Autism and Anorexia: What’s the Link?

autism and anorexia

Autism and anorexia nervosa might seem like completely separate conditions, but research suggests a surprising connection. People with autism spectrum disorder (ASD) are at a higher risk of developing eating disorders, particularly anorexia. This article explores this link and how to approach treatment for autistic individuals struggling with anorexia.

autism and anorexia

The Link Between Autism and Anorexia

Research suggests a surprising link between autism spectrum disorder (ASD) and anorexia nervosa. While the exact reasons are still being explored, several studies have identified a higher prevalence of autism in individuals with eating disorders, particularly anorexia. This co-occurrence points towards a potential bi-directional relationship, meaning being autistic might increase the risk of developing anorexia, and vice versa.

autism and anorexia

Why Might Autistic People Be More Prone to Anorexia?

Several factors unique to autism may contribute to this connection:

  • Sensory Sensitivities: Many autistic individuals experience strong sensory aversions or preferences related to food. Textures, tastes, and smells can be overwhelming, leading to restricted eating patterns and a reduced variety of safe foods.
  • Repetitive and Restrictive Behaviors: People with ASD often thrive on routine and predictability. Food restrictions can become a way to exert control over their environment and manage anxiety. They may limit themselves to a small number of familiar foods, making it difficult to introduce new healthy options.
  • Social Difficulties: Eating is often a social activity, and social situations can be stressful for autistic people. They might avoid eating altogether to escape these situations, leading to unhealthy food intake.

The Challenge of Diagnosing and Treating Co-occurring Conditions

The way anorexia manifests in autistic individuals can differ significantly from those without ASD. While body image concerns can be a factor, autistic people often restrict food intake due to sensory sensitivities, anxiety, or the desire for control. This highlights the importance of a nuanced diagnosis that considers both conditions to create effective treatment plans.

Emerging Research on the Bi-directional Link

Recent studies suggest a potential two-way street in this relationship. A 2021 review found that autistic traits often appear before the development of anorexia. Additionally, a 2017 review linked increased autistic traits with higher obsessive-compulsive tendencies, a common feature in eating disorders. This could explain why some autistic individuals use food restriction as a compulsive behavior to manage anxiety, mirroring an obsession.

Further Considerations: Gender Bias and Prenatal Influences

It’s important to acknowledge the limitations of current research. Most studies focus on females with anorexia, potentially overlooking the prevalence in autistic males who are often underdiagnosed with both conditions. 

Furthermore, a recent Swedish study suggests a possible link between a mother’s history of anorexia and an increased risk of autism spectrum disorder in their children. This finding warrants further investigation into potential genetic or environmental factors at play.

https://youtu.be/wHQWYZ0JlZs?si=JR6F9FsSjJb1W2pb

Why So Many People with Autism Have Eating Disorders

People with autism spectrum disorder (ASD) are at a significantly higher risk of developing eating disorders, particularly anorexia nervosa. Understanding the reasons behind this link is crucial for providing effective treatment. Here are some key factors contributing to this increased risk:

1. Emotional Regulation Issues

Autism is characterized by challenges with emotional regulation, making individuals more susceptible to anxiety and depression. These mental health struggles can lead to the development of eating disorders as a coping mechanism. 

Foods high in fat and sugar can trigger the release of calming neurotransmitters, offering a temporary escape from overwhelming emotions. This can create a cycle where food becomes a preferred method of managing anxiety, leading to disordered eating habits.

2. Restricted Foods and Sensory Sensitivities

Children with ASD often exhibit restrictive eating patterns that can persist into adulthood. Beyond a higher prevalence of food allergies, sensory sensitivities around food play a significant role. Certain textures, tastes, or even colors of food can be overwhelming or unpleasant, making mealtimes a stressful experience. 

3. Social Pressures and the Desire to Fit In

For autistic girls who already struggle with social interaction and acceptance, losing weight can become a misguided attempt to gain social currency and feel “normal.” Marianne’s story exemplifies this phenomenon, highlighting how the desire to fit in can inadvertently trigger a lifelong eating disorder.

4. Obsessive Interests and Fixations

A hallmark of autism is the tendency to develop intense interests and focus on specific topics. This can manifest as an unhealthy fixation on food, with calorie counting and dietary restrictions becoming the focus of an autistic individual’s world. 

5. Rigidity and Difficulty Adapting

Executive function challenges, including difficulties with cognitive flexibility, are common in autism. While autistic individuals can be incredibly determined and persistent, this can become a barrier when it comes to changing established routines. 

When a fixed idea about food and eating takes hold, the rigidity associated with autism can make it difficult to shift towards healthier eating patterns. This inflexibility can fuel or exacerbate an existing eating disorder.

autism and anorexia

Treating Anorexia in Autistic People 

Traditionally, Family-Based Treatment (FBT) has been the gold standard for treating anorexia in young people. This approach involves actively engaging the family in supporting the individual’s recovery through mealtime assistance and weight restoration.

Recent studies offer promising news. A 2022 study by Bentz et al. found that FBT can be just as effective for autistic adolescents with anorexia as for their non-autistic counterparts in achieving weight restoration and treatment goals. This challenges previous assumptions about treatment outcomes for autistic individuals.

However, the same study also revealed a need for adaptations to FBT for autistic individuals. Loomes and Bryant-Waugh suggest incorporating strategies like:

  • Increased predictability: Providing consistent routines and schedules for therapy sessions and meals can reduce anxiety for autistic individuals.
  • Sensory considerations: Accommodating preferences for textures, tastes, and smells can make mealtimes less overwhelming. This might involve offering choices or introducing new foods gradually.
  • Routine and sameness: Recovery often involves gradual increases in food intake. Therapists can work with families to create predictable routines for reintroducing variety while ensuring adequate nutrition.

Beyond FBT adaptations, therapists specializing in both ASD and eating disorders offer crucial support. They can address the underlying autistic traits that might contribute to the eating disorder, such as anxiety or social difficulties.

Considering ABA Therapy?

If you’re looking for support for someone with autism in New Jersey, Oklahoma, Georgia, or Texas, Rainbow ABA offers top-rated Applied Behavior Analysis (ABA) therapy services. ABA therapy can be a valuable tool in addressing the core challenges of autism, which may indirectly help with eating difficulties.  

Contact us in Rainbow ABA today to learn more about our programs and how we can help!

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