Autism and Eating Disorders: Food for Thought
18th July 2019
Autism spectrum conditions (ASCs) and eating disorders do not at first glance seem like they would overlap. ASCs are characterised by difficulties in social interaction and communication, while eating disorders are characterised by abnormal or disturbed eating habits; symptoms which on the surface sound vastly different. Equally, people with autism are often (incorrectly) assumed to not be able to empathise with the emotions of others, while people with eating disorders are (again, incorrectly) often stereotyped as the complete opposite, and are portrayed as oversensitive.
However, recent research has suggested that up to 20% of people with eating disorders have autism. These figures are even more evident when only considering females with autism; findings suggest that as many as one in five women presenting to clinics with anorexia may also have autism. Because women with autism are overwhelmingly underdiagnosed, and their symptoms are often misinterpreted by schools and services, it is often the case that the first time these women are made known to clinical services is when they present with an eating disorder. This has led some people to go as far as to refer to anorexia as “the female Asperger’s!”
When you begin to remove the misconceptions that veil both conditions, it becomes apparent how similar many of the behaviours and symptoms can be. Research has shown that restrictive and repetitive patterns of behaviour, adherence to routine, resistance to chance and obsessive thoughts feature inherently in both ASCs and eating disorders; the difference is that in eating disorders, these symptoms are centred around a fear of fatness. Studies have also shown that emotional styles and thinking styles that have been found to create vulnerability to anorexia, are also present in many autistic people.
The fictional story of Caitlin, which can be found on the autism.org website, is a great example of how an ASC can manifest as an eating disorder. Caitlin is described as a fussy eater, who started to develop a strict routine around her food consumption and eat pretty much the same thing every day, so that she did not experience uncertainty and thus anxiety around her food. This kind of adherence to routine and difficulty with surprises or change is characteristic of an ASC. However, it also meant that Caitlin started to lose weight rapidly and this led her to be diagnosed with anorexia nervosa. It wasn’t until her 20s that she was diagnosed with autism.
Whilst this story is fictional, it is based on the real experience of many autistic women whose ASC has gone unrecognised during their treatment for eating disorders. As a result, clinicians are not able to adapt their treatment techniques to account for the unique needs of those on the autistic spectrum.
Often, eating disorder treatment involves group therapy, however this can be challenging for some of those on the autistic spectrum who find social interaction and communication challenging. Furthermore, treatment often centres around discussing concerns about body image and fear of fatness, however, for many autistic people with eating disorder diagnoses this may not be driving their restricted eating and therefore may not be helpful for them.
On top of this, clinical environments in which treatment may be carried out can be very overwhelming for some autistic people with sensory processing difficulties, as there may be bright lighting or uncomfortable chairs. Without the knowledge that someone may struggle with these factors, it can be very difficult for clinicians to make any changes to the treatment space to make them accessible for autistic people. All of these factors may mean that autistic people cannot participate in treatment for their eating disorder as well as those without an ASC, and thus they can appear unengaged or unmotivated. Often as a result of this their treatment is not effective, and they will continue to struggle with food restriction. Research studies suggest that currently, autistic women specifically diagnosed with anorexia receive less benefit from therapy than their non-autistic counter-parts (Stewart et al, 2017).
It is clear from these findings that it is vital that we continue to research the links between autism and eating disorders, so that health care professionals can provide the best treatment tailored to the complex needs of the individuals they are seeing. Hopefully, by recognising the issue, we can promote better treatment and increased understanding of eating disorders in autistic people.
References
https://www.nationaleatingdisorders.org/blog/link-between-anorexia-and-autism
https://www.spectrumnews.org/features/deep-dive/the-invisible-link-between-autism-and-anorexia/
https://network.autism.org.uk/good-practice/evidence-base/anorexia-nervosa-autistic-females