Unmasking the Invisible: ADHD, Autism, and OCD in Late-Diagnosed Women - By Sobia Mansoor (RP, CCC)

The Silent Epidemic of Late Diagnosis

For decades, ADHD and Autism were understood through a narrow, male-centered lens — the “hyperactive boy” or “withdrawn child” stereotype (Young et al., 2020). Girls and AFAB (assigned female at birth) individuals were left unseen, their neurodivergence mislabeled as anxiety, depression, or personality issues. Recent research reveals that thousands of women are being diagnosed for the first time in adulthood or midlife, leading to a powerful wave of re-identification and self-compassion (Attoe & Climie, 2023; Lockwood Estrin et al., 2021).

The Art and Cost of Masking

Masking — or camouflaging — is the invisible labor many neurodivergent women perform daily. It involves mimicking neurotypical behaviors: smiling at the right times, rehearsing conversations, suppressing stimming, or forcing small talk.
Hull et al. (2017) describe this as “putting on my best normal,” an adaptive but exhausting effort to appear socially acceptable. Women mask more frequently than men, driven by social expectations and the fear of rejection (Alaghband-Rad et al., 2023; Perry et al., 2022).

Although masking can help women “fit in,” the emotional cost is severe. High levels of camouflaging are correlated with anxiety, depression, and autistic burnout (Hull et al., 2021). After social interactions, many women feel drained, overstimulated, or plagued with self-criticism — a pattern that often hides the underlying neurodivergence.

ADHD and Autism: Shared Threads, Distinct Patterns

While ADHD and Autism are distinct diagnoses, their overlap — particularly in women — can blur clinical boundaries (Krakowski et al., 2020; Nickel et al., 2019).
Both conditions share traits such as emotional dysregulation, executive dysfunction, and difficulties with social reciprocity (Young et al., 2020).

• ADHD often appears as restlessness, mental clutter, impulsivity, and an inconsistent ability to complete tasks. In women, this is typically the “inattentive” type — marked by internalized distraction and overthinking rather than outward hyperactivity (Attoe & Climie, 2023).

• Autism tends to feature sensory sensitivities, a preference for routine, literal communication, and intense focus on special interests (Hull et al., 2017).

Both groups experience chronic fatigue and low self-esteem — not from their differences, but from constantly compensating for them.

The Hidden Overlap with OCD

A further diagnostic challenge emerges in the overlap between ADHD and obsessive-compulsive disorder (OCD). Both involve intrusive thoughts or repetitive behaviors, but their roots differ.
In OCD, compulsions arise from anxiety and the need for control or to neutralize obsessional fears; in ADHD, similar repetitive actions often stem from impulsivity or difficulty shifting attention (South & Bellgrove, 2016; Abramovitch et al., 2015).

Research shows that up to 30 % of individuals with ADHD also meet criteria for OCD, complicating treatment planning (Cabarkapa et al., 2019; Mersin Kilic et al., 2016). Understanding the emotional why behind behavior — control versus distraction — is essential for accurate diagnosis and intervention.

Why Women Are Missed: Gender Bias and Emotional Masking

Traditional diagnostic criteria were designed around boys. Girls, on the other hand, were often praised for being quiet, helpful, or empathetic — qualities that disguised internal chaos (Young et al., 2020). Many late-diagnosed women recall being told:

“You’re just too sensitive.”
“You overthink everything.”
“You’re so smart — why can’t you stay focused?”

These statements reveal how emotional sensitivity, hyperfocus, and perfectionism — core neurodivergent traits — were pathologized or dismissed (Lockwood Estrin et al., 2021). The result was decades of self-blame before finding the right name for their struggles.

Unmasking and Healing

A diagnosis in adulthood often brings both relief and grief — relief in finally understanding oneself, and grief for years spent misunderstood. As women unmask, they reconnect with sensory needs, re-evaluate relationships, and rebuild identity (Miller et al., 2021).

Therapeutic approaches such as Cognitive Behavioral Therapy (CBT), Emotion-Focused Therapy (EFT), and psychoeducation support emotion regulation and self-acceptance (Shankar et al., 2017). Community connection with other late-diagnosed women fosters belonging and reduces internalized stigma.