Why autism in Indian women often goes unseen
Summary
Women on the autism spectrum in India often get misdiagnosed owing to a misconception that it's a ‘male condition’, societal norms that expect girls to be compliant, and the behaviour of masking they adopt to blend in
When Shreya Pawar from Mumbai was first diagnosed with borderline personality disorder in her late twenties, the label seemed to explain her whirlwind of emotions, constant anxiety, and frequent shutdowns. Therapy focused on emotional regulation. Medications took the edge off her panic. But something never quite clicked. Despite diligently following every recommendation, she didn’t feel seen or understood.
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The real turning point came during a late-night scroll on Instagram. A short video on autism in women caught her attention. It mentioned masking, sensory overload, and social exhaustion. As she watched, it felt like the person on screen was describing her life. Within months, Shreya was re-evaluated, and finally, diagnosed with autism spectrum disorder.
Across India, stories like Shreya’s are becoming more common. Yet autism in women remains grossly underdiagnosed or misdiagnosed, and the consequences can span decades of psychological strain. The reasons are rooted in outdated science, cultural blind spots, and the immense social pressure placed on women to conform even when it harms them.
For years, autism was thought of as a “male" condition. In fact, early research and diagnostic criteria were built entirely around male subjects. “Autism is often missed in women because the existing diagnostic tools and clinical understanding have largely been based on how autism presents in males," explains Dr Nitin Kumar Sethi, chairman at PSRI Institute of Neurosciences, Delhi NCR. “Girls with autism tend to display fewer outward behavioural issues. Instead, they internalize symptoms like anxiety, withdrawal or emotional overwhelm."
The result is a distorted picture of what autism looks like. When a girl excels in school, maintains surface-level friendships, or appears “polite," her deeper struggles often go unnoticed. Deekshaa Athwani, clinical psychologist at Fortis Hospital Mulund, says the mismatch between presentation and expectation is key. “Traits like repetitive behaviour or focused interests show up differently in girls. They may obsess over books, animals, or celebrities but because these are socially acceptable, no one flags them as unusual." This quiet difference means many women aren’t just missed—they’re actively misread.
MASKING: A SURVIVAL STRATEGY
One of the biggest reasons women on the autism spectrum are overlooked is masking—a behavior unique in both form and frequency among autistic women.
“Masking is when someone consciously or unconsciously hides traits of autism in order to blend in," says Dr Kadam Nagpal, head of Neuroimmunology at Manipal Hospital, Dwarka. “It may include mimicking others’ tone of voice, copying how they dress or gesture, even rehearsing entire conversations before speaking."
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For autistic women, masking often starts in childhood. Socialized to be agreeable and “well-behaved," girls learn early that their natural responses like fidgeting, avoiding eye contact, or reacting strongly to noise aren’t welcome. “Over time, masking can lead to burnout, identity confusion, and emotional breakdowns," says Athwani. “You’re constantly playing a character just to get through the day. Eventually, you forget who you are beneath the performance."
What’s more, because masking works on the surface, therapists and psychologists may entirely miss the signs of autism, especially in adults. A woman can appear perfectly functional in a one-hour assessment and still be unraveling internally. When this happens, the treatment targets only the symptoms. Patients bounce between medications and therapy models, feeling like something is missing. And because they don’t fit the expected autism profile, they begin to doubt themselves.
THE INDIAN CONTEXT
For most Indian women with autism, the first stop is not an autism diagnosis. Instead, as Sethi, Nagpal, and Athwani point out, it’s a familiar pattern of women coming in complaining of anxiety, depression, or interpersonal conflict. But rather than digging deeper, they’re often labeled with borderline personality disorder, social anxiety, or even eating disorders. “These diagnoses are not always wrong," explains Sethi. “But they’re often secondary. The core issue – autism – remains unaddressed."
The Indian socio-cultural environment adds another layer of complexity. “In India, girls are expected to be quiet, compliant, and emotionally restrained," says Athwani. “So when an autistic girl withdraws from group settings or reacts strongly to loud noise, she’s often seen as shy or sensitive - not struggling." Nagpal agrees. “Traits like bluntness or emotional outbursts are chalked up to bad behavior or poor upbringing. Autistic traits in women get absorbed into cultural expectations of how a ‘good girl’ should behave."
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This cultural camouflage is dangerous. It teaches girls to hide their discomfort rather than seek support. Families may avoid clinical evaluation until a crisis hits – by which time the woman has already spent years misunderstood, isolated, and ashamed. What’s especially troubling is that these misinterpretations happen not just at home, but in schools and even clinics. “Most families don’t seek help unless the behavior is disruptive," Athwani adds. “And quiet suffering is never seen as disruptive."
THE EFFECTS OF MISDIAGNOSIS
Living for years or decades without understanding one’s own neurodivergence comes at a steep price. Women report extreme exhaustion, a chronic sense of not belonging, and deep confusion about why social life feels so hard. Some retreat into isolation. Others chase perfectionism in academics or work as a coping strategy. Still others cycle through failed relationships, seeking validation or emotional stability they can’t seem to find. “A misdiagnosed woman can spend years in therapy that doesn’t resonate," says Sethi. “She may feel like a failure for not getting better, not realizing she’s been solving the wrong puzzle all along." For some, the emotional distress escalates into self-harm, substance abuse, or suicidal ideation.
WHAT NEEDS TO CHANGE
Experts agree that tackling this issue requires a multi-level shift in diagnostic frameworks, clinical training, school systems, and public awareness. Clinicians need specific training to recognize the subtle and often masked signs of autism in women, says Sethi. “You can’t diagnose what you can’t see or what you weren’t trained to see." Nagpal stresses the importance of updating screening tools.
“We need tests and checklists that consider traits more common in women like social mimicry, sensory sensitivities, or internalized anxiety. Right now, too many tools are built for boys." At a broader level, awareness campaigns must confront the gender bias in autism. Teachers and parents need to know that autism doesn’t always look like what they’ve seen in boys. Finally, says Athwani, we need cultural permission for women to be different. “If we create spaces where women feel safe being themselves without judgment, they’ll come forward. And they’ll find help sooner."
Divya Naik is an independent writer based in Mumbai.
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