The Different Presentation of Asperger Syndrome in Females

As we know Asperger syndrome (AS) is said to be more common and more obvious to men that to women. That’s because of the typical symptoms usually associated with males like narrow interests like computers, trucks and numbers and lack of communication and social skills. Likewise females can be affected too but oftentimes are undiagnosed or misdiagnosed and can “slip through cracks” of diagnosis and intervention for Asperger syndrome.

How is that? Asperger syndrome has defined characteristics so how females with AS are undetected?

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Image courtesy of 123rf.com

A possible reason for missing Asperger diagnosis in females is the “masculinizing diagnosis” of AS[1]. This is because historically AS is predominantly studied in boys and no girls were studied until 1980s when psychiatrist Lorna Wing introduced the term “Asperger’s syndrome” upon realizing her daughter Susie was found to be autistic.[2]

By masculinizing AS it means that the symptoms of AS are always attributed to male interests and not female. For example, while neurotypical boys’ interests are almost exclusively sports, AS males are usually fond of math and related concepts, computers and trains, whereas both neurotypical and AS females have virtually the same interests (fashion, celebrities, soap operas, animals, cleaning). This makes diagnosis of AS in girls very hard.

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(C) Hasbro. I bet both neurotypical and AS girls love My Little Pony (I myself included) which makes AS diagnosis in girls very difficult.

Another reason why AS in females has a different presentation is the “concealment” of symptoms of AS in girls.[1] Women generally are more apt to conceal their AS behavior as early as childhood by mimicking neurotypical girls’ social behavior, adopting a passive girl role, or putting a “mask” to make her appear “neurotypical.”

Unlike AS boys who are more likely to be disruptive and destructive when change is introduced (rigidity is a telltale sign of AS) AS girls are more likely to  be passive (aka passive girl role) to avoid being labeled by peers, parents and teachers as “disruptive.” This way girls with AS are less likely to be diagnosed and receive intervention which could have ill effects when they enter adolescence and adulthood.

What are the ill effects of masking AS symptoms in girls?

As girls become women efforts of concealing can become very tiresome and added with puberty (which is another change AS girls cannot cope with) develop psychological problems which can affect their daily lives.

Below are some as listed by the “Asperger’s Syndrome for Dummies“[1]: book by Georgina Gomez de la Cuesta and James Mason

Anorexia nervosa (AN) – or in layman’s term just anorexia (means weight loss), is an eating disorder, a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.[3] It is said to be more common in women and is more common in women in the autism spectrum disorder (ASD) range where Asperger syndrome is included. It is also found that there is a strong genetic link between AN and ASD including AS where both anorexic and autistic patients have a tendency to behave obsessively and suffer from rigid ways of thinking.[4]

anorexia

Emaciation is a sign of anorexia nervosa – too skinny that your bones are already obvious.

Why anorexia is prevalent in AS females?

While AS males are more preoccupied with male things, AS females are very much preoccupied with girly things – unfortunately – female thinness included, which may lead girls into believing that thinness is beautiful wholeheartedly that they come to a point of averting to food and self starving.

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Image courtesy of Pinterest. AS girls are obsessed with their appearance which may cause them developing anorexia nervosa

 

“Both autism-spectrum conditions and anorexia share a narrow focus of attention, a resistance to change and excellent attention to detail,” says Simon Baron-Cohen, director of the Autism Research Centre at Cambridge University.[4]

It’s easy to see how an outsized sense of perfectionism in a female might lead to an unhealthy obsession with thinness — given society’s preoccupation with physical appearance — while a male might end up obsessing about cars or trains, which is typical in autistic boys. “The reason [Asperger’s] is usually diagnosed less often in females may be because it takes a different form — anorexia may be just one of the forms,” says Baron-Cohen, adding that there are likely multiple routes leading to anorexia and that autistic features may not factor in all of them.[4]

AN has increased rigidity and obsession characteristics similar to autism. This makes AS females more prone to have anorexia nervosa than females without AS.

