Rebecca Jaspan, MPH, RD, CDN, CDCES
Eating disorders are often co-occurring with many other mental health conditions, including depression, anxiety, obsessive compulsive disorder, and personality disorders. The incidence of autism and eating disorders is gaining more attention and interest. It is estimated that 5% of the population struggles with eating disorders and approximately 20% of those people may also have autism or display certain characteristics of autism spectrum disorder.1 One study showed that women with anorexia nervosa scored significantly higher on the Autism Spectrum Quotient questionnaire than women without anorexia.2
Individuals on and off the autism spectrum can have challenges with food, body image, and self-esteem. Research has noted that individuals with eating disorders and those with autism share many similar characteristics. These include rigid thought patterns, repetitive behaviors, sensory processing issues, dependence on routines, and limited executive functioning. More research is needed to determine whether eating disorders produce traits similar to autism or whether autism predisposes someone to eating disorders. One study points to the possibility that autistic traits in childhood predate an eating disorder. 5,000 teenagers were followed and those who showed autistic traits at age 7 were 24% more likely to show disordered eating behaviors by age 14.3
Why are people with autism at such high risk for developing an eating disorder? This is due to many overlapping characteristics. Individuals with autism have challenges with emotional regulation. People with autism are more likely to experience mental health issues including anxiety and depression and many develop eating disorders as a coping mechanism for anxiety or difficulties with emotional expression and communication.4 Food may become a way to cope with feelings of overwhelm and anxiety and a way to impose control.
Additionally, children with autism often display restrictive eating patterns which may continue into adulthood. Autistic children may also have sensory issues around food and find particular textures, tastes, and colors unpalatable or scary. This can predispose them to a type of eating disorder called avoidant/restrictive food intake disorder or ARFID. This can lead to malnutrition and intense fear and overwhelm around food and mealtimes.
Children with autism have many obsessive interests and focus on particular subjects. They may develop an unhealthy obsession with food and calories. This can lead to intense calorie counting and restriction. Concurrently, they may display issues with cognitive flexibility. While this can serve as a positive trait in that they determinedly pursue an idea or goal, they also find it very difficult to shift to a new way of doing things. This results in an inability to eat in a less controlled manner, distress when presented with new foods, or eating in new situations, which can trigger or intensify an eating disorder.
Research finds that adolescents with autism are just as likely to recover from an eating disorder, but adults with autism may experience longer-lasting or more severe symptoms.5 At Laura Cipullo Whole Nutrition, our dietitians recognize the importance of developing a therapeutic relationship with our clients with autism and the increased time this may take. We also acknowledge the sensory issues that individuals with autism may face around food and take that into account when designing treatment plans. It is important to consider the rituals, routines, and rigid thinking that people with autism and eating disorders display to help shape nutrition interventions.
- Solmi, F., Bentivegna, F., Bould, H.et. al. (2020) Trajectories of autistic social traits in childhood and adolescence and Disordered eating behaviours at age 14 years: A UK general population cohort study. The Journal of Child Psychology and Psychiatry, 62(1), 75-85. https://doi.org/10.1111/jcpp.13255
- Hambrook, D, Tchanturia, K, Schmidt, U, et. Al. (2008) Empathy, systemizing, and autistic traits in anorexia nervosa: a pilot study. British Journal of Clinical Psychology, 47(3), 335-9, doi: 10.1348/014466507X272475. Epub 2008 Jan 21.
- University College London. (2020, May 12). Children with autism face higher risk of eating disorders, study finds. ScienceDaily. Retrieved September 17, 2021 from sciencedaily.com/releases/2020/05/200512205555.htm
- Cage, E, Troxell-Whitman, Z (2019) Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899-1911
- Tchanturia, K, Adamson, J, Leppanen, J, Westwood, H (2019) Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme. Autism, 23(1) 123–130