I’m an eating disorder therapist, but today, I’m writing about autism spectrum disorder (ASD). Why? Eating disorder and autism are commonly co-occurring disorders.
That might come as a surprise, considering eating disorders are stereotypically “female” illnesses and autism seems to be most common in males.
There are a lot of misconceptions about eating disorders that you’ll need to throw out the window in order to gain a better understanding of how the illness operates in tandem with autism. The assumption that they discriminate based on sex is one of them. Another is the false idea that they are fueled by a person’s desire to be thin.
Eating disorders are about control. Broadly speaking, they are also coping mechanisms. So, a person with autism might use disordered eating behaviors to cope with anxiety in social situations, sensory overload, and other difficult situations. When you can’t always control your environment and your response to it, controlling your body by exercising and limiting your food intake can be tempting.
Both neurotypical people who develop anorexia nervosa and people on the spectrum often exhibit perfectionistic tendencies. This includes thinking in black and white, following strict rules, and seeking the “right” way of doing things.
But the similarities between people with anorexia and people with autism go beyond perfectionism, and can include:
-
A tendency to focus on small details rather than the big picture
-
Difficulty interpreting social cues
-
A lack of awareness of their impact on others
-
High levels of sensitivity and empathy
-
A strong desire for social acceptance
-
Rigidity in routines
-
Difficulty dealing with change
-
Eating rituals or what we might refer to as “OCD” behaviors
A study found that women with anorexia struggle to make friends and maintain relationships before, during, and even after recovery. The prolonged starvation they subjected their bodies to only exacerbated their struggles with cognitive and social skills, and other autism traits they exhibited.
The gendered stigma around ASD means that many people who are assigned female at birth (AFAB) will be diagnosed later in life. But stigma alone isn’t responsible for the misdiagnosis and underdiagnosis of female-bodied people with autism. Autism also presents differently in the female sex. AFAB people with autism often exhibit less repetitive behaviors, more desire for social interaction, and overall, they have an easier time fitting in because they have a better understanding of how to mimic other people, the act of which is called “masking.”
AFAB people on the spectrum who have eating disorders often receive the eating disorder diagnosis and treatment before their autism is ever acknowledged or addressed. This can be problematic for a number of reasons, including the fact that eating disorder treatment can often involve group therapy, which may be difficult for people with ASD to navigate, and the fact that the food in residential treatment centers and hospitals might raise sensory issues due to taste and texture.
Treating an eating disorder in someone with undiagnosed ASD can be frustrating for professionals, because they won’t be able to understand the reasons their client has turned to eating disorder behaviors, and therefore, won’t be able to help them overcome the disorder.
In many cases, autism must be diagnosed and properly addressed in order for eating disorder treatment to be effective.
If you or your child has been diagnosed with ADHD, OCD, BPD, and/or PTSD and an eating disorder, it may be worthwhile to bring up the possibility of ASD with your primary care provider or therapist.
Therapists who treat women and AFAB trans/nonbinary clients may want to take a closer look at the communication in their sessions. If you notice a client is taking everything you say literally, being extremely blunt, or having difficulty understanding what you mean, it may be helpful to refer them to someone who specializes in autism or other communication disorders.
If you are located in California and you or a loved one is struggling to have a healthy relationship with food and/or exercise, please contact us for a free 15-minute consultation to explore your options for recovery.
