Intersecting conditions in treatment and recovery
When treating mental health conditions, co-occurring diagnoses are extremely common.
It is frequent, for example, to see anxiety and depression together, and often alongside PTSD or another trauma diagnosis. Similarly, OCD and depression are often co-occurring, as are many eating disorders and anxiety. The link between such conditions has been well established and informs the work of clinicians, psychologists, and other healthcare workers.
In light of this, recovery becomes a process of acknowledging and working with the links between various conditions and how they may be related to or rooted in the same past traumas or experiences. Treatment can be effective in the long term by taking into account how one condition may be affecting the other—and vice versa.
Recent research has helped illuminate a number of the more common co-occurring disorders, some of which have been highlighted above. This is extremely helpful in creating treatment plans for young people, as it offers a broader understanding of how and where certain behaviours, compulsions, thoughts, and feelings are likely to be linked to others where they may otherwise have seemed disconnected or random. However, there are other strong connections between mental health or developmental conditions that are less well understood but which should nevertheless inform treatment.
One such connection is among eating disorders (ED), autism spectrum disorder (ASD), and anxiety disorder (AD). These are all conditions which frequently affect young people, but few people consider just how they interact with one another as co-occurring diagnoses. Here we’ll explore how these three conditions are likely to interact as they co-occur in young people and how that affects behaviours, treatment, and recovery.
Overlapping Behaviours
Interest in the co-occurrence of eating disorders (ED) and autism spectrum disorder (ASD) rose out of frequent reports by clinicians and therapists that ED patients often exhibited ASD-like symptoms and that ASD patients often exhibited ED-like symptoms.[1] For example, constant movement or hyperactivity, which is a symptom of ASD, was also often seen in patients with ED. And in turn, patients who were diagnosed with ASD often displayed tendencies to restrict, control, or obsessively manage food intake, which is one of the most significant symptoms of ED.[2]
The same is true with symptoms of anxiety disorder (AD). One of the marked symptoms of AD is heightened alertness, which may manifest in the body as restlessness, difficulty concentrating, or changes in appetite, which are typical symptoms of ED. It may also manifest socially as a flat affect or an inability or lack of desire to pursue social interactions or relationships. These are all also common symptoms of ASD.[3]
Researchers examining these overlapping behaviours began questioning the possible links between these conditions. And as studies began to look more closely at the connections, they found compelling evidence to suggest that not only are the symptoms of ED, ASD, and AD often similar, but that co-occurrence between these three conditions is consistently high.
Co-Occurrence and Treatment
While it is widely known that those with ED are also likely to suffer from AD, it was only very recently that research was published that indicated that those with ASD are significantly more likely to suffer from ED than the general population, particularly among young people.[4] More recent research has indicated that approximately 20% of people with ED also have ASD and that diagnoses of ASD in children can be considered a likely indicator of diagnoses of ED in adolescence.[5]
With regards to anxiety, research suggests that 65% of patients with ED meet the criteria for an anxiety disorder [6] and that up to 90% of children with ASD experience clinically significant anxiety.[7]
But why is it that these three conditions are so likely to co-occur, and what does it mean for recognising and treating young people who are struggling with these diagnoses?
Dr Claire Jack, an ASD researcher, outlines five main factors behind these intersections:
- Emotional Regulation Issues – ASD is characterised by an inability to regulate emotions, which often leads to anxiety. Individuals may begin to develop ED as an attempt to control their circumstances since they cannot control their emotions.
- Restricted Foods – Restrictive eating – refusing to touch or consume foods based on certain arbitrary rules such as colour or texture – is a common trait exhibited by children with ASD and can lend itself to anxieties about food which may manifest as ED.
- Social Pressures – ASD is often characterised by an inability to fit in due to differently aligned or understood social practices and habits. For young people, looking a certain way – i.e. thinner or more conventionally physically attractive – may seem like an easy way to make friends or be accepted. This can lead to disordered eating in order to achieve the desired, acceptable body.
- Obsessive Interests – Another characteristic of ASD is obsessiveness, particularly regarding particular interests. This lends itself very easily to being obsessed with foods, exercise, calories, etc., all of which are symptoms of ED. Anxiety can also lead to obsessive behaviours and heighten existing ones.
- Routines and Rigid Thinking – ASD often comes with an inability to display cognitive flexibility. In other words, people with autism may find it hard to move from a certain set path. The determination to follow exact routines often extends to food, which can lead to anxiety around eating and ED.[8]
At The Wave Clinic, we specialise in treating ED and AD. Our highly skilled team of clinicians, therapists, and dieticians are specially trained to address co-occurring diagnoses and provide treatment and care for diverse individual needs. Understanding the complex intersections between conditions such as ED, ASD, and AD – particularly as they affect young people who are already in a time of transition and often uncertainty – helps us build collaboratively towards a meaningful recovery.
To learn more, visit our treatment pages: https://thewaveclinic.com/eating-disorders/, or get in touch via our contact page.
Sources
[1] Carpita B, Muti D, Cremone IM, Fagiolini A, Dell’Osso L. Eating disorders and autism spectrum: links and risks. CNS Spectr. 2022 Jun;27(3):272-280. doi: 10.1017/S1092852920002011. Epub 2020 Nov 9. PMID: 33161925.
[2] Nickel, et. al. (2019) Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. Frontiers in Psychiatry. 10: 708. doi: 10.3389/fpsyt.2019.00708
[3] ARI. (2021) Autism and Anxiety. Autism Research Institute. https://www.autism.org/autism-and-anxiety/
[4] Westwood, H. and Tchanturia, K. (2017) Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review. Eating Disorders. Current Psychiatry Report. 19:41. DOI 10.1007/s11920-017-0791-9
[5] Solmi, F. 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. Journal of Child Psychology and Psychiatry. Volume 62, Issue 1 p. 75-85. https://doi.org/10.1111/jcpp.13255.
[6] DeBoer, L. and Smits, J.A.J. (2013) Anxiety and Disordered Eating. Cognitive Therapy and Research. Oct 1; 37(5): 887–889. Published online 2013 Jul 4. doi: 10.1007/s10608-013-9565-9.
[7] Nadeau, J. (2013) Treatment of comorbid anxiety and autism spectrum disorders. Neuropsychiatry (London). Dec; 1(6): 567–578. doi: 10.2217/npy.11.62
[8] Jack, C. (2021) Why So Many People with Autism Have Eating Disorders. Psychology Today. Sept 14. https://www.psychologytoday.com/us/blog/women-autism-spectrum-disorder/202109/why-so-many-people-autism-have-eating-disorders
