Autism And Eating Disorders: How Autistic Traits And Eating Disorder Symptoms May Interact
Autism and eating disorders may not often be discussed concerning their comorbidity. However, anyone can have an eating disorder. Autistic people with eating disorders may face more complications in receiving treatment and help. Understanding the connection between these conditions and the support options available can help children and adults with autism receive support.
What is autism spectrum disorder?
Autism spectrum disorder (ASD), commonly referred to as autism, is listed in the developmental disorders category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The condition's symptoms emerge during the developmental phase in children, typically before they go to school. However, autism spectrum disorders can be diagnosed at any age. This condition causes difficulty in social situations, repetitive behavior, and hyperfixation.
Symptoms of autism spectrum disorder
Symptoms of autism typically fall into one of two categories: social communication difficulties and restricted or repetitive behaviors. Social communication difficulties can include the following:
- Difficulty understanding or responding to social cues like facial expressions, tone of voice, or body language
- Difficulty initiating and maintaining conversations
- Difficulty recognizing or interpreting humor, particularly sarcasm
- Trouble forming lasting friendships
- Delayed speech development in children, in some cases resulting in a total lack of verbal speech
Restricted and repetitive behaviors can include:
- “Stimming,” a self-soothing behavior that can involve flapping one’s hands, rocking back and forth, spinning in circles, or repeating words, phrases, or sounds
- Having highly focused interest areas
- Following established daily routines that tend to be highly consistent, with deviations producing distress
Common eating disorders: Anorexia nervosa and bulimia nervosa
The two most common eating disorders are anorexia and bulimia. Below are symptom presentations that can occur.
Anorexia nervosa
Anorexia nervosa, often referred to as anorexia, is an eating disorder characterized by an obsessive desire to control one’s weight, typically caused by an intense fear of gaining weight and a distorted sense of body image. People with anorexia may take extreme steps to control or lose weight, like restricting their food consumption, constantly exercising, or overdosing on laxatives.
People with anorexia can also behave in obsessive ways, like performing complex rituals when eating (cutting their food into a certain number of pieces, etc.), counting calories, tracking their food consumption via an app or spreadsheet, body “checking” behaviors (like lifting their shirt to look at their stomach), or avoiding certain food groups.
Bulimia nervosa
Bulimia nervosa, often abbreviated to bulimia, is characterized by two behaviors: binging (eating large amounts of food) and purging (performing compensatory behaviors to “get rid of” the food). Purging could include vomiting, fasting, engaging in excessive exercise, or taking laxatives. People with bulimia may have a sense of being out of control and might believe they can’t stop during their binges. These difficulties can lead to deep guilt, shame, and anxiety afterward, which they may attempt to alleviate by purging.
Unlike anorexia, which can result in extreme, potentially life-threatening weight loss, people with bulimia may not lose much weight. They may experience a host of other health problems, though, including gastrointestinal issues and electrolyte imbalances from the constant digestive cycling. Body type does not determine whether someone might be living with an eating disorder.
The relationship between autism and eating disorders
Historically, autism and eating disorders have been studied as separate conditions with little potential for co-occurrence between an autism diagnosis and an eating disorder diagnosis, but this attitude is changing. Emerging research indicates that some autistic traits may put people at a higher risk of developing eating disorders, particularly anorexia.
The overlap between people with eating disorders and those with autism spectrum disorder may be related to the rigidity and desire to adhere to a routine that is commonly seen in autism, which could evolve into rituals around food and eating patterns. Because Autistic individuals may experience extreme distress at the thought of uncertainty, they may use their routines and rituals to soothe anxiety, which is where maladaptive eating patterns could become a disorder.
Can Persons with Autism have difficulties with food?
Persons with Autism may be more likely to experience sensory sensitivities, making trying and eating certain foods more complex. However, there is a difference between avoiding food for this reason and having an eating disorder.
The difference between a person with Autism including food avoidance and the combination of autism and eating disorders
A difference between food avoidance and a potential eating disorder is that with food avoidance, only particular foods may be problematic. A person who has Autism with an eating disorder may avoid many kinds of foods, and their avoidance can be related to rigid patterns and rituals. In some cases, these symptoms might meet the criteria for avoidant-restrictive food intake disorder (ARFID), which causes avoidance of eating due to sensory sensitivities.
Addressing food avoidance in people with Autism
People with autism can manage their sensory sensitivity to specific foods. However, the process may be complex and highly individualized. Food avoidance might not be an issue for some and can often be worked around. However, if avoidance results in nutritional deficits or social concerns (like the person wanting to eat at a restaurant but not being able to), steps can be taken to address the situation.
Such a person can gradually introduce small amounts of problematic food to their meals to build up their tolerance, working with the same principles that apply to exposure therapy for phobias and other distressing stimuli. Individuals may benefit from taking this process slowly and ensuring engagement is on their terms.
Unique challenges people with Autism may have in navigating eating disorders
People with ASD who also have eating disorders (not food avoidance) may encounter different challenges with eating disorder treatment than non-Autistic people. Standard interventions for treating eating disorders may not be as effective for those with Autism, as they may have been designed with neurotypical people in mind. Social communication barriers can also make treatment challenging, as it may be more difficult for those who live with ASD to communicate their anxieties and fears to eating disorder professionals. Joining support groups for specific populations of eating disorder patients, like women living with Autism, may mitigate this difficulty.
