UCLA

Background: Research on empathy in autism has historically emphasized deficits in social cognition and relied on male-dominant samples (Lemos et al., 2026; Loomes et al., 2017; Song et al., 2019). Consequently, less is known about how autistic women experience empathy, particularly in relation to masking, gendered social expectations, and communication differences. Objective: This exploratory qualitative study examined how autistic women describe and make sense of their lived experiences of empathy, investigated contextual factors that shape how empathy is experienced and expressed, and explored what can be learned from autistic women to advance the understanding of empathy. Methods: A participatory co-design (PCD) approach was used to center autistic perspectives throughout the study (Gomez, Kyza, & Mancevice, 2018). Three autistic women collaborated with the researcher to co-design semi-structured interview questions (Cooper, Kumarendran, & Barona, 2024; Nicolaidis et al., 2011). Nine autistic women participated in the interviews, which were analyzed using reflexive thematic analysis with iterative inductive and deductive coding. Results: Empathy was conceptualized as multidimensional, involving emotional identification, affective experience, perspective taking, and prosocial behavior. Participants described intense emotional experiences, difficulty identifying specific emotions, and a disconnect between internal emotional experiences and outward expression. Participants also described masking and camouflaging as effortful processes that were influenced by gendered expectations. Experiences of being misunderstood contributed to feelings of isolation and reluctance to communicate emotional needs, whereas supportive environments facilitated understanding. Participants described reciprocal communication difficulties with both autistic and non-autistic individuals, gendered expectations and masking or camouflaging, which shaped experiences of empathy and emotional expression. Conclusions: The findings challenge previous conceptualizations of empathy in autistic women and emphasize the importance of distinguishing between expressing, and having empathy recognized by others. Centering autistic women's lived experiences provides a more nuanced understanding of empathy as heterogeneous, contextually shaped, and relational. Future research should continue incorporating autistic perspectives and examine how gender, masking, and communication influence the expression and recognition of empathy. *Language Statement: The language ‘autistic’ is used when referring to individuals on the autism spectrum to respect and utilize the language preferred by the majority of autistic individuals (Taboas et al., 2023).