A 41-year-old female physician self-refers for autism evaluation after her son is diagnosed with ASD at age 7 and she recognizes similar traits in herself. She has a history of three prior psychiatric diagnoses: social anxiety disorder at age 19 (treated with SSRIs with partial response), generalized anxiety disorder at age 25, and borderline personality disorder at age 32 (which she contested, as she did not identify with the fear of abandonment or identity disturbance criteria). She graduated at the top of her medical school class. She reports that she has always found social interaction effortful but learned to mimic colleagues' behavior to navigate professional relationships. She avoids the physician lounge because the noise and fluorescent lighting are overwhelming. She eats the same lunch every day and becomes intensely distressed when her schedule changes unexpectedly. Her husband describes her as 'brilliant but socially exhausting to coach.' Which factor most commonly contributes to delayed autism diagnosis in patients like this one?