Autism Spectrum and Eating Disorders

Written by Ayron Walker, dietetic intern and PhD candidate

Current research suggests and overlap with autism spectrum disorders (ASD) and eating disorders. ASDs comprise a spectrum of conditions that are characterized by abnormalities in three domains: social interactions, language and communication, and restricted/repetitive patterns of behavior ¹. In 1983, Gillberg conceptualized the possible relationship between ASD and anorexia nervosa (characterized by restrictive eating, very low body weight, intense fear of gaining weight, and persistent lack of recognition of seriousness of low body weight) ². Since then, the research on eating disorders and ASDs has evolved and suggests that ASD’s may be overrepresented in the eating disorder population ³. For example, recent statistics suggest that up to 30% of patients with anorexia are autistic ⁴.

There are commonalities between the two conditions, which sparked research in the connections between ASD and eating disorders. Specifically, many traits of anorexia mimic autistic traits including restriction and high levels of social and flexibility difficulties ⁵. Likewise, there is another potential link for autism: avoidant/restrictive food intake disorder (ARFID). ARFID is a diagnosable eating disorder that is characterized by a general lack of interest in eating and may not feel hungry or are turned off by the smell, taste, texture, or color of food ⁶. Similarly, people who are diagnosed with ARFID typically have a co-occurring ASDs, like attention deficit hyperactivity disorder (ADHD) ⁶. People with ADHD have a wide variety of symptoms, including lack of focus, restlessness, hyperactivity and hypoactivity, low tolerance level for frustration, problems prioritizing needs and time. There are many parallels to ARFID and ADHD functionality, which can lead to co-morbidities. Further, it seems that ASDS are overrepresented among females with eating disorders ⁴. Additionally, current evidence suggests that women with high autistic traits benefit less from current interventions and care pathways and typically have worse outcomes when compared to other women with anorexia ⁵. This is a cause for concern and need for intervention adaptations.

Current treatment for ASDs disorders primarily include medication and therapeutic strategies. Yet, some of the therapeutic strategies for ASDs do not align with the strategies for eating disorders and therefore do not produce positive outcomes ⁵. ASDs treatments are to help individuals cope with functional impacts, whereas a lot of ED treatment aims to recover completely from the disorder. However, certain physicians are starting to see the alignment with ASDs and eating disorder behaviors, such as communication challenges, rigidity of thinking, behavior patterns and routines, and difficulty identifying underlying thoughts and emotions ⁴. Likewise, there are additional barriers to identifying ASDs among eating disorder clients because many physicians lack the confidence to identify ASDs individuals ⁵. Additionally, some of the medications, specifically for ADHD, suppress appetite, which is a concerning comorbidity particularly with the relationship to AFRID and eating disorders. Culminating these circumstances paints a very stark picture of ineffective treatment for ASDs and eating disorders, specifically anorexia and ARFID.

Fortunately, early research is working on uncovering treatment that is positive for ASDs and eating disorders. For example, early and effective diagnosis for ASDs continue to see positive results in treatment. Additionally, if more individuals receive an ASDs diagnosis prior to eating disorder treatment, this could help physicians seek more individualized and specialized care. As for specific care for eating disorder treatment, studies suggest that exposure and response treatment work effectively in mitigating many of the anxieties individuals face about food ⁷. Additionally, continuous collaboration and dialogue between physicians, registered dietitians and therapists can ensure consistent messaging and treatment for clients with co-morbidities. Lastly, individuals should be referred to a registered dietitian nutritionist who specializes in eating disorders to ensure eating patterns are meeting nutrition requirements prior to prescribing medicine.

References

1. Huke V, Turk J, Saeidi S, Kent A, Morgan JF. Autism Spectrum Disorders in Eating Disorder Populations: A Systematic Review. European Eating Disorders Review. 2013;21(5):345-51.
2. Gillberg C. Are Autism and Anorexia Nervosa Related? British Journal of Psychiatry. 1983;142(4):428-.
3. Wentz E, Lacey JH, Waller G, Råstam M, Turk J, Gillberg C. Childhood onset neuropsychiatric disorders in adult eating disorder patients. European Child & Adolescent Psychiatry. 2005;14(8):431-7.
4. Brown CM, Stokes MA. Intersection of Eating Disorders and the Female Profile of Autism. Child Adolesc Psychiatr Clin N Am. 2020;29(2):409-17.
5. Brede J, Babb C, Jones C, Elliott M, Zanker C, Tchanturia K, et al. “For Me, the Anorexia is Just a Symptom, and the Cause is the Autism”: Investigating Restrictive Eating Disorders in Autistic Women. Journal of Autism and Developmental Disorders. 2020;50(12):4280-96.
6. National Eating Disorders Association. What are Eating Disorders? 2022 [updated 2012-06-03. Available from: https://www.nationaleatingdisorders.org/learn.
7. Glasofer DR, Albano AM, Simpson HB, Steinglass JE. Overcoming fear of eating: A case study of a novel use of exposure and response prevention. Psychotherapy (Chicago, Ill). 2016;53(2):223-31.