical boys than boys with autism.

Girls and women with ASD are frequently diagnosed with depression, anxiety, borderline personality disorder, bipolar disorder, or ADHD. Female ASD also more easily lends itself to eating disorders such as anorexia and bulimia, and obsessive-compulsive disorder (OCD).

The intense focus associated with autism is believed to be behind anorexia, dieting, and body obsession. Researchers estimate about 20 percent of women with anorexia also have autism.

There are many reasons why so many girls go undiagnosed. One reason is girls are much better at “masking,” or hiding their symptoms and mimicking neurotypical behavior. This is believed to be due to girls’ greater desire and ability to connect socially. However, masking takes an enormous mental and physical toll in the way of chronic stress and exhaustion. This can lead to the sensory overloads and “meltdowns” typical of the disorder.

The diagnostic criteria for autism were derived from studies on boys. Primary symptoms in boys include difficulties with socialization and communication and repetitive, inflexible behavior patterns. Girls with ASD do not typically exhibit these behaviors to the same degree.

Studies also show that only girls with more extreme ASD symptoms received a diagnosis, leaving many girls on the milder side of the ASD spectrum undiagnosed but still struggling.

Some studies show girls with autism are more like neurotypical boys

Brain scans show girls with ASD process social information much differently than neurotypical girls and more like neurotypical boys. In tests assessing friendship quality and empathy, ASD girls scored closer to neurotypical boys than to neurotypical girls or boys with ASD.

In the book Aspergirls, the author explains how most girls and women with ASD feel they are sometimes more like boys than girls, or half and half.

Girls and women with ASD often labeled as “too intense”

The book Aspergirls goes through a number of symptoms that girls and women diagnosed with ASD commonly share. One of the most common underlying ones, and one that has so many growing up with shame, is always being described as too sensitive, too intense, and so forth.

This stems in part from the hypersensitivity and sensory overload associated with the disorder.

Autism can make girls more vulnerable to bullies, depression, and isolation

Unfortunately, symptoms of autism, such as not understanding social cues and being very literal, can make girls more vulnerable to bullies and predators.

Social discomfort and awkwardness also make girls and women with ASD more prone to isolation.

ASD girls are also more likely to suffer from anxiety, low self-esteem, social isolation, and depression. In fact, mild autism is associated with a significantly higher risk of suicide. Two-thirds of women with milder forms of ASD report suicidal thoughts.

The role of brain inflammation in autism

Diagnosis is extremely important in girls and women with ASD. This is because it can relieve years or decades of shame and anxiety around feeling like such an outsider to the rest of the world. Knowing why they feel and act the way they do can bring enormous relief from feeling like they are constantly failing.

Autism is increasingly being linked with inflammation and autoimmunity in the brain that began in infancy and affected brain development. Studies show maternal autoimmunity, high blood sugar, or infections are linked with an increased risk of giving birth to a child who will develop ASD. When the developing child’s brain is fighting inflammation, it does not have the resources to appropriately “prune” synaptic pathways.

Strategies to dampen autoimmunity and brain inflammation have helped many people tame the symptoms of autism that can cause suffering, such as being too easily overwhelmed. Ask my office for ways to dampen brain autoimmunity and inflammation.