Background

Mental health problems can be more common amongst autistic people, compared to the general population.

The relationship between eating disorders and autism is highly complex, with many aspects to consider. Some people may be assessed for autism 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 autism is a direct contributory risk factor for eating disorders is still an open question. Some autistic people may experience a range of food related difficulties that are challenging, but that are distinct from the primary eating disorders: anorexia nervosa, bulimia nervosa or binge eating disorder.

Challenges

Some autistic people, or parents, may describe long-standing social and communication difficulties.

• Challenges at school and with friendships, prior to the onset of an eating disorder.
• Social situations centred on eating and food.

Some may experience anorexia nervosa and the effects of starvation on the cognitive, emotional and social aspects of their life may, at times, draw similarities with autism. However, when someone is acutely unwell with an eating disorder, assessment for autism may prove incredibly challenging since issues such as restricted and repetitive behaviours may overlap.

Autistic people may experience more severe eating disorder symptoms, depression, and difficulties in work and the social spheres of life.

Cognitive difficulties experienced by autistic people with eating disorders include:

• Seeing the bigger picture, not just details
• Shifting from one action to another with ease
• Understanding that others (who are not autistic) 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 over-reliance 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 autistic people with eating disorders. Where autism is a factor, treatment will depend on the presentation of eating disorder symptoms and the person’s experience of being autistic. Variations in ability across the spectrum are important points to consider when determining what is the best course of support. Given that inflexibility is associated with autism, 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 autism and eating disorders.

Resources that may help:

• Information from the Irish Nutrition & Dietetic Institute
• Information fact sheet from the British Dietetic Association
• Proposed model of autism-specific mechanism underlying restrictive eating difficulties
• Sensory-friendly resource pack – NHS