Isolation – Because AS females are socially naive and cannot fathom social language, they cannot form permanent bonds with other women (and sadly men too) and many women on the spectrum end up lonely and isolated.[1] While autistic men are completely unsuccessful in social relationships since childhood, women may form some social bonds at school but they’ll be no more different than men when they reach adulthood. Peers marry and become parents while women on the spectrum are left behind.[1]

Post-traumatic stress disorder – is a condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock, typically involving disturbance of sleep and constant vivid recall of the experience, with dulled responses to others and to the outside world.[5]

AS females’ naivety puts them at risk to be picked up by “predatory” boys and men (I mean abusive, dysfunctional men) thus making them suffer bad and sometimes terrible experiences (domestic violence, spousal abuse), resulting in post-traumatic stress disorder.[1]

Borderline personality disorder (BPD) – This is a personality disorder marked by unstable moods, behavior, and relationships.[6]

People on the spectrum find others unpredictable (remember AS people are resistant to change) because they have a weakness in their ability to consider other people’s thoughts (theory of mind).[1] This weakness makes them prone to develop maladptive personality disorders like BPD.

Agoraphobia – or extreme or irrational fear of crowded spaces or enclosed public places[5]. It also means fear of what may happen in those spaces – the outside world.[1] This causes women with AS rather stay at home (homebody) than go outside which makes them more socially isolated. This is called agoraphobia.

Obsessive-compulsive disorder (OCD) – a classic complication of ASD. Both sexes with AS may have OCD but different presentation per gender. If men learn train timetables, women obsess over cleaning.[1] AS females are more prone to have OCD than men.[1]

These are some of the common difficulties associated with Asperger syndrome in females.

The Three Types of Asperger Females

What?

You read it right. Asperger syndrome in women has three different presentations[1]:

The Female Mathematician – She’s very much into her subject and doesn’t pay much attention to “girly” subjects.[1] She doesn’t see much point in small talk, but gets really into discussion of Gödel’s theorem[1] (what’s that? its actually a math theory that you cannot prove everything).

You can say this is the obvious one. Not girly. Not reacting when given a photograph of Channing Tatum or Zac Efron (or other hot celebrity). And yes, she’s masculine. No sissy stuff please.

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(C) Riyoko Ikeda. Do you think this is a woman?

Not necessarily true. She can be more fashionable and more feminine than you – she learnt the importance of how you dress and other social niceties at school.[1] Only those with more severe form of AS going to ASD do struggle with social niceties (clear signs are not washing, unkempt hair, odd eye contact) and needs to study social niceties academically.

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(C) Riyoko Ikeda. Yes, she’s a woman. A character like Lady Oscar can be identified to AS females.

She may act masculine, love everything boyish ie Clash of Clans, mechanics stuff, military stories (though can be strong or clumsy) but still she can be still a girl in heart. Still this type of AS female has high rates of bisexuality, homosexuality and asexuality (no sexual preference).

The Asperger’s Fashionista

She’s got all the clothes: her makeup is perfect. She demurely ignores all approaches by the many men who notice her, and scares quite a few of them off just by her presence. An appearance of aloofness may be the result of panic about what to do or say.[1] She’s a goddess but her AS symptoms are still obvious, making her look like the ice queen, scaring people off. She may have a grasp of small talk thanks to imitation to neurotypical girls. She holds a doctorate degree in studying women but the problem is the AS fashionista is more prone to talk about her looks or hair that makes her look like a bitch to other girls and poof… bullying and isolation follows.

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(C) People. I think many AS fashionistas idolize Kim Kardashian and imitate her (this may include her traits also which could intimidate boys and irritate girls).

There’s a comment about the AS fashionista which explains that though this AS girl makes a “mask” of herself, she cannot totally hide her AS symptoms[7]:

Very often though the Aspergers Fashion Goddess goes much further than my feeble attempts and is often stunningly attractive and groomed within an inch of her life. She has a ‘to die for figure,’ which she works tirelessly to preserve. Her wardrobe is crammed with all the right labels and often her credit card is under a constant considerable strain also. The Aspergers Fashion Goddess also has perfect nails, luscious locks and she has an instinctive ability to spot a fake fashion item from a great distance.

