Eating disorders have a devastating effect on the lives of those affected and are associated with the highest mortality rates of all mental illnesses. While they can affect anyone, there is a higher incidence of people with autism who have eating disorders compared to the general population. Studies have found that between 20 and 30 percent of people with eating disorders also have autism or display signs of the condition.1 One study showed that women with anorexia nervosa scored significantly higher on the Autism Spectrum Quotient questionnaire than women without anorexia.2
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Source: Niklas Hamann, Unsplash
Like many others with autism, especially women, I have faced a lifetime of disordered eating, including binging and purging. I was overfed by my mother from a young age and discovered that food calmed me down long before I started school. My emotional eating became extreme binge eating by the age of 8. By the time I was a teenager, I’d either be binging or following such restrictive eating regimes that eating has never, ever been a natural or worry-free activity.
Why Are People with Autism at Such High Risk of Developing Eating Disorders?
1. Emotional regulation issues
Autism is characterised by emotional regulation issues; people with autism are more likely to experience mental health issues in general, including anxiety and depression.3 Many people develop eating disorders as a coping mechanism for anxiety or difficulties with emotional expression and communication.
Foods that are high in fat and sugar, in particular, can stimulate neurotransmitters that make someone feel calmer. Many autistic people frequently find themselves in situations that are difficult to cope with, and food can be a way to deal with feelings of overwhelm and anxiety. In a disordered world, food, and sometimes excessive exercise, can become a way to impose control.
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2. Restricted foods
Children with autism often display restrictive eating patterns which may continue into adulthood. Autistic children not only have a higher incidence of food allergies than the general population, but they may also have sensory issues around food and find particular textures or tastes unpalatable.
My client Fiona described how, from childhood into adulthood, she could not eat certain colours of food together. “Mealtimes have always been a nightmare,” she said. “As a child, I used to end up having meltdowns if anything red was placed on my plate. I couldn’t have the wrong textures together. I once made myself vomit after a meal because I was forced to eat it. As an adult, I have a lot of fear around food and sometimes starve myself because eating is too overwhelming.”
3. Peer pressure
In many cultures, there is a high degree of pressure to be slim—particularly for girls, though boys are affected as well. For autistic girls, who may already find it hard to fit in with their peers, trying to be thin could be a way to feel “socially acceptable.”
Another client, Marianne, told me, “I was always the odd one out and I figured that this was because I was a bit fat. I thought if I lost weight, I’d be accepted by the other girls. Of course, that didn’t happen. But my obsession with fitting in led to a lifelong eating disorder.”
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4. Obsessive interests
Autism is characterised by intense levels of interest and focus on particular subjects, and developing an unhealthy obsession with food can fit with this general autistic profile.
Jenny described how she became obsessed with calorie intake and restriction as a teenager. “I’m good with numbers anyway, and when I discovered calorie counting it became a complete obsession. I could reel off the calories in hundreds of foods. I’d obsessively count, and I started to restrict more and more. I became obsessed with eating as little as possible, and by then the eating disorder had taken complete control of me.”
5. Routines and rigid thinking
People with autism often display problems with executive function, including cognitive flexibility. This means that, while they may be fantastic at determinedly pursuing an idea or course of action, they find it hard to shift to new ways of doing things. When a person with autism is set on a particular path—such as eating in a controlled manner—they can display such determination in sticking to that path that it can trigger or intensify an eating disorder.
How is Treatment Influenced?
While research finds that adolescents with autism are as likely as neurotypicals to recover from an eating disorder,4 adults with autism tend to experience longer-lasting and more severe disorders.5
Facilities specialising in the treatment of eating disorders should allow increased time to develop a therapeutic relationship with autistic patients. Acknowledging the sensory issues that people with autism face around foods is also important when drawing up treatment plans.
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Eating disorder practitioners who are working with autistic clients could also benefit from additional training and an understanding of the types of strategies that help autistic people regulate their emotions. Considering the rituals, routines, and rigid thinking which people with autism display in other aspects of life will also help shape therapeutic interventions.
To find help near you, visit the Psychology Today Therapy Directory.
References
1. 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
2. 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.
3. 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
4. Nielsen, S, Anckarsäter, H, Gillberg, C, et.al. (2015) Effects of autism spectrum disorders on outcome in teenage-onset anorexia nervosa evaluated by the Morgan-Russell outcome assessment schedule: a controlled community-based study. Autism, 8(6), doi: 10.1186/s13229-015-0013-4. eCollection 2015.
5. 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
