Autism and Eating Disorders: A Connection We Can’t Overlook
Mental health clinicians are starting to more deeply examine the connection between autism and eating disorders because research points to a crucial overlap in these two experiences.
Understanding this link isn’t just helpful; it’s essential to effective treatment and sustainable healing. If this is new to you, or you want to learn more about the connection between autism and eating disorders, you’ve come to the right place.
What’s the Link Between Autism and Eating Disorders?
A recent meta-analysis found, “Individuals with anorexia nervosa exhibit higher levels of autistic traits compared with the general population, and there is an overrepresentation of autism spectrum disorder (ASD) among those with anorexia nervosa.”
Some folks with autism also have a lack of interest in food altogether, which can escalate into avoidant-restrictive food intake disorder (ARFID). According to the International Journal of Eating Disorders, ARFID can co-occur with autism in as much as 88 percent of cases.
The presence of autism in folks struggling with an eating disorder also correlates with longer recovery times and poorer treatment outcomes, 2022 research in Frontiers in Psychiatry suggests. One reason for this may be that clinical models for eating disorder care are not built to meet the unique needs or experiences of folks with autism, the research continues.
Why Do Autism and Eating Disorders Often Intersect?
The Journal of Eating Disorders shows an overrepresentation of eating disorder symptoms in both adults and children with at least one form of neurodivergence, with autism being one of the most common. This co-occurrence becomes more prevalent if you factor in other intersectional identities like race, gender, ability, sexual orientation, or chronic illness as well.
Here are some of the underlying causes that can account for this overlap.
Sensory Processing
Many autistic folks are hypersensitive to the texture, smell, temperature, color, taste, or even presentation of food. This can make mealtimes feel overwhelming and result in extreme food selectivity or neophobia (a fear of trying new foods), the European Eating Disorders Review points out. These sensory processing abnormalities can leave folks with a limited number of “safe” food options, which frequently leads to restrictive eating.
Predictable Routines
Another characteristic of autism is a preference for structure and sameness. Research shows that nearly 90 percent of those with autism eat the same foods repeatedly or will not deviate from strict meal routines. While these behaviors can help maintain predictability and comfort, they can also lead to issues such as malnutrition, gastrointestinal problems, drastic weight fluctuations, or social isolation from eating avoidance.
Lack of Interoception
Interoception is the ability to recognize and then respond to internal cues like hunger and fullness. Some folks with autism have trouble interpreting these bodily signals since their emotional and sensory reactions often dull their physical awareness, according to Frontiers in Psychiatry. If someone can’t reliably feel their own hunger and fullness sensations, eating consistently, or eating to the point of discomfort could become a challenge.
Heightened Anxiety
Increased rates of anxiety among people with autism can also contribute to eating disorder behaviors. Anywhere from about 25 to 70 percent of those with autism meet the clinical threshold for anxiety due to traits such as social withdrawal, cognitive inflexibility, and emotional dysregulation. As such, extreme food rules or restrictions can be a coping mechanism to soothe anxious feelings and latch onto a sense of control in overwhelming situations.
Tailor Eating Disorder Healing to the Needs of Folks with Autism
Research emphasizes the need to center treatment around both the diversity and complexity of eating disorder behaviors in neurodivergent folks. This means tailoring a plan to fit their lived experiences, the causal factors of their symptoms, and how they process information, emotions, and sensory input.
This starts with recognizing that autism isn’t a pathology to be “fixed,” but rather, a distinct human experience. As such, eating disorder clinicians should not attempt to minimize or erase autistic traits. Not only is this an unrealistic goal, but it also communicates to the client that an integral piece of who they are is a problem.
Instead of trying to combat someone’s neurodivergence, the goal is to tailor the treatment plan to accommodate it in a way that respects autonomy and nurtures well-being. In an article for the Renfrew Center, Rebecca Berman, LCSW-C, CEDS-S, MLSP, suggests considering the following:
'Stimming'
Stimming (self-stimulation) supports sensory processing, emotion regulation, communication, and stress relief by activating neurotransmitters like dopamine and serotonin, and restricting it removes a vital avenue for self-expression.
While commonly associated with ASD behaviors like hand-flapping or rocking, stimming can also include staring at stimuli or making sounds. Clinicians should approach it with curiosity, staying open to whether a behavior serves as avoidance or as a processing tool, and keeping that conversation ongoing as purposes can shift over time.
Language and Semantics
Autistic individuals tend to interpret language literally, and a lifetime of miscommunication can make ambiguity feel unsafe and contribute to communication-based trauma.
What a neurotypical clinician might read as avoidance or non-compliance, questioning rules, seeking clarification, and flagging inconsistencies often reflects a genuine need for safety and understanding. Clinicians should be direct, detailed, and specific, and never assume implied meaning will land.
Executive Functioning
Executive dysfunction can show up in both obvious and subtle ways in the eating disorder and in treatment, and is often a deep source of shame for neurodivergent individuals. Difficulty completing tasks, hyperfocus that crowds out eating, and struggles with task-switching can all fuel the eating disorder when met with neurotypical expectations rather than curiosity.
Clinicians should explore barriers collaboratively, finding solutions that match the individual's actual capacity, and work to reduce the shame surrounding these challenges.
Healing from an Eating Disorder Is Possible with Autism
We cannot afford to overlook the connection between autism and eating disorders anymore. Doing so will only make it harder for those who are suffering to find the healing resources they deserve.
When we recognize how autism intersects with eating disorder behaviors, it can lead to compassionate, transformative care, built with this community in mind.
