Dice, Depth, and Diagnosis: The Therapeutic Potential of TTRPGs for Autistic Women

Abstract

Autistic women are often marginalized by medical and social systems. The modern diagnostic view of autism is male-focused. As a result, many autistic women are misdiagnosed or diagnosed late in life. The challenges of not being diagnosed, or not understanding oneself as autistic, can cause autistic women challenges related to fitting in with the general society. Camouflaging or shifting behavior to pretend to be like everyone else can result in a distorted view of the self, anxiety, depression, and other challenges to mental health. This dissertation proposes the use of tabletop role-playing games (TTRPGs) as a framework for therapeutic interventions to support self-expression and identity development in late-diagnosed and self-identifying autistic women. Using an alchemical hermeneutic methodology through a feminist lens, data from autistic individuals and gamers, including literature, YouTube videos, blogs, and Reddit threads, were analyzed, with a focus on content created by women. From these data, five themes emerged: challenges with day-to-day experiences, identity discovery, women’s gaming experiences, identity in gaming, and TTRPGs as therapeutic tools. Drawing on depth psychology, play therapy, narrative therapy, and drama therapy, this study proposes incorporating TTRPGs into group interventions. Clinical implications highlight the need for clinician competence in therapeutic practice, gaming culture, intentional group composition, and structured safety tools. TTRPGs offer a framework for addressing identity development, social skills, and anxiety and depression reduction in autistic women.