The thread on X about masking?
try this
”Dr Sanil Rege FRANZCP | MRCPsych
@sanilrege
Mar 7, 2026 at 9:45 AM
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Masking is not performance. It is protection. 1/16 Masking is ( or was) trending on Twitter. It’s also increasingly heard in clinical practice. As with most phenomena that suddenly become popular, it can be misunderstood ( and are applied broadly) “Masking” is not one thing. ( yes it was originally described as social camouflaging in ASD) It can be heterogeneous. ( in its functions) Let’s explore it from a neurobiological and psychological perspective
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1/ The first ‘mistake’ is to treat masking as though it simply means “pretending.” It doesn’t. Masking is often a functional adaptation. A way of regulating arousal, preserving attachment, maintaining safety, and meeting needs in environments where direct expression may not feel possible.
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2/ One useful way to understand masking is through interoception. Interoception is the brain’s capacity to detect and interpret internal bodily signals: heart rate tension fatigue gut sensations breathlessness heat pain the bodily component of emotion In simple terms: how the brain reads the body from within.
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2/ In conditions where interoceptive sensitivity is altered ; prediction errors are high = high arousal = masking becomes a strategy to manage arousal recruiting Top down modulation to manage arousal
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3/ This is why Masking can be more prominent in ASD because baseline arousal is high - interoceptive sensitivity is altered. It’s also why ASD is associated with higher rates of MECFS / Long Covid and pain syndromes When the brain’s interoceptive system (e.g., insula + anterior cingulate) isn’t giving clear early warnings, people can keep functioning ‘masking’ until the system tips into: - shutdown / meltdown -alexithymia (“I can’t tell what I feel”) -autonomic surges (“it hits all at once”) I’ve covered interoceptive blindness here
youtube.com
ADHD Burnout & Autistic Meltdowns: The Hidden Brain Circuit
This video explains how interoceptive blindness — the brain’s inability to read internal body signals — fuels burnout, meltdowns, and emotional dysregulation...
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4 / Masking in ASD may reflect a growing split between the person’s embodied, affective self and a more rational, externally organised self built to manage the social world It’s what can happen when the social self becomes over-developed in the service of adaptation.
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5/ That is where masking links to the idea of a False Self. ( Winnicott) …… I was able to see the defensive nature of the False Self. Its defensive function is to hide and protect the True Self, whatever that may be. ( Winnicott ,1960) A shift from an immediate, embodied, felt self toward a more abstract, disembodied, socially compliant self. Ultimately to meet the needs of others and the environment.
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6/ That top-down modulation can take many forms: -hyperfocus -over-preparation -perfectionism -constant activity -excessive exercise -social scripting -over-intellectualisation -rigid self-monitoring In clinical practice the above will be given labels But understanding the phenomenon is a different skill.
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7/ This is why masking is often misunderstood. (And can be misused ) People see the output and assume the internal state matches it. It doesn’t. A person may appear controlled while exerting enormous effort to stay organised, coherent, acceptable, or connected. The performance gets mistaken for ease.
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8/ This is crucial in clinical practice because of the impact of countertransference. When someone appears polished, articulate, or socially skilled, the clinician may begin to doubt the depth of distress, the diagnosis, or the authenticity of what is being presented. Or worse - we may label them ‘manipulative’ or performing If that is not recognised, it can significantly weaken the therapeutic alliance. The task is to recognise what the mask evokes in us, so we do not mistake our reaction for the patient.
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9/ Why is the mask used? Usually because it serves a function. The function may be to: -avoid rejection -maintain attachment -reduce shame -prevent conflict -stay safe -remain competent -gain validation - keep distress from becoming visible -hold the self together The mask protects the person underneath.
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10/ And this is also why it is hard to simply “take the mask off.” Because the mask is rarely just a superficial behaviour. It is often built on automatised predictions shaped across childhood and adolescence: -This is how I stay safe. -This is how I stay liked. -This is how I avoid being too much…. So the mask becomes organised into the person’s way of functioning.
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11/ Masking in ASD is known to be associated with core automatic social scripts but also comes at a cognitive cost - a cost that results in the service of the external world at the expense of the internal ( emotional world) This often forms the foundation of burnout ..
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12/ A consciously worn mask can easily be misread as ‘manipulative’. But often what is being called “manipulative” is a person who has learnt that direct expression of need, vulnerability, anger, fear, or confusion is too risky. This is automatised. Like the person who repeatedly breaks rules ; when asked how they met needs - ‘By being bad’ So the self organises around performance, adaptation, or pleasing…. Not because the person is false. But because the strategy once worked. The other side of the mask is ‘non-existent’ *That is not to say that manipulation can’t exist.
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13/ That is why the right question is not: “Are they acting?” It is: What is the mask protecting? What happens if it comes off? What need is it meeting? Because many masks exist to avoid anticipated pain.
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14/ Clinically, Different masks emerge from different combinations of: -arousal -interoception -top-down control -attachment -development -temperament -shame -personality organisation -emotional need….
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15/ And perhaps the most important point: The opposite of masking is not ‘true authenticity at all times.’ Most of what we do we don’t ‘know’ That forced smile in a party you don’t want to be at? False or ? Or the superficial talk? The spontaneous gesture is the true self in action ( Winnicott , 1960) For many people, the capacity to remove the mask safely only develops when the environment becomes more predictable, attuned, and emotionally survivable. In other words: safety precedes unmasking.
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16/ So when “masking” is talked about on here, or heard in clinic, it is worth asking what it is doing. Not asking whether the mask is real. Because the function of the mask is often not deception. It is protection. Yes the word masking is being applied broadly beyond ASD ( the original term ) - but as clinicians the question remains - what function does it serve ? END