The Hidden Tragedy of Autistic Women and Over-Accommodation

Today, we’re uncovering a myth that’s rarely talked about—how autistic women often mask so well that they end up over-accommodating others to the detriment of their health.

One woman on the Autistic Culture Podcast recently said something that stopped me in my tracks. She claimed that if a male boss offered her a 15-hour-a-day job where she got no credit for her work, she’d jump at the opportunity. She thought this was a gender-only issue, when in fact, it is both a gender and autism issue—but I see the tragedy of this pattern all the time.

The Double Standard in Masking: Autistic Women vs. Autistic Men

Women in general are better at masking than men, but for autistic women, this ability often backfires. While little autistic boys may be allowed to be goofy—especially if they excel at math, video games, or rebuilding engines—autistic girls are often shunned for not “looking” or behaving like NT girls.

One of my high school friends carried a man’s leather briefcase to class instead of a purse, and it made her a social outcast. Another woman I knew earned a Ph.D. in paleontology and actually fit in fairly well because she was brilliant—but she spoke too loudly and had no friends. Autistic women are often overlooked or dismissed in professional and social spaces, not because they lack intelligence or skill, but because they fail to match NT expectations.

The Hidden Struggles of Autistic Women

Many autistic women experience profound challenges in connecting with others, even within their own families. One young woman on the Autism Spectrum told me that she tried to tell her mother about her autism by sending her TikTok videos. But her mother, who was in the midst of divorcing her autistic father, still didn’t understand. This same 22-year-old described how she would memorize five topics before going to a party so she would have something to talk about—as if conversation was just talking rather than a dynamic exchange.

She also spoke about the fatigue of masking all day at school as a child. While other kids played outside after school, she went home to take a nap. In her desperation to connect with her mother, she remembers making the decision to invent a thought when her mother asked what she was thinking. She knew she couldn’t tell her mother that she was mesmerized by the serrations of a leaf lying on the ground by the picnic table and wasn’t actually engaging in conversation.

Real Stories of Over-Accommodation

• Autistic women often experience hormonal imbalances that lead to PMDD (premenstrual dysphoric disorder). My daughter, Bianca, would faint and have to sleep in the nurse’s office until I could pick her up and bring her home. This connection between autism and hormonal regulation is rarely discussed but has a significant impact on quality of life. I’ll be exploring this topic in more depth in a future episode, as it’s an essential part of understanding the unique challenges faced by autistic women.
• A woman who would call in sick to help her boyfriend get to work on time, even though he lived across town and routinely overslept.
• A woman who suffered severe hair loss and digestive problems trying to accommodate a demanding boss. She only realized she was autistic at age 45—when she came to my office for hypnosis and finally got a proper diagnosis.

Autistic women, particularly those who mask well, often become people-pleasers to their own detriment. Liane Holliday Willey, in her book Pretending to Be Normal, describes this experience—how masking allows autistic women to blend in but at a profound personal cost. They comply so thoroughly with societal expectations that they don’t recognize when their own needs aren’t being met, leading to emotional exhaustion and burnout.

Breaking Free from the Over-Accommodation Trap

The solution isn’t to tell autistic women to stop caring—it’s about helping them set boundaries, recognize their needs, and advocate for themselves without guilt.