The Exhaustion Beneath People-Pleasing
I keep seeing empathy blamed for exhaustion, especially among women who describe themselves as highly sensitive, deeply caring, or empathic.
They are told that they absorb too much, feel too much, and care too much, as though the obvious solution would be to become less receptive to other people. They are told that they need to avoid “energy vampire” people.
Sometimes emotional contagion is part of what they are experiencing. There are people who feel another person’s distress so intensely that it becomes difficult to separate what belongs to whom. That is real. That’s also likely, codependence.
Still, I think we have placed the word empathy over a much more complicated collection of behaviors, including monitoring, anticipating, accommodating, suppressing, and performing.
A woman may believe she is exhausted because she cares so deeply about everyone around her. When we look more closely, we may find that she is also reading facial expressions, adjusting her tone, preventing disappointment, hiding discomfort, agreeing before she has processed the request, and trying to make sure no one has a negative experience of her.
That is a tremendous amount of work.
For many autistic women, people-pleasing becomes part of masking.
It may also be a form of protection, developed after years of being misunderstood, corrected, rejected, or treated as difficult. It helped her navigate the world. It may even have helped her remain connected to people she depended upon.
A protective strategy can still become exhausting.
Empathy has become the convenient explanation
Empathy is a broad word, and this is where I think people get confused. It can refer to understanding another person’s perspective, feeling concern for them, experiencing compassion, or emotionally mirroring their distress. Those experiences are related, although they are not psychologically identical.
A recent meta-analysis examining more than 20,000 people found that empathic concern and perspective-taking were generally associated with fewer symptoms of burnout. Emotional resonance, particularly absorbing another person’s distress, showed a different pattern and could increase vulnerability to burnout.
A systematic review focused on clinical nurses also found that the relationship between empathy and burnout was far more complicated than the popular idea that caring too much wears people out. Workplace conditions, emotional regulation, professional support, workload, secondary traumatic stress, and other mediating factors mattered.
This research does not prove that empathy protects every person in every circumstance. Much of the research comes from healthcare settings, and many of the studies are correlational. It does, however, give us a good reason to stop treating empathy as though it were a single psychological substance that accumulates until someone collapses.
It also raises another question: What else is happening while a person is being empathic?
The woman who notices everything
One woman I worked with could sense the smallest change in another person’s mood almost immediately. She had always understood this as evidence that she was deeply empathic, and she was. She also had trauma, and was taught early on in life that she had to monitor her father’s moods. many times, this “gift” is also a trauma response; scanning.
As we talked, something else became visible.
She was also internally monitoring constantly.
A slight change in someone’s expression, posture, or tone triggered an internal search. Did I say something wrong? Should I explain myself? Do I need to become quieter, warmer, funnier, or more helpful? Is this person disappointed in me? How can I make this interaction feel comfortable again?
Her sensitivity to other people was genuine. Much of her exhaustion came from what she believed she had to do with the information.
She could not merely notice another person’s discomfort. She felt responsible for resolving it.
That responsibility is often hidden inside people-pleasing. From the outside, the woman appears caring, thoughtful, flexible, and remarkably easy to be around. Internally, she may be running a continuous threat assessment.
People-pleasing can function as masking
People-pleasing is often discussed as though it were a bad habit, a problem with boundaries, or a slightly irritating tendency to seek approval. Sometimes it is approached as a self-esteem issue: learn to say no, stop worrying about what people think, and prioritize yourself.
Those suggestions are not necessarily wrong. They are incomplete.
For an autistic woman, people-pleasing may be woven into a much larger masking system.
Masking can include suppressing natural movements, controlling facial expressions, preparing dialogue, imitating other people’s communication, forcing eye contact, hiding sensory distress, and consciously constructing the response that seems socially expected.
People-pleasing can become the relational part of that mask.
Years ago, during a group discussion, several women began talking about how quickly they agreed to things. These were competent, intelligent women who could advocate very effectively for other people. Yet when a request was directed toward them, they often said yes before they had determined whether they wanted to do it.
The agreement came first. Their own response arrived later, sometimes as resentment, anxiety, physical tension, or complete depletion.
They had learned to keep the interaction moving smoothly. Pausing might disappoint someone. Asking for time might appear difficult. Saying no could produce a facial expression, a tone, or a moment of tension they would then spend hours analyzing.
People-pleasing gave them a way to avoid that uncertainty.
Protection does not always feel like fear
When we call people-pleasing a protective behavior, people sometimes imagine an obviously frightened person trying to appease someone dangerous. Protection is often quieter than that.
It can look like being pleasant.
It can look like becoming indispensable so that no one has a reason to reject you. It can mean remembering what everyone needs, noticing what has not been said, volunteering before anyone asks, laughing at the correct moment, or becoming the person who causes the least inconvenience.
