Burnt out, exhausted, overwhelmed, self-blaming and feeling like no one gets you – this is often the experience of autistic females who come to us for therapy.
Autism can present uniquely in females in a way that can often cause missed or late diagnosis because they often internalise their experience whereas males are more likely to externalise, mask less, and be diagnosed younger. In fact, there are around four men diagnosed to every one woman.
Autism in females (often called an ‘Internalised Profile’), can be quite different to stereotypical male presentation (for example developed social skills and being deeply empathic).
Internalised Traits
Masking
Masking is the hiding of autistic traits to fit into society. This may be hiding sensory needs, overcompensating or rehearsing for social situations, minimising stims, internalising meltdowns into shutdowns, or avoiding situations others may find easier. Because Internalised autists are more socially conditioned, masking is much higher and more unconscious.
Special Interests on living things
Autists often have intense special interests which are regulating for them, and we can lose track of time or very much focus and fixate on them. Males are stereotyped as having those interests as objects or activities e.g. trains or video games.
Internalised special interests can often be much more socialised and alive. This may be a favourite band, certain people, or animals. As these special interests are more socialised, they can be missed more.
Limerence
Limerence feels like an intense connection or even obsession with a person. It may be romantic but can also be platonic. I like to think of limerence as a special interest in a specific person which can be higher in internalised profiles (as it is with certain attachment styles). Limerence isn’t a choice and can be quite debilitating finding ourselves preoccupied with a person and our worth feeling like it is based on them
Creative
Internalised autists are often creative and able to express this with things such as crafts or arts and Divergent valuable thinking
Emotional Sensitivity
Alexithymic (which literally means not being able to describe feelings) is a common trait in autism, which harmful research has in history labelled as not being emotional or empathic.
The internalised profile can be the opposite of this – with intense overwhelming emotions that may be experienced at an intensity disproportionate to the triggering event. Emotional regulation may be more of a challenge in an internalised profile, compared to emotional literacy and understanding in a stereotypical autistic profile. Some people with an internalised profile may also speak with similar prosody and intonation in their voice which can cause a double effect where you say you are suffering, but people interpret your body language the opposite way.
Deep Empathy
Autists are empathic (contrary to myths from the double empathy problem) and with the internalised profile, they may deeply introject and feel other people’s feelings. This deep empathy can feel hurtful and lead to vicarious trauma from absorbing other people’s feelings. In moderation, deep empathy can help with attunement, but when it feels beyond our control it can affect us bodily and burn us out.
Sensory Sensitivities
Sensitivities to senses with some being more intense and others being less intense than neurotypicals. Being socially conditioned more can increased our exposure to overwhelming sensory stimuli and leave people with internalised profiles often exhausted by this.
More subtle stims
Stimming is a repetitive behaviour that can be used to self-regulate for example hand flapping, playing with an object or stim-toy, or rocking. It may be less pronounced in the Internalised Profile with more subtle stims to regulate and meet our sensory needs that may be overlooked or not quite regulate.
Burnout
A combination of highly social environments, masking, and not meeting our needs can lead to burn out that is common in an internalised profile. Rather than a more visible melt-down to being overwhelmed, shut-downs and burn out can be more common with Internalised autism
Developed Social Skills
Developmentally, male play is often focussed on activity for example in sports on the playground, whereas female play is more social. This can cause a lot of conditioning to be more social and learn to masquerade social skills. There can be an expense to this: forced eye contact, rehearsing conversations, literal thinking, and struggling with humour.
‘High Functioning’
Often needs can be missed or masked with Internalised Profiles often being diagnosed late in life. Their needs can be quite spikey, with some areas excelling and others needing support, but this perception of being ‘high functioning’ can mean their support needs are missed or people don’t believe them or are surprised when they are struggling.
Routine
The world is chaotic and routine and structure can make sense of this. This may look like a strong need for predictable routine with Internalised autists.
Social Justice
A lot of social justice is overlooked and autists can be particularly attuned and emotionally wounded by social justice issues. The pain of this can event present physically, and affect us existentially as themes which are universally agreed as ethical such as animal welfare, peace, and looking after the misfortunate are not acted on and oppression and war loom.
Internal Monologues
Internal profiles can be highly attuned to demands on their life that can be introjected as inner voices – often critical and contradictory like the dialectics of how to behave. This can be confusing, critical, and overwhelming creating separate parts of you – each trying to conform and act socialised.
Rejection Sensitivity
RSD can be common from invalidating environments such as being told you are communicating or conforming wrong in school. A lifetime of getting it wrong, can leave internal autists susceptible to a deep seated emotional pain at rejection or criticism that can almost feel physical.