Supporting people who live with eating disorders
If you are a parent of a child with ASD or want to support a loved one with autism and an eating disorder, below are a few ways to offer guidance.
Routines
Routine is often highly beneficial for persons living with autism, but adherence to routines can sometimes lead to the maladaptive behaviors associated with eating disorders. Creating alternative rituals and patterns may help those with ASD move away from their disordered eating habits. These new routines could involve meal planning and ensuring food is consumed at similar times each day.
Therapy
Communication with mental health professionals can be a healthy part of eating disorder recovery, but the social interaction difficulties associated with autism can sometimes be a significant barrier. Online therapy through a platform like BetterHelp may take away some social pressure in such cases. With online therapy through an accredited service, clients can talk to their therapist using various methods, including video chat, phone calls, and in-app messaging. In addition, they can access tools like journaling prompts, support groups, and worksheets.
Research has found that online therapy may be as effective as traditional in-person therapy at addressing mental health concerns, including those related to autism and eating disorders. One study evaluated an online therapeutic intervention on a group of individuals with neurodevelopmental disorders, including autism, and found that online therapy improved outcomes for those living with Autism.
Takeaway
What is the most common eating disorder in autism?
One of the most common types of eating disorders in those with autism is avoidant/restrictive food intake disorder (ARFID). Some research investigating restrictive eating disorders suggests that as many as 54.8% of children diagnosed with ARFID also have autism, which is a much higher rate than in the general population.
Do people with autism struggle with eating?
Some Autistic children and Autistic adults alike may struggle with eating. Sensory processing challenges associated with autism spectrum disorder (ASD) traits may also lead to disordered eating behaviours in some. For example, some people with autism develop avoidant/restrictive food intake disorder (ARFID). This condition involves disordered eating behaviours like severely limited food choices due to sensory issues. Over time, this maladaptive coping mechanism for sensory challenges can result in a lack of sufficient weight gain in children and nutritional needs not being met.
What food issues do people with autism spectrum disorder have?
Some individuals living with autism may face challenges related to food. Oral or digestive issues are not uncommon in those with ASD, which can make eating difficult or unpleasant. Some Autistic people may also find the textures, colors, or smells of certain foods to be intensely off-putting due to sensory differences, or they may have very specific preferences about when, where, or how they eat. Research suggests as well that autism spectrum disorder frequently co-occurs with certain eating disorders, such as avoidant/restrictive food intake disorder and anorexia nervosa. Many Autistic women in particular may be at higher risk of eating disorders.
Do kids with autism have eating disorders?
It is possible for a child with autism to develop an eating disorder. The most common types are restrictive eating disorders like avoidant/restrictive food intake disorder (ARFID). A systematic review published in the British Medical Journal suggests that people with autism may be at a higher risk of developing ARFID. The same article in the British Journal also indicates that timely interventions for ARFID symptoms may help improve long-term health and treatment outcomes.
If you suspect your child may have an eating disorder, it's generally recommended that you meet with their doctor and/or a child psychology professional. They can compare your child’s mental and physical symptoms to diagnostic criteria for certain disorders and recommend treatment as needed. Eating disorder treatment for supporting Autistic people may consist of some form of therapy in milder cases or an inpatient treatment programme in more severe cases.
What are unusual eating habits of autism?
Some people living with autism spectrum disorder may exhibit unusual habits related to food and eating. These can range from harmless preferences to potentially dangerous signs of an eating disorder. Some examples of preferences may include wanting to eat off of the same plate for every meal or not wanting different foods to touch each other. Some examples of potential eating disorder symptoms include an intense interest in obsessive calorie counting, repetitive behaviours related to binge eating or purging, and concerns about body image or weight.
Meeting with a doctor if you're concerned about your or a loved one’s eating habits can be helpful. They can evaluate the habits and decide if they're just a symptom of autism or a sign of another disorder, such as binge eating disorder or an anorexia nervosa-related illness.
Why do Autistic people struggle with weight?
Not all Autistic people struggle with weight, but some do. For example, a pilot study in the European Eating Disorders Journal suggests that as many as 37% of people with anorexia nervosa also meet the criteria for autism spectrum disorder (ASD). Researchers aren't sure exactly why this correlation seems to exist, but it may be related to autistic social traits around sensory processing that affect the way individuals with ASD relate to food.
What is the comfort food for autism?
What qualifies as a comfort food for one person with autism may not for the next. That said, it's not uncommon for Autistic individuals with sensory-related food restrictions to prefer carbohydrates and processed foods over fruits and vegetables.
Is overeating a symptom of autism?
Overeating is not part of the diagnostic criteria for autism spectrum disorder (ASD), but some people with autism may struggle with this behavior. One expert suggests that this may be because of “difficulties in behavioral flexibility, such as struggling to shift between tasks or settings,” which can be common in those with ASD.
Why do kids with autism eat so much?
Food-related behaviors are not part of the core diagnostic criteria for autism spectrum disorder, so individuals with autism can have diverse eating patterns. Children with autism who have a tendency to overeat may benefit from cognitive behavioral therapy with a specialist to help them learn to manage their eating behaviors and preferences in a healthy way.
What’s the link between autism and eating disorders like anorexia nervosa?
As a study in the Molecular Autism journal suggests, both autism and eating disorders (ED) can be comorbid with each other. It indicates that this may be because of alexithymia: ”a difficulty identifying and describing emotional states which is observed in both autism and ED.”
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