Autism Spectrum Disorder (ASD) is a lifelong developmental condition that can be caused by a variety of genetic factors and physical factors that affect brain development. Whereas an eating disorder (ED) is a mental health condition that can affect anyone. They are two distinct conditions, yet ASD and eating disorders share many similar traits.
Because there’s a strong overlap in symptoms, and ASD can present itself in many wonderfully unique ways, ASD is often misdiagnosed.
What we see in our practice is that sometimes, it might be evident that someone is living with an eating disorder, but the presence of ASD may not be immediately identified.
In this post, Dr Amy Harrison, Senior Associate with Altum Health, explains the link between ASD and eating disorders. We look at the similarities, differences, and why and how ED treatment should be adapted for people with ASD.
How do eating disorders and ASD overlap?
Research suggests that between 4-23% of people with an eating disorder are also autistic. But why is this, and what are the similarities?
It’s largely due to the way people with ASD and those with anorexia think, i.e. their cognitive profiles. Traits can include:
- The need for rules, routines, and rituals
- An inflexible thinking style
- The need for familiarity and control
- Restricted and repetitive interests
- Difficulty with social and emotional interaction
- Fixation with finer details rather than the bigger picture.
How do eating disorder symptoms mask ASD?
Given the number of similarities between ASD and eating disorders, ASD can be tricky to spot when both are present.
As we mentioned at the start of this post, ASD is a developmental condition. It’s part of the person’s development and will always be with them. However, an eating disorder is an illness that you can recover from.
Therefore, a specific diagnosis of ASD can be made by:
- Assessing the person’s developmental history, i.e. whether ASD has always been evident.
- Analysing the motive behind the person’s behaviours.
To diagnose someone with ASD, we look at their developmental history. This is done by speaking with the individual, and with their loved ones, who’ve known them from an early age and can answer questions about their development. This helps us to gather evidence of ASD traits.
With ASD, people get a lot of pleasure from their routines and rituals. Restricted and repetitive rituals surrounding food will often limit someone with ASD to certain types of food based on taste or texture.
People with an eating disorder, however, are compelled by these rituals and repetitive behaviours. And while these behaviours may make them feel safe or better able to cope with difficult emotions, they are ultimately very distressing and not enjoyable.
It’s worth noting that someone with an eating disorder could be mistaken for having ASD, due to the effect of starvation on the brain. These effects can include avoiding social interaction, becoming more reclusive, being fixated on tiny details, showing inflexible behaviours, and the breakdown of relationships. When weight is restored, these effects may disappear; it could be worth waiting until the person is at a healthier weight to decide whether ASD assessment is genuinely needed.
Is it more challenging to recover from an eating disorder if you have ASD?
Due to the traits of ASD, and the challenges it can create with communication and social interaction, it can be much harder for someone with ASD to recover from an eating disorder compared with a neurotypical person.
Why do ASD traits make eating disorder recovery more difficult?
People with ASD typically engage in repetitive behaviours and rituals. Their thinking style is inflexible, being averse to change or a shift from their rules and routines. Often, someone with ASD will experience sensory issues, sometimes around texture and taste.
Eating disorder therapy requires people to change their thoughts and behaviours around their eating habits. This could be particularly difficult for someone with ASD, who has set rules, rituals, and routines concerning food.
What’s more, the nuances of ASD make an eating disorder more severe, enduring, and harder to recover from in comparison with a neurotypical person, but not impossible!
How do the challenges of social interaction and communication make ED recovery harder for those with ASD?
We know that people with ASD might not have the same supportive social network as a neurotypical person, yet social support is very important as part of eating disorder recovery.
Ordinarily, therapy is a form of social interaction that relies on communication. For someone with ASD, who may find social interaction and communication difficult or overwhelming, it can be harder to take part in, or benefit from therapy.
As practitioners, it’s our job to be mindful of these differences and adapt eating disorder therapy to better suit the needs of someone with ASD.
Where to turn if you suspect you have ASD
It might be a shock to realise you could have ASD. The word ‘autism’ often conjures up a stereotypical image of a child who can’t communicate, not an adult with an eating disorder.
However, if you’re reading this and it resonates with you, getting a diagnosis could help to explain why you may have been struggling with eating disorder therapy and why you may have felt stuck.
The first port of call should be your GP, where you can ask for an ASD assessment.
Alternatively, the team at Altum Health are here to offer a professional assessment, too.
These are normally done via an Autism Diagnostic Interview (ADI), which we conduct with you and with someone who’s known you since early development, e.g. a parent or sibling. This person should be someone who can reliably tell us about your developmental history to help identify signs of ASD. We combine the information gathered with the client’s own understanding of their own lifelong difficulties.
How is eating disorder therapy adapted for people with ASD?
With a diagnosis in hand, we then look at how we can adapt treatment for the eating disorder to make it more accessible and effective for someone with ASD.
- We start by taking the time to understand the client’s differences so they can be accounted for within the therapeutic environment.
As an example, if direct conversation is really overwhelming, we can adapt the interaction. We might explore phone conferencing rather than therapy in person. Some people prefer to sit side-by-side rather than face-to-face with their therapist. Sometimes people prefer a plain room with lowlights to minimise the sensory elements.
- When it comes to the eating disorder therapy itself, we are mindful of the ASD traits that might make it more difficult for that person to engage positively in the process.
For example, rather than increasing the diversity of foods as part of eating disorder recovery, it might be more effective to look at which foods the person would eat before the eating disorder appeared, and increase the volume of those. Typically, this might be bland foods with simple textures.
Crucially, there’s no ‘one size fits all’ approach. Each person with ASD is beautifully different from the next, so it’s important to understand these differences in order to adapt the therapeutic environment, and how therapy is delivered, to make it most effective.
Managing eating disorder recovery with ASD
Hearing the word ‘autism’ may feel upsetting, but I urge you not to panic. ASD is simply a difference. It’s not a barrier to achieving all the things you want to achieve, either with therapy, or with life in general.
It’s important to be open and honest about your feelings with your loved ones. They might make suggestions as to how things could be adapted to make things easier for you.
There’s a wealth of information online about ASD. You may choose to read up to discover which parts of this condition make sense to you.
And please do reach out to our licensed and trained professionals for help and advice. You can book a free 20-minute consultation with us by clicking here.