A pattern I have heard from women across years of individual and group work is some version of, “I’m just the person everyone comes to.” They often say this with pride, and understandably so. They are trustworthy. They are perceptive. They know how to care for people.
As the conversation continues, though, some realize that being the dependable one has become compulsory. Being easy has become a requirement. They have very little experience of remaining connected to another person while also being inconvenient, uncertain, unavailable, sensory-overloaded, or simply uninterested.
This is where generosity can gradually become self-erasure. The woman still cares, although her caring is now accompanied by surveillance, performance, and responsibility for everyone else’s emotional state.
The labor beneath an ordinary day
One autistic woman described coming home from work and sitting in her car because she could not immediately make herself go inside. Nothing particularly dramatic had happened that day. She had attended meetings, responded appropriately, remained pleasant, and completed her work.
From the outside, the day had gone well.What remained invisible was the management underneath it.
She had monitored her face, controlled her movements, tolerated sensory discomfort, searched for the expected response, and worked to ensure that no one interpreted her incorrectly.
Research on autistic masking reflects many of these experiences. Autistic adults have described masking as mentally and physically exhausting, with consequences that include disconnection from identity, anxiety, depression, reduced self-esteem, and burnout. Researchers are still examining direction and causation, so we should be careful with claims that masking alone produces every negative outcome. The associations are nevertheless concerning, and the consistency of autistic accounts should not be dismissed.
In one study of autistic and nonautistic adults, participants across groups described exhaustion associated with masking. Autistic and other neurodivergent participants also described pressures connected to stigma, sensory suppression, and the perceived need to conceal difference.
Masking is not exclusive to autism.
The context and cost can be different for autistic people, particularly when the performance extends across communication, sensory experience, movement, identity, and daily functioning.
When the explanation finally changes
Another study followed 11 recently diagnosed autistic adults as they used a neurodiversity-affirming “Welcome Pack.” It was a small qualitative study, so it cannot tell us how every late-diagnosed autistic adult will respond. What it captured was still important.
Participants described relief, grief over years of masking, a stronger sense of belonging, and the need for support that extended beyond receiving information. They wanted connection, practical guidance, and help making sense of their identities.
That grief makes sense to me.
Learning that you are autistic can reorganize the story you have been telling yourself. What you called oversensitivity may have included sensory overload. What you called social anxiety may have included years of trying to calculate communication in real time. What you called empathy may have included hypervigilance. What you called kindness may sometimes have been appeasement.
None of this makes the empathy false. It means more than one process was happening at the same time.
Caring without disappearing
The goal cannot be to strip people-pleasing away without understanding what it protected. A woman who learned to survive through careful accommodation may experience abrupt demands for boundaries as another situation in which she is expected to perform correctly.
She may also have legitimate reasons to mask in certain environments. Workplaces, families, healthcare settings, and social groups are not uniformly safe for autistic authenticity. Unmasking requires discernment. It can involve deciding where greater authenticity is possible, what remains private, which adaptations are useful, and which ones now cost more than they protect.
A helpful place to begin is with the moment between noticing and responding.
I can recognize that someone is uncomfortable without assuming I caused it.
I can care about a person without immediately reorganizing myself around their feelings.
I can ask for time before answering.
I can notice the urge to become more agreeable without treating that urge as an instruction.
The deeply empathic woman may not need to become less caring. She may need the experience of caring while remaining present inside her own body, with access to her preferences, discomfort, uncertainty, and limits.
That is often the part that has been missing.
Sources & Further Reading|My rabbit hole :)
Alison Jane Martingano, “No, Empathy Doesn’t Cause Burnout,” Psychology Today, updated August 25, 2026.
Hongyan Zhou, “Relationship Between Empathy and Burnout as Well as Potential Affecting and Mediating Factors From the Perspective of Clinical Nurses: A Systematic Review,” BMC Nursing, 2025.
Chris Edwards and colleagues, “‘I’m Not Feeling Alone in My Experiences’: How Newly Diagnosed Autistic Adults Engage With a Neurodiversity-Affirming ‘Welcome Pack,’” Autism, 2025.
Joshua A. Evans, Elizabeth J. Krumrei-Mancuso, and Steven V. Rouse, “What You Are Hiding Could Be Hurting You: Autistic Masking in Relation to Mental Health, Interpersonal Trauma, Authenticity, and Self-Esteem,” Autism in Adulthood, 2024.
Danielle Miller, Jon Rees, and Amy Pearson, “‘Masking Is Life’: Experiences of Masking in Autistic and Nonautistic Adults,” Autism in Adulthood, 2021.
