Autism & Eating Disorders

Autism Spectrum Disorder (ASD) and Eating Disorders

Background

Mental health problems can be more common amongst those with ASD compared to the general population. The relationship between eating disorders and ASD is highly complex, with many aspects to consider. Some people may be assessed for ASD at a young age, however for others, this may not occur until later in life, or when they are at a crisis point – such as an eating disorder. Whether ASD is a direct contributory risk factor for eating disorders remains an open question. Some people with ASD may experience a range of food related difficulties that are challenging, but that are distinct from the primary eating disorders: anorexia, bulimia and binge eating disorder.

Challenges

Some people with ASD, or parents, may describe long-standing social and communication difficulties, such as challenges at school and with friendships, prior to the onset of an eating disorder. Some may experience anorexia and the effects of starvation on the cognitive, emotional and social aspects of their life may, at times, draw similarities with ASD. However, when someone is acutely unwell with an eating disorder, assessment for ASD may prove incredibly challenging since issues such as restricted and repetitive behaviours may overlap.

Social situations centred on eating and food can be difficult for some people with ASD. People with ASD may experience more severe eating disorder symptoms, depression, and difficulties in work and social functioning. Social situations centred on eating and food can also be difficult for some people with ASD.

Cognitive difficulties experienced by people affected by ASD and eating disorders include:

  • Seeing the bigger picture, not just details
  • Shifting from one action to another with ease
  • Understanding that others (those who do not have ASD) have distinct beliefs, desires, hopes and intentions

Food and eating difficulties

Behavioural rigidity in the context of food and consumption

  • Food cravings
  • Food refusals
  • Limited diet – a narrow focus on specific foods and an overreliance on specific food categories (for example, refined carbohydrates). This may be associated with ARFID
  • Sensory problems that contribute to eating difficulties
  • Behaviours with significant health risks – for example, Pica, rumination and disruptive mealtime behaviours
  • Rapid eating behaviours – for example, binge eating disorder

What can help?

There is no single strategy that works for those affected by ASD and eating disorders. Where autism is a factor, treatment will depend on the presentation of eating disorder symptoms and the person’s level of ASD. Variations in ability across the spectrum, from high functioning to non-verbal, are important points to consider when determining what is the best course of support. Given that inflexibility is associated with ASD, the persistent nature of eating disorder symptoms, and in some instances, poor introspection, therapeutic approaches need to be adapted to accommodate these challenges. It is preferable that clinicians providing treatment have knowledge of both ASD and eating disorders.

Resources that may help:

References
Dudova, I, Kocourkova, J. & Koutek, J. (2015) Early-onset anorexia nervosa in girls with Asperger syndrome. Neuropsychiatric Disease and Treatment, 2(11), 1639-1643.

Gillberg, C. (1985) Autism and anorexia nervosa: related conditions? Nordisk Psykiatrisk Tidskrift, 39(4), 307-312.

Goldschmidt, J. (2018) A broad view: Disordered eating on the autism spectrum. Eating Disorders Review, 29(3), https://eatingdisordersreview.com/a-broad-view-disordered-eating-on-the-autism-spectrum/

Karlsson, L., Rastam, M. & Wentz, E. (2013) The SWedish Eating Assessment for Autism spectrum disorders (SWEAA)-Validation of a self-report questionnaire targeting eating disturbances within the autism spectrum. Research in Developmental Disabilities, 34(7), 2224–2233.

Huke, V., Turk, J., Saeidi, S., Kent, A. & Morgan, J.F. (2013) Autism spectrum disorders populations: A systematic review. European Eating Disorders Review, 21(5), 345-351.

Mandy, W. & Tchanturia, K. (2015) Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Molecular Autism,

Rothery, D.J. & Garden, G.M. (1988) Anorexia nervosa and infantile autism. The British Journal of Psychiatry, 153(5), 714.

Stewart, C.S., McEwen, F.S., Konstantellou, A., Eisler, I. & Simic, M. (2017) Impact of ASD Traits on Treatment Outcomes of Eating Disorders in Girls. European Eating Disorders Review,

Tchanturia, K. Adamson, J., Leppanen, J. & Westwood, H. (2017) Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme. Autism, DOI: 10.1177/1362361317722431

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