Unfortunately though for the Aspergers Fashion Goddess her appearance is actually just her mask i.e. her defense mechanism that she uses to defend herself from the confusing, frightening neurotypical world or just her way of attempting to fit in.

It has largely been through observation and research that the Aspergers Fashion Goddess has garnered her in-depth knowledge of the fashion world. So her current image only actually came about as the result of relentless observations of women she admired until she pieced all her studies together and used this knowledge to create a ‘neurotypical,’ version of herself. Autistic girls do this to try to mask their autistic confusion, difference and the inadequacy that their autistic brain feels because they have no idea why they see the world differently because they are usually unaware of their Aspergers Syndrome. So the Fashion Goddess image is actually just one defense mechanism adopted by autistic girls to cope with their inner confusion and psychological turmoil.

Of course it usually doesn’t work so well because other women are unnerved by this Fashion Goddess’s constant state of perfectness along with her ensuing stony silences and her more than occasional aloof attitude. Other females also often perceive the Aspergers female as being self-centered or maybe just totally detached or uninterested. As an Aspie female I know though that this is not intentional on the part of most Aspie females.

The truth of the matter actually is that many women with Aspergers Syndrome (especially when they have never received a diagnosis) are usually just insecure and lacking in the necessary ability to know how to handle intense social interactions that certainly do not come easily to them. So rather than making themselves more anxious by doing or saying the wrong thing often the Aspergers girl just prefers to remain silent so she can observe and learn how to be social.

Men on the other hand are often attracted to this beautiful woman but the vibes that she gives off usually turns them off or maybe her icy stare just scares them to death. Also the Aspergers Fashion Goddess is often very confused as to how to handle any male advance and often misses the usual subtle flirting cues that neurotypical ladies will instinctively just get and know how to handle.

So the Aspergers female will often find it difficult and very hard work to try and form a relationship with a significant other. This is also hard to handle when you are already constantly making such a huge effort to appear normal and in spite of this you are still being singled out as different.

This is usually the biggest dilemma for every female with undiagnosed Aspergers Syndrome. Deep down she innately knows that she is different to other people. So she feels she has to work extra hard at socializing and despite all the effort she puts in to her Fashion Goddess image underneath her confusion and lack of confidence at her absence of social and communication skills means she is often in constant psychological turmoil. So even though these Aspegers females may appear super confident on the outside underneath she is actually experiencing total turmoil and panic. So please just give the next Fashion Goddess Aspie you meet the benefit of the doubt and just try to get to know her before writing her off.

The Asperger’s Cook

This woman is most people’s idea of a domestic goddess. Her kitchen is clean and organised; she has dozens of cookbooks on the shelves.[1]

She is often most likely caught watching cooking shows like Masterchef and she obsesses over spotless clean house. She cannot tolerate seeing excess dust or flying dander all over. She may even study germs that linger the household and then say “yuck” on such stuff.

Nevertheless, she has (nearly) mastered all the delicious recipes from Masterchef and really loves to cook even for guests. (By that way she can avoid small talk with other people that she dreads about).  The Domestic Queen with Aspergers Syndrome is massively house-proud and undoubtedly her home could easily adorn the pages of any ideal homes magazine. If you are ever asked for dinner it is both an anxiety ridden experience (I might break something or dirty the tablecloth) but also a culinary delight as you will be fed with many delectable dishes.[7]

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(C) Disney. You can compare the AS cook to Tiana of Princess and the Frog

That’s the three types of females with Asperger’s.

The AS female is hard to detect because of her personality profile. She looks like anybody else with these types and because the AS female are very good at masking their AS symptoms of social immaturity, difficulty regulating emotions and sensory problems.

How to Spot an AS Female?

