The link between Autism and Anorexia

Autism is a way of being that is due to neurocognitive differences. Autistic people generally find social communication and interactions challenging. They also, often, have restrictive and repetitive interests. From a medical perspective, Autism is understood to be a disorder however, what is important to note is that many people with Autism do not view their different way of experiencing and approaching life as a disorder. This is largely due to the fact that Autism is a state of being and not something that is cured and nor should it be. People with Autism have great inner resolve and strengths and for many, the diagnosis serves as a comfort as it provides them with the language and tools to understand themselves better. The value of psychiatric diagnosis, generally, is to provide people with a greater understanding of themselves and their behaviour. Unfortunately, for many people with Autism, particularly girls (but not only), the misdiagnosis of Autism results in a life of constantly being misunderstood which can cause the development of eating disorders.

In recent years there has been increased interest in the underdiagnosis of girls with Autism with research suggesting that girls (and other people too) do not necessarily present with Autism in the expected way. It would seem that due to genetic reasons females with Autism are less likely to have a restrictive interest or repetitive behaviour and they are also more likely to camouflage their Autistic traits which means that they appear on the surface to have fewer social difficulties. However, below the surface people, who camouflage easily, are often in turmoil as they try and stay afloat in a world that feels foreign to them. The experience of being seen as okay but never feeling okay eventually starts seeping to the surface and one such way is through the individual’s relationship with food and their body.

Difficulties with food and body image are commonly linked to emotional challenges and stress however, research is now suggesting that Autism might also have a role to play in this relationship. It is hypothesised that the presence of undiagnosed Autism may interact with social and cultural beauty expectations leaving some people, with Autistic traits, susceptible to the development of eating disorders. Interestingly, women with eating disorders score similar to women with Autism in restrictive interests, repetitive behaviour, reductions in social attention, and low social motivation and enjoyment. Based on these findings it has been argued that eating disorders may, in fact, be a manifestation of Autism and that the obsession with food and one’s body forms part of special interest common in Autism. The idea that there is a strong link between Autism and eating disorders is also supported by neuroscience with evidence that there are grey matter correlates between Anorexia Nervosa and Autism.

In order to understand the relationship between eating disorders and Autism better Brede and others (2020) have developed a model which highlights the autism-specific mechanism underlying restrictive eating disorders. According to the model, the following areas of autism-related difficulty are numbed through restrictive eating:

· Food-specific sensory sensitives

· Sensitivities related to eating, digestion and bodily changes

· General sensory difficulties

· Understanding and regulating emotions

· Social interactions and relationships

· Intolerance to uncertainty

· Rigidity and routinized behaviour

· Rigid thinking around food, weight and diet

· Intense interests related to food, weight and exercise

Brede and others (2020) explain that the reliance on restrictive eating to numb or partially resolve autism-related difficulties are moderated by bullying, unrecognised autism, stressful life events and puberty. This means that when those factors are present, they increase negative emotions resulting in an increased need to use restrictive eating as a means of coping. Thus, it is imperative that more is done to screen people with Autism when they present with eating difficulties because a lack of diagnosis of Autism, in those who are actually Autistic, might be making the eating disorder worse.

Based on the above, understanding the link between eating disorders and Autism is important because it provides new knowledge and understanding about the reason for eating disorder development, in so many, and also has implications for treatment. On a more personal level, it helps individuals with eating disorders, who have unknowingly been relying on food because of Autism, feel better understood and less alone in their experience. Just recently a prominent woman battling ED recovery on Instagram was diagnosed with Autism. She expressed in an Instagram post that the diagnosis was hugely important to her because she now understands that there is nothing wrong with her but that she lives in a neurotypical world that is not set up for her. She went on to say that the diagnosis was helping her understand why she finds the world so difficult and why she struggles with certain things. She also explained that the diagnosis of Autism has helped her understand why certain eating disorder treatments have not worked for her. There is no doubt that her experience is echoed by many others.

Eating disorders are complex psychiatric disorders caused by multiple factors. For those with undetected Autism, the road to recovery might be more difficult due to a lack of awareness and appropriate support. Our hope is that as more awareness and research (which needs to be more inclusive) is generated there will be better treatment options available so that all people with eating disorders can get the help and support that they need to live a life of fulfilment in a world that is beautifully diverse.

References

Baron-Cohen, S., Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular Autism, 4(1), 1-8.

Björnsdotter, M., Davidovic, M., Karjalainen, L., Starck, G., Olausson, H., & Wentz, E. (2018). Grey matter correlates with autistic traits in women with anorexia nervosa. Journal of Psychiatry and Neuroscience, 43(2), 79-86.

Brede, J., Babb, C., Jones, C., Elliott, M., Zanker, C., Tchanturia, K., ... & Mandy, W. (2020). “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, 50(12), 4280-4296.

Kerr-Gaffney, J., Hayward, H., Jones, E. J., Halls, D., Murphy, D., & Tchanturia, K. (2021). Autism symptoms in anorexia nervosa: a comparative study with females with autism spectrum disorder. Molecular autism, 12(1), 1-12.

Rhind, C., Bonfioli, E., Hibbs, R., Goddard, E., Macdonald, P., Gowers, S., ... & Treasure, J. (2014). An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents. Molecular Autism, 5(1), 1-9.

Westwood, H., Eisler, I., Mandy, W., Leppanen, J., Treasure, J., & Tchanturia, K. (2016). Using the autism-spectrum quotient to measure autistic traits in anorexia nervosa: a systematic review and meta-analysis. Journal of autism and developmental disorders, 46(3), 964-977.