Chronic pain
A combination of masking, exposure to little t traumas, sensory sensitivities to pain, and physical health issues like hypermobility or GI issues that are common in autism – many Internalised autists suffer with chronic pain.
How Counselling and Coaching can help
Hope therapy and counselling has a team of over 90 experienced counsellors and coaches based across the UK – as well as capacity to work remotely from the comfort of your own home or if you’re overseas. This can provide a safe neuro-affirming space where your preferences are respected by your counsellor.
Many of our counsellors have done extensive training in autism or have lived experience – including with female presentation. We promise that you will be believed, that we will adapt to meet your way of communicating and processing, and to work collaboratively with you.
Do book in for a free 15min Consultation Call with one of the team – we can chat more about what you’re going through, the type of counselling or coaching that would work best for you, and tell you about some members of the team that could work with you
Examples of how we can help
Managing Anxiety and Stress
Counselling provides techniques such as mindfulness, relaxation exercises, and cognitive behavioural therapy (CBT) to help manage anxiety and stress.
Developing Coping Strategies
Counselling helps individuals develop coping mechanisms to deal with sensory overload, changes in routine, and other stressors. This can include sensory integration therapy, grounding techniques, and establishing predictable routines.
Building Self-Esteem and Self-Identity
Counselling can help individuals with autism build self-esteem and a positive self-identity. Therapists work on recognising strengths, celebrating achievements, and fostering a sense of self-worth.
Providing Emotional Support
Counselling offers a safe space for individuals with autism to express their feelings and experiences. This emotional support can help them process their emotions and develop healthy ways to express them.
Enhancing Executive Functioning
Executive functioning skills, such as planning, organising, and time management, can be improved through counselling or coaching. Techniques may include creating visual schedules, using reminders, and breaking tasks into manageable steps.
Improving Social Skills
Counselling can teach social skills, such as understanding social cues, initiating and maintaining conversations, and building relationships. Role-playing and social stories are often used to practice these skills in a safe environment.
Enhancing Communication Skills
For individuals with communication difficulties, counselling can offer strategies to improve both verbal and non-verbal communication. Techniques may include speech therapy, the use of visual aids, and alternative communication methods.
Family Support and Education
Counselling can involve family members/partners, providing them with strategies to support their loved one. Education about autism and its impact helps families understand behaviours and how best to respond.
Transition Planning
Counselling can assist with transitions, such as moving from school to work or living independently. Therapists help individuals and their families plan for these changes, develop necessary skills, and manage associated anxiety.
Promoting Independence
Counselling encourages independence by teaching daily living skills, problem-solving techniques, and self-advocacy. This empowers individuals to take more control over their lives.
Addressing Co-occurring Conditions
Many individuals with autism experience co-occurring neurotypes like ADHD, BPD, or OCD. Counselling can address these concurrently, providing a comprehensive approach to treatment.
Sensory Integration Therapy
For those with sensory processing issues, counselling can include sensory integration therapy. This therapy helps individuals respond to sensory input in a more adaptive way.
Improving Relationships
Counselling can help individuals with autism improve their relationships with family, friends, and colleagues. Therapy can focus on communication, empathy, and understanding social dynamics.
Developing Problem-Solving Skills
Counselling teaches problem-solving skills, helping individuals with autism navigate challenges and make decisions effectively. This can boost confidence and reduce reliance on others.
Conclusion
The Internalised (female) presentation of autism can present differently to other autistic profiles which can lead women’s autistic experience to be missed, not believed, or heavily camouflaged. Hope has a team of experienced counsellors and coaches that can support with your autistic identity, traumas that occur from a lifetime of not being understood, holding a space where you can authentically be you, and even provide some practical tips.
Written by Hope therapists, Simon Hughes & Francesca Nour
Simon is a counsellor based in Oxford with a passion for clients who find themselves stuck in patterns of self-blame – often from a lifetime of being told they are wrong or do not belong. This presents strongly in autism, especially in internalised profiles where masking and perfectionism can be that much more intense.
Francesca (Chessie) is one of our experienced counsellors with Hope, as well as an AuDHDer with lived experience of the internalised profile of autism. She was undiagnosed until a critical head teacher. She knows that common experience of teachers having preconceived ideas of ADHDers (telling us to concentrate, stop day dreaming, or scolding our social struggles). She is passionate about psychoeducation of autism, the stigmas attached to it, and especially for people in authority such as teachers who can help children with neuroaffirmation at that developmental age. She advocates for inclusion and reasonable adjustments, knowing how common bullying is. She went on to thrive, studying neuropsychology and joining the team with us at Hope.