Asperger’s Syndrome for Dummies list some of the common features of AS in women[1]:

Bookworm

Though common in gifted women, AS women are naturally born bookworms. Be it classical literature, foreign language books or even textbooks are a source of entertainment for AS women. The internet can be a toy too for AS women. Reading can be more pleasurable than being with others.[1]

Tomboy

Like from the AS mathematician type the AS female has no interest in talking about typical female things (that’s despite being some AS females are masters in fashion and makeup and showbiz). They see these things as trashy. As some AS females aren’t that interested in being girly they are seen across as masculine in interests, behaviour, and appearance.[1]

Poor Multitasking

Women in the spectrum are not as good as neurotypical women in multitasking or doing a lot of things at the same time. So do not expect to tell them to cook while taking care of babies or disaster will follow.

Strong Systematizing

Systematizing is a male brain trait: make lists, break things down into components and understand the function of each component (including ideas) and to arrange and catalogue things.[1] But this is a great trait for the female Aspie. Talk to her and she’ll give you every information you need, including when the bra was invented (when the bra was first really invented?).

Emotional Outbursts

This is the Aspie female’s Achilles heel. While women are known to be emotional (men on the spectrum are more likely to be spotted because we’ll tell them they’re sissies) the AS woman has an overacting emotional response. This is not because they cannot control emotions or is childish but rather AS females cannot read emotions even of herself adding up poor negotiation skills and not showing outward signs of stress and chaos follows. This is somewhat embarrassing to both the AS female and other people.

Puritanical View of Sexuality (or the opposite)

This is not included in the Asperger Syndrome for Dummies book but this is included in Rudy Simone‘s book 22 Things a Woman with Asperger’s Syndrome Wants Her Partner to Know where it is evident in adolescent Aspie girls that they value their sexual purity and will give it on their wedding night to their husbands.[8] Parents, teachers and clergymen do no be overjoyed yet. While she is considered an ideal woman to all (and in fact some men are do attracted to the Aspie female’s childlike innocence and naivety[8]) she is prone to be taken advantage off by sexual predators hence will be more likely to be victims of rape and abusive relationships.

Why is that so? While the AS teen girl is rewarded by the elders for her goody two shoes behaviors she can devalue her moral conviction and instead “join the crowd” to be in whilst being clueless in the social world which can have a risk for her.

…adolescent girls with Asperger’s syndrome can develop low self-esteem due to being bullied and teased by peers, and rather than enforce social and moral conventions, decide to actively contravene them, becoming vulnerable at a relatively early age to relationship and sexual predators. They may not have the intuitive ability to identify disreputable characters, but tend to set the relationship expectations very low, and often experience multiple abusive relationships.[8]

That is the sad truth for AS females. I can say that most victims of domestic violence are AS females. I can say that because AS females are actually very kind, loyal companions but because of their social immaturity and brain difference they are rejected by peers, which causes them to be insecure and instead seek unhealthy attention like becoming provocative which attracts the wrong kinds of men.

There are some AS females who are sexually promiscuous (and some are porn stars or prostitutes) who enjoy sex without emotional attachment but in general AS women are renowned for being loyal and trustworthy and for having a strong moral code.[8] This is why AS girls must be protected more and as much as possible be taught of socialization in an academic manner (and also sex education) to avoid becoming a victim of relationship/sexual abuse.

Conclusion

Asperger syndrome has a different presentation to females. While males are easily more detected and managed females are much diagnosed and managed later, which, the sad part is that they have had suffered much more psychological issues before they were given a diagnosis and management. I hope more and more awareness will be spread around the world about Asperger syndrome in females, as they too, are part of neurodiversity that makes the world more colorful.

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How wonderful the rainbow is! This is when AS females become when all of us become aware and accepting of them – their strengths, weaknesses as well as their character.

References:

  1. Gomez de la Cuesta G. and Mason J. (2010) Asperger’s Syndrome for Dummies. Wiley and Sons. ISBN: 9780470660874
  2. https://en.wikipedia.org/wiki/Lorna_Wing
  3. https://www.nationaleatingdisorders.org/anorexia-nervosa
  4. http://content.time.com/time/health/article/0,8599,1904999,00.html
  5. Google Dictionary
  6. http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
  7. http://hubpages.com/health/TheAspergersFemaleUncovered
  8. Simone R. (2012)  22 Things a Woman with Asperger’s Syndrome Wants Her Partner to Know. Jessica Kingsley Publishers. ISBN:
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