“Dear HER-Health” with Heather Florio: Autism Awareness

Dear HER-Health,

I’m a 38-year-old woman who has always felt like I was “too much” or “not enough” — too sensitive, too intense, too in my head. I’ve struggled with friendships, felt completely drained after social events, and have had to develop very rigid routines just to function. Recently, I came across information about autism in women, and for the first time in my life, things started to click. But when I brought it up with my doctor, she said I “seemed too social” to be autistic and changed the subject. I feel dismissed. Could I really be autistic? And why is this so hard to get answers about?

First, I want you to know: you are not imagining this. What you are describing — the exhaustion, the rules you’ve built just to survive the day, the feeling of being perpetually out of step — resonates deeply with me. I received my own autism diagnosis at 41. As a CEO and a woman, I know firsthand how profoundly that discovery reshapes how you understand yourself, your relationships, and the way you’ve been moving through the world all these years. You are not broken. You have simply been operating without the right map.

Now, to your doctor’s comment — “you seem too social to be autistic” — this is one of the most common and most damaging misconceptions that causes women like you to go undiagnosed for decades. The image most people carry of autism was built almost entirely on research conducted on young boys. Women present differently, and the medical community is only beginning to catch up.

Why autism looks different in women

Autistic women are extraordinarily skilled at what researchers call masking — the unconscious (and exhausting) process of studying social behavior, mirroring others, and performing neurotypicality in order to fit in. You may have spent your whole life watching people closely, carefully crafting responses, and rehearsing conversations in your head. From the outside, this looks like social competence. On the inside, it feels like running a marathon every single day just to appear normal.

Women on the spectrum are more likely to be diagnosed instead with anxiety, depression, ADHD, or borderline personality disorder — conditions that share surface symptoms with autism but don’t address what is actually happening neurologically. By the time many women receive a correct diagnosis, they have often accumulated years of treatments that helped only partially because the root was never identified.

Some of the signs that are more common in autistic women — and more commonly overlooked — include:

•            Intense, deep-focus interests that may appear “normal” (literature, psychology, animals, art) rather than stereotypically unusual interests

•            Profound social exhaustion and the need for significant recovery time after interactions

•            Hypersensitivity to sound, light, texture, or emotional environments

•            Rigid routines or rituals that feel essential, not just preferable

•            Difficulty identifying or expressing emotions (a trait known as alexithymia)

•            Feeling like an outsider even in rooms you’ve been welcome in for years

What a late diagnosis actually changes

When I was diagnosed at 41, I didn’t just receive a label — I received a completely new framework for my entire life. The professional relationships I had found draining, the workplace dynamics that had felt inexplicably difficult, the personal interactions where I always seemed to be speaking a slightly different language — suddenly, so much made sense. A late diagnosis doesn’t diminish who you are or what you’ve accomplished. In many ways, the strategies you’ve quietly developed to navigate a world not designed for your brain are a testament to your resilience.

What diagnosis can offer is permission — to stop performing, to set boundaries without guilt, to build your life around how your mind actually works rather than how you’ve been told it should.

What to do next

Do not let one dismissive appointment be the end of this conversation. You deserve to be heard. Seek out a psychologist or psychiatrist who has specific experience evaluating adult women for autism — this distinction matters enormously. Organizations like the Autism Speaks and the Autistic Women & Nonbinary Network can help you find providers and communities where your experience will be recognized, not minimized.

Keep a journal of the experiences that prompted your question. Document the sensory sensitivities, the masking, the exhaustion, the routines. Bring that record with you. Your lived experience is data, and it is valid.

You asked if you could really be autistic. I can’t answer that — only a qualified clinician can. What I can tell you is that your question deserves a real answer, and you deserve a provider who will help you find it. The pieces you have been quietly putting together your whole life are worth understanding. Don’t stop looking.