Autism and eating disorders

We have more and more research being conducted on the links between autism and eating disorders, with some research suggesting that 20% of those diagnosed with anorexia are autistic. The Maudsley Hospital - UK leaders in the treatment of eating disorders and creators of the Maudsley Treatment Model for eating disorders, found that 35% of the women they treated met the diagnostic criteria for autism. Why? 

There are several reasons for the high proportion of autistic people suffering from eating disorders. Anxiety can be very high in autistic individuals (studies suggest anywhere up to 84% of people struggle with it) which is a huge contributing factor to an eating disorder. Not only is food used as a strategy for coping with the anxiety, stress or negative emotions being felt, but there can also be a lot of anxiety around the food itself (see below on ARFID).

Trauma is known to often be the root cause of an eating disorder, and autistic individuals are at serious risk of experiencing trauma due to increased potential for social isolation, lack of caregiver attunement and social/relational/peer rejection and harassment. The extended waiting time for a diagnosis increases these risks; many autistic individuals are not diagnosed until adulthood, meaning they can potentially spend their developmental years without the self-awareness, understanding and self-acceptance that is so important for building self-esteem.

Eating disorders and body dysmorphic disorder mean the sufferer will feel extremely preoccupied with their weight, appearance, or a particular body part. This can feel even more intense and overwhelming for an autistic person due to the differences in their cognitive processing of information. Similarly, they are more likely to experience alexithymia (difficulty in identifying and describing emotional states).

ARFID and autism

Avoidant/restrictive intake food disorder (ARFID) is an eating disorder that means the sufferer avoids certain foods which leads to restriction. This could be sensory-based avoidance, facing a distressing or traumatic experience with food or not being in tune with hunger cues meaning there is a lack of interest in eating.

ARFID is more common for autistic individuals because of their sensory processing differences, higher levels of anxiety, differences in reading/understanding body sensations, their need for structure or routine in a potentially unsafe/unstable world and a preference for repetition or sameness.

Treatment (and barriers)

Everyone will present differently, and it is therefore important that treatment can be tailored to the person’s specific needs. This means that the commonly used CBT and DBT approaches (although sometimes helpful in building coping strategies) for eating disorders may not adequately support the individual as they can be very formulaic.

An integrated, person-centred approach is vital. It can take some autistic people longer to form trusting relationships, so shorter-term/solution-focused therapy is not as helpful.

Similarly, it is important that any treatment offers stability, routine and safety which makes going to treatment centres such as inpatient/outpatient units very challenging for someone with autism due to the change of environment and the sensory overload that comes with that (e.g., hospital settings, lighting, noises etc.). Therefore, a more holistic, relational approach to the therapy/nutritional therapy is needed.