Mental health disorders are more common among autistic young people than those who are not autistic. Research by Autistica suggests that seven out of ten autistic people experience challenges with their mental health. This can make daily life more difficult for autistic young people and prevent them from pursuing their passions and goals.
Eating disorders are serious and complex mental health conditions with physical, psychological, and social consequences. There are several different types of eating disorders with varying underlying pathologies, characteristics, and symptoms. Eating disorders (of several types) are more common among young autistic people than others – and many young people with eating disorders are autistic.
While eating disorders are complex conditions, they are treatable. With the right support, young people can recover and enjoy a healthy, fulfilling future. Treatment providers who have experience working with autistic people can adapt therapy sessions and other approaches to ensure that treatment is comfortable and welcoming for each individual.
This blog offers some information on autism, eating disorders, and why they often come together.
What Is Autism?
Autism is a neurodevelopmental condition where a person’s brain works differently from others. It is not an illness, mental illness, or mental health condition. It means that someone may act, think, and relate to the world in a different way.
Autism is a spectrum, and every autistic person is different. Because many aspects of the world are set up and designed for neurotypical people who are not autistic, autistic young people may need additional support to live within these systems. Some autistic people need more support to navigate daily life, and others need less, or even none.
Autism can involve a diverse range of traits and characteristics. Some of the most common include:
- repeating the same thought process or behaviour many times
- finding new or unfamiliar situations stressful
- being overwhelmed by certain sensory experiences, such as loud sounds or bright lights
- becoming fascinated by specific topics
- finding it hard to read or understand what another person is experiencing
How Common Are Eating Disorders Among Autistic People?
Research suggests that eating disorders are more common among autistic people than the general population. This includes anorexia nervosa, bulimia nervosa, and binge eating disorder, as well as avoidant/restrictive food intake disorder (ARFID).
Unlike the other three disorders, ARFID doesn’t involve concerns about body shape or weight. This means that it’s sometimes helpful to consider it separately.
A study among autistic adults found that 10.8% had an eating disorder. Of these, 6.7% had anorexia nervosa, 2.7% bulimia nervosa, and 1.4% binge eating disorder. The study suggests that eating disorders are more common than among non-autistic people, particularly anorexia nervosa.
Other research among female adolescents found that girls with a form of autistic spectrum disorder were at a higher risk of developing eating disorders than others. 26.8% of girls with Asperger’s syndrome scored above the cut-off point of the eating attitudes test, compared to only 7.1% without.
Research has also found that people with eating disorders may be more likely than others to have autism spectrum disorder (ASD) or show autistic traits. People who have a current diagnosis of (or have recovered from) anorexia nervosa are more likely to meet the DSM-V criteria for ASD. Equally, some studies suggest that around 20-30% of people with eating disorders are autistic.
Why Do Autism and Eating Disorders Often Come Together?
Experts still aren’t sure exactly why eating disorders are so common among people with autism (and vice-versa). One theory is that some autistic traits overlap with character traits that are common among people with eating disorders (or considered risk factors for EDs). This might mean that autistic people are more likely to develop disordered eating behaviours.
Autistic traits are traits that are common to people with autism spectrum disorder. Because autism is a spectrum, some people may exhibit autistic traits without meeting the criteria for an ASD diagnosis. Equally, someone with an ASD diagnosis may only show some common autistic traits.
Some autistic traits, such as narrow or focused interests, difficulties handling change, and perfectionism, are also common among people with eating disorders. For young people with EDs, these traits may be expressed in relation to eating and concerns about body image. For example, perfectionist traits may manifest as a preoccupation with an ‘ideal’ body shape that underpins disordered eating behaviours.
Equally, young people with eating disorders sometimes think and act in ways that mimic autistic traits. People with anorexia are more likely than others to experience social anhedonia and alexithymia – an inability to enjoy social situations and difficulty expressing emotions. These patterns are also found among autistic people.
That said, it’s still not clear whether overlapping autistic and eating disorder traits are responsible for their common co-occurrence. An alternative theory explains the link between autism and eating disorders as a more general consequence of autism and mental health. Within contemporary society structures, young autistic people are at a higher risk of developing mental health symptoms like depression, anxiety, and low self-esteem than non-autistic people. These experiences, in turn, may make the development of eating disorders more likely.
Understanding ARFID and Autism
ARFID is a type of eating disorder involving selective or restrictive eating. Young people with ARFID may avoid certain food groups or types of food or only eat a small selection of foods. They may also eat little food in general.
People with ARFID are not just ‘picky’ eaters. Instead, they sometimes feel unable or find it very difficult to eat and don’t meet their energy or nutritional requirements. ARFID involves disordered eating behaviours that are not driven by body image issues or a fear of gaining weight.
Research shows that ARFID is more common among autistic people than those who are not autistic. It also suggests that while it’s normal for both autistic and non-autistic children to have phases of picky eating, autistic children are more likely to experience persistent selective or avoidant eating and eat a narrower range of food.
What Causes Selective Eating and Food Avoidance Among Autistic People?
There are several different reasons that autistic traits may lead to food avoidance or selective eating. These include:
- Sensory sensitivities
- Needing specific eating routines
- Anxiety about new eating experiences and difficulties coping with change
Sensory Sensitivities
Autistic people are often more sensitive to certain sensory experiences or process them in a different way. This includes feeling overwhelmed by bright lights or loud sounds but also sensitivity to particular sights, sounds, tastes, smells, and textures. Studies have found that 90% of autistic people have sensory symptoms.
The most common reason for food avoidance among autistic people is an aversion to the sensory experience of eating a certain food, most often its texture. This means they may find it very distressing or almost impossible to eat certain kinds of food.
Some autistic people only eat food with little texture, such as pureed foods. Others may find it hard to eat food that is not bland and starchy, like pasta and potatoes. This can lead to a narrow diet without the nutrients required to stay healthy.
Specific Eating Routines
ARFID is often caused by aversions to foods or types of food, but it can also be connected to the process of eating or eating environment. Autistic people who find it distressing or difficult to change routines may need certain conditions to comfortably eat food. This might mean using specific cutlery or only eating food that’s presented a certain way.
Anxiety About Eating
Autistic people often experience anxiety about trying new things or changing routines. This may make it difficult to try new foods and eat a varied and balanced diet. Research shows that autistic young people who are less able to adapt to change have higher levels of selective eating and food avoidance.
The Wave Clinic: Making a Difference in the Lives of Young People
The Wave Clinic offers world-leading recovery support for young people, specialising in eating disorders, borderline personality disorder, and complex trauma. We set the global standard for child and adolescent mental health care, offering a diverse range of evidence-based modules led and delivered by experts from around the world.
Our residential centre combines exceptional clinical care with education, enriching experiences, and social responsibility. It supports young people in growing in self-confidence and finding their place in the world. Our programs are about finding new life paths, learning new skills, and building life advantages.
Our core values of fairness and inclusivity underpin everything we do. We cater to neurodiverse young people throughout our programs with experience and expertise.
If you’re interested in finding out more about our programs, contact us today. We’re here to make a difference.
