A licensed psychotherapist specializing in psychosis, mood disorders, and the intersection between neurodiversity and mental health examines the statistics and stereotypes regarding people with autism as well as people with eating disorders, and describes how research indicates a greater prevalence of eating disorders in autism than is widely recognized.
Analysis
The author delves into the findings of several studies published between 2017 – 2022 to learn about how the mental health profession identifies and treats both autism and eating disorders, and the ways that current practices may be failing to account for common factors between the two. There are certain assumptions about the characteristics of an “average” autistic person that seem to run counter to assumptions about characteristics of who is likely to develop an eating disorder–which has led to the erroneous conclusion that autistic people are unlikely to develop eating disorders at all.
In fact, there are multiple factors that run parallel between the conditions, especially for autistic women. Social influences and individual behavioral traits for autistic people might even have the potential to interact in ways that are especially aggravating, which puts them at higher risk of developing an eating disorder such as anorexia or Avoidant/Restrictive Food Intake Disorder (ARFID). The article calls upon the mental health profession to look more closely at the interrelationship between eating disorders and autism to increase the accuracy of diagnosis, as well as provide more effective methods of prevention and treatment.
Key Points
- As many as one-third of people living with anorexia have higher-than-expected levels of autistic traits.
- Studies show a significant overrepresentation of autism in people living with eating disorders including anorexia and Avoidant/Restrictive Food Intake Disorder (ARFID).
- Exceptionally low self-esteem, a strong risk factor for eating disorders, is often present in autistic individuals who experience high levels of rejection, exclusion, and pressure to mask.
- Research indicates a similar cognitive profile between those with autism and those with eating disorders, which may include a tendency towards “rule-governed” thinking that places a high priority on body image metrics such as weight.
- Traditional eating disorder treatment might be particularly difficult for autistic individuals who display significant sensory problems.
- Radically open DBT (RO-DBT) treatment is effective in reducing eating disorder symptomology in individuals with anorexia, as well as reducing emotional distress in autistic individuals, but further research is needed to determine its effectiveness for patients who are both autistic and have eating disorders.
Individual Risk Factors
Certain social norms and expectations have long been associated with the development of eating disorders. Weight and body image, for example, may be used as a measurement of social worth, and failure to achieve idealized characteristics can lead to feelings of isolation. The article describes how people with autism–and particularly women with autism–may find these social pressures magnified, as neurotypical behavior is also perceived with higher value than neurodivergence. As autistic people experience rejection, exclusion, and pressure to mask their identity or expression, they suffer a lower sense of self-esteem–a strong risk factor for eating disorders. Research has also shown that people with eating disorders have a similar cognitive profile that shares an autistic tendency towards “rule-governed” thinking, including the impulse to derive comfort from numbers such as weight–another key risk factor.
Characteristics of eating disorders often include an atypical response to hunger cues, such as a simple lack of awareness of the body’s needs. Autistic people may experience similar interoceptive alterations, which may then be further compounded by commonly occurring sensitivities to taste and texture that place one at higher risk for developing ARFID. Interventions designed to reintroduce the concept of intuitive eating may therefore be more difficult for the autistic individual with an eating disorder, whose understanding of their own hunger cues may already be different than those of neurotypical people.
Treatment
Eating disorders present one of the highest mortality rates among all psychiatric disorders, which means that early and effective treatment is crucial for ensuring patient survival. Traditional treatment methods focus on medical stabilization and refeeding, and may include a regimented process of required, scheduled meals that are either prescribed or offered from a menu. The article notes that autistic individuals with sensory problems may find elements of these methods to be challenging, presenting an obstacle to productive care. Fortunately, steps are being taken to alleviate this issue through such initiatives as the Pathway for Eating Disorders and Autism developed from Clinical Experience (PEACE), which has introduced adaptations such as sensory-friendly color schemes or dietary accommodations, communication passports, or other specialized modifications that meet the needs of autistic people. Research has also shown that the therapeutic method of radically open DBT (RO-DBT) may show promise, as its focus on treating emotional loneliness through social connection has provided relief to individuals with anorexia and those with autism–although further study is required to discern how well it might work in individuals who have both conditions.
Prevention
The article calls upon the community of mental health professionals to reconsider their biases and methods to better prevent the occurrence of eating disorders in autistic people. Early identification of autism-related behaviors as well as programs that affirm neurodiversity at a school level will be beneficial. The author also urges her colleagues to acknowledge how autism presents differently among women, observing that modern social structures and expectations emphasize conformity over divergent behavior. Feelings of isolation and low self-esteem become a fertile ground for development of an eating disorder.
Conclusion
Misconceptions about both autism and eating disorders have resulted in situations where individuals who have both conditions often go undiagnosed or underdiagnosed. Even when the assessment correctly identifies the presence of both autism and an eating disorder, treatment options may not be adequately adapted to answer the needs of the individual. While much research has already been conducted on the prevalence of eating disorders in the autism community, much more is needed to develop a complete understanding of who is affected and how to care for them–and the voices of autistic individuals need to be included in this important conversation.