In brief
Many people on the autism spectrum wish for friendships and relationships, and difficulties with them are not automatically explained by a lack of interest. [1] A systematic review (8 qualitative studies) found: many use camouflaging to make friends; for most this is exhausting, often not very effective and calls social authenticity into question. [1] On partnerships the review found little evidence. [1] A further review (34 articles) on loneliness named anxiety and depression as well as lack of understanding as possible factors that increase it, and relationships and self-acceptance as possible factors that reduce it. [2] The 2021 guideline has expired. [4]
This English translation was produced with AI assistance and has not yet been independently reviewed.
The wish for closeness and what can stand in the way
The authors of the review on friendship and partnership state that difficulties in social relationships are common in people on the spectrum and are often explained by differences in social interaction and communication, which some interpret as low social motivation. They argue that this theory does not explain camouflaging and call for rethinking the social motivation theory. [1] This is the authors’ classification and not a general consensus. For the basics: Social communication and interaction in autism.
Camouflaging and authenticity
According to the review, camouflaging is often used to win friendships with people without autism; the pressure to do so often begins early. Many remained dissatisfied with the relationships won this way, some withdrew or sought friendship in the community or in situations in which camouflaging seemed less necessary; many nevertheless remained lonely. [1] The review included only eight qualitative studies; on partnerships there was “little evidence”. [1] More: Masking: when adapting is exhausting.
Loneliness
The review on loneliness (studies up to April 2021) found little research that asked people on the spectrum directly about their experience, and hardly any questionnaires developed for people on the spectrum. It named anxiety, depression and lack of understanding as possible factors that increase loneliness, and relationships and self-acceptance as possible factors that reduce it. [2] “Loneliness” in the sense of “not belonging” (collective loneliness) was important but less often studied. [2]
Support services
For adults without intellectual disability, the 2021 guideline recommended a time-limited, manualised group therapy to promote social interaction (grade of evidence A; contents including making contact, building and maintaining friendships, dealing with wishes for intimate relationships and sexuality as well as with stress and loneliness). The body of studies consisted of three small studies. [3, Rec. 17] For adults living in social isolation, it also named a structured leisure programme as a consensus-based idea of the source guidelines. [3, Ch. C.4.2.1] More: Autism-specific therapy and support.
What do we know – what is still open?
Finding (reviews, only abstracts read): Camouflaging is common and often unsatisfying; loneliness is linked with anxiety, depression and lack of understanding and can be reduced by relationships and self-acceptance. [1; 2]
Evidence-based recommendation (expired): Time-limited group therapy on social interaction for adults (grade A, evidence level 2, small studies). [3, Rec. 17]
Open:
- On partnership and sexuality there is hardly any evidence in the sources read.
- Whether group services permanently improve relationships in everyday life is unclear; the guideline reported stable improvements in social skills over three months for group trainings; it gave no information on longer periods in the part read. [3, Ch. C.4.2.2]
- Experiences of people with high support needs are not described in the abstracts read.
What else you should know
- There is no “right” model of relationship. The sources describe no norm.
- Exchange with others on the spectrum can bring relief; self-help and contact points: Contact points.
- In acute emotional distress you can reach the TelefonSeelsorge free of charge on 0800 1110111. [5]
- Not covered: dating, sexuality, wish for children and separation.
Note: This article offers general information. It does not replace counselling or psychotherapy.
Sources and literature
- Ridgway K, Cooke K, Demmer DH, Hooley M, Westrupp E, Stokes MA. Camouflaging Autism in Pursuit of Friendship and Intimate Relationships: A Systematic Review. Autism in Adulthood 2025;7(5):543–557. https://doi.org/10.1089/aut.2023.0160 – Systematic review
- Umagami K (in PubMed als Grace K geführt), Remington A, Lloyd-Evans B, Davies J, Crane L. Loneliness in autistic adults: A systematic review. Autism 2022;26(8):2117–2135. https://doi.org/10.1177/13623613221077721 – Systematic review
- DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Empf. 17; Kap. C.4.2). – Guideline (in German); expired on 23 March 2026 (see no. 4)
- DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
- TelefonSeelsorge Deutschland: Startseite mit Rufnummern. https://www.telefonseelsorge.de/ – Counselling service (website in German)
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