This study revealed that alexithymia and social camouflaging played a serial mediating effect in the association between autistic traits and anxiety symptoms among Chinese college students. Moreover, it was found that only alexithymia demonstrated mediating effects in the relationship between autistic traits and depression symptoms, whereas this was not the case for social camouflaging. Upon further consideration of sex differences, it was noted that there was a comparable mediating effect of alexithymia and social camouflaging in females. Nevertheless, social camouflaging did not exhibit any mediating effects on the correlations of either anxiety or depression in the male group.
Increasing researches are stressing that subthreshold autistic traits are distributed in a continuum from the clinical to the general population. These traits are associated with high-risk mental health problems [10, 40]. Our findings revealed the association of autistic traits with symptoms of anxiety and depression symptoms among Chinese college students, consistent with the previous researches [41, 42]. Besides, the current study contributes to the expanding body of evidence suggesting that autistic traits could potentially lead to increased symptoms of anxiety with mediation by alexithymia and social camouflaging. Several potential mechanisms could account for the development of this relationship. Firstly, strong associations between alexithymia and social camouflaging were found in this study, indicating that alexithymia is one of important cognitive predictors of social camouflaging. The level of alexithymia and social camouflaging have been found to positively associated with autistic traits [15, 21] and demonstrate shared antecedents and consequences. Individuals with elevated levels of alexithymia may encounter more challenges in understanding and effectively responding to their own or others' emotions [43]. Hence, individuals might need to utilize social camouflaging strategies to adjust or regularize their behavioral inclinations in order to navigate social contests appropriately. Furthermore, Morie, Jackson [44] have illustrated that alexithymia and emotion regulation, identified as significant cognitive predictors of social camouflaging [18], sequentially mediated the association between autistic traits and anxiety. Therefore, alexithymia could potentially influence social camouflaging, serving as serial mediators in the relationship between autistic traits and anxiety. Limited information existed regarding the neural mechanisms underlying the interaction among alexithymia, social camouflaging, autistic traits, and mental health. However, existing literature has begun to elucidate potential connections among these factors, offering preliminary insights into their relationship. For instance, neuroimaging studies have demonstrated that functional connectivity patterns of the social brain regions, such as ventromedial prefrontal cortex, amygdala, and orbital frontal cortex, among individuals with ASD were distinct from those of the typical population [45, 46]. In addition, aberrant activation of the ventromedial prefrontal cortex has been demonstrated to be associated with alexithymia and social camouflaging [30, 47, 48]. The prefrontal cortex and amygdala are recognized for their significant involvement in cognitive processes, especially concerning emotional regulation[49]. Further investigation is necessary to clarify the neural mechanisms that underlie the inheritance relationship.
While social camouflaging may be closely associated with mental health problems [17], the current study indicated that alexithymia played a more significant role in mediating the association between autistic traits and depression compared to social camouflaging. Research on the effects of social camouflaging on symptoms of depression has yielded varied outcomes. While certain studies have indicated an association between social camouflaging and increased levels of depression [25], contrasting findings have shown no conclusive evidence supporting the direct prediction of depression symptoms by social camouflaging [27]. Moreover, the practice of social camouflaging been found to notably decrease the likelihood of experiencing depression within the broader population. This phenomenon occurs because individuals without neurodevelopmental conditions may also utilize social camouflaging techniques to mask symptoms of depression as a means of adhering to societal norms and expectations [50]. Our findings provided a potential rationale for the differentiation between the adverse effects of social camouflaging on depression, suggesting that these effects may originate from the predictor, alexithymia, associated with it, rather than from social camouflaging itself. Compelling research has consistently demonstrated that individuals with depression exhibit significantly higher rates of alexithymia in comparison to those with other psychiatric disorders [51, 52], especially concerning challenges in recognizing and articulating emotions [53].
This study employed subgroup analyses to investigate potential sex disparities in the serial mediating models. While the results in the female group mirrored those of the overall sample, the effect of autistic traits on social camouflaging in the male group, which was previously observed, became statistically non-significant. Previous research has indicated that females diagnosed with ASD exhibit higher levels of camouflaging behavior compared to males with ASD [54]. Interestingly, previous studies have suggested that there is no significant sex difference in individuals with autism or those exhibiting high autistic traits [28, 55, 56]. Our study results emphasize the existence of sex-specific pathways within the general population, indicating potential variations in the mechanisms that underlie social camouflaging between males and females. While the serial mediation model remained valid, it was found that autistic traits did not have a direct influence on social camouflaging in male groups. Despite this, alexithymia completely mediated the association between autistic traits and social camouflaging in this particular group. This implies that among males, alexithymia might play a more significant role in motivating social camouflaging than autistic traits per se. In contrast, females seemed to demonstrate greater proficiency and capability in social camouflaging [29]. This phenomenon could be partially ascribed to the societal expectations of agreeableness imposed on individuals [57]. Consequently, women may exhibit a higher motivation to conceal the difficulties linked to autistic characteristics, even when emotional challenges are not prominently present as a result of alexithymia.
Autistic traits in the general population exert subtle influences on individuals' lives and have a significant impact on their overall well-being and life expectancy. Our study emphasizes a significant deficiency in our existing knowledge, indicating that even subclinical autistic traits can impact mental well-being through the mechanisms of alexithymia and social camouflaging. This highlights the pressing necessity for heightened social consciousness and the prioritization of mental health services for individuals exhibiting high autistic traits. By investing in suitable care and interventions, there is a substantial potential to enhance the quality of life for this marginalized population.
Limitations
This study is subject to several limitations. The cross-sectional design of the study captures data at a specific point in time, suggesting that it establishes associations rather than causal relationships between the primary variables. The strength of the study is primarily attributed to its utilization of a sizable and inclusive sample, thereby augmenting the generalizability of the results. We performed a subgroup analysis to validate our results. Secondly, the sample was recruited on a voluntary basis, potentially leading to selection biases influenced by the participants' subjective interest in the research and/or other factors. Consequently, the population may not accurately represent university students. Furthermore, while the incorporation of alexithymia as a mediating factor offers valuable insights into the connection between autistic traits and social camouflaging, which in turn affects mental health, additional research into the fundamental neural mechanisms is necessary to enhance comprehension of these associations. Employing neuroimaging techniques such as functional magnetic resonance imaging (fMRI) or electroencephalography (EEG) could elucidate brain activity patterns during social camouflaging in both autistic and non-autistic individuals, offering a more comprehensive understanding.