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.  

Explore the relationship between ASD and eating disorders

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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

Food avoidance is not unusual in autism, even among adults with Autism, but typically, this avoidance is not related to concerns about weight or body image but sensory sensitivity. Some people with Autism may avoid certain foods because they do not like the texture of the food or the smell or taste overwhelms them. 

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

Eating disorders are serious mental health conditions, but they are treatable. Treatment access and efficacy can sometimes be more complex for people with eating disorders who also have autism. Talking to a therapist could be one way to tailor eating disorder treatment for such specific needs. Consider reaching out to a therapist online or in your area for support.