Approximately four per cent of the Australian population are currently impacted by an eating disorder, which equates to around one million people.

And around one in four of these people may also have autism. These staggering statistics indicate an alarming number of people are struggling – and many are not receiving appropriate care.

With eating disorders being so prevalent in both neurodivergent and neurotypical communities, it’s vital that all those affected, and their loved ones, have access to information and support that is relevant to their needs and circumstances. In this post, we’ll take you through some of the eating disorders that often affect neurodivergent people, with links to further resources for neurodivergent people and their loved ones:

• What’s the link?
• Myths and misconceptions
• Anorexia nervosa
• Avoidant Restrictive Food Intake Disorder (ARFID)
• Pica
• Your next steps

What's the link?

Over the past few decades, research has pointed to a link between autism and certain eating disorders, particularly anorexia nervosa. Although the reason for this link isn’t completely understood, some potential reasons have been explored:

Sensory sensitivities

The sensory sensitivities experienced by people on the autism spectrum can make consistent and healthy eating a challenge. Autistic people can have heightened reactions to the colours, textures, smells and appearances of certain foods, which can vastly restrict their diets and nutrition.

Social and emotional challenges

Eating disorders might also develop due to a desire to gain acceptance in social settings. By striving towards a thin body type, an individual may hope to be admired by their peers and be included in social circles that share this ideal.  

Many autistic people may restrict their diets as a coping mechanism to mask anxiety and other emotions. Alexithymia, defined as the inability to recognise or articulate one’s emotions, is a common challenge for autistic people, preventing them from communicating their struggles with others and accessing appropriate support. If unable to share their struggles effectively and be taken seriously, they may develop an eating disorder as an attempt to grapple with difficult emotions and experiences.

Calorie counting, excessive exercise and other behaviours associated with eating disorders can also be classed as repetitive behaviours for people on the autism spectrum.

Myths and misconceptions

Autism and eating disorders share another frustrating commonality: they’re both clouded in harmful myths and misconceptions. To understand both experiences and better support autistic people struggling, we need to separate fact from fiction.  

Research indicates that for autistic people, eating disorders are less likely to be motivated by body image issues, perhaps making them harder to identify and treat. For people with autism, unaddressed sensory sensitivities, emotional challenges, and harmful restrictive and repetitive behaviours are often a bigger contributor.

It’s also important to remember that eating disorders don’t just affect young women and girls: they can impact people of any age, gender, culture, sexuality or size. And those are affected often hide their symptoms. Just because someone doesn’t look or behave in ways typically associated with an eating disorder doesn’t mean they’re not struggling.

And finally, although eating disorders are complex and often don’t have a clear cause, complete recovery is still possible. Many autistic and non-autistic people who have struggled with eating disorders go on to live happy and fulfilling lives.

Anorexia nervosa

Anorexia is a psychological illness defined as an obsession with weight, eating and avoiding being overweight. It often develops during adolescence, but can impact people of any age, gender or background. A link between autism and anorexia has been observed as early as the 1980s, with approximately 20-35% of women with the disorder also meeting the diagnostic criteria for autism.

Below are some of the signs of anorexia nervosa:

• Preoccupation with body shape, appearance, weight, food and food-related activities.
• Obsession with body-checking behaviours, repetitive dieting, rituals involving food, excessive or compulsive exercise or restrictive or rigid eating patterns.
• Fear of food-related activities, social situations involving food and heightened anxiety around mealtimes.
• Heightened sensitivity to comments or criticism around weight, appearance, exercise, body shape or eating habits.
• Constant or repetitive dieting, restrictive or rigid eating patterns.
• Rigid thinking (‘good and bad’ foods) and feeling out of control. 
• Changes in clothing style and/or food preferences.
• Negative or distorted body image.
• Intense fear of gaining weight.
• Impaired work or school performance.
• Deceptive or secretive behaviour around food.
• Low self-esteem, mood swings, anxiety or depression.
• Suicidal or self-harming thoughts or behaviours.

Anorexia can cause a range of physical, emotional and social challenges and has the highest mortality rate of any psychiatric illness. Complete recovery is possible for those affected, but they must have access to appropriate treatment and support from professionals, such as a psychologist or dietician.

Avoidant Restrictive Food Intake Disorder

Avoidant Restrictive Food Intake Disorder (ARFID), previously referred to as SelectiveEating Disorder, is defined by the DSM-5 as a continued pattern of irregular feeding or eating that results in a person failing to meet their energy or nutritional needs. A person affected by ARFID will display at least one of the following symptoms that cannot be explained by another medical condition or eating disorder (e.g., food allergies or intolerances):  

• Significant weight loss or inability to achieve physical growth/weight gain (children).
• Significant nutritional deficiencies.
• Impacted psychosocial functioning (e.g., struggles with basic daily activities).
• Dependence on tube feeding or oral nutritional supplements.

Many autistic people are labelled as ‘picky’ or ‘fussy’ eaters, however, some of these people may be experiencing ARFID. And although this disorder typically develops in childhood or adolescence, it can affect people of any age. For people with autism, ARFID can be caused and exacerbated by a range of factors:

• Sensory sensitivities (e.g., discomfort with the texture or colour of food, avoiding fruit and vegetables).
• Lack of interest and/or pleasure in food (e.g., reduced appetite, lack of enjoyment with eating, forgetting to eat).
• Fears and phobias relating to eating (e.g., choking, phobias of foods).

Complete recovery from ARFID is possible with professional treatment and support.

Pica

Pica involves the craving and chewing of substances that are not considered food or have little to no nutritional value. Items that are commonly craved by those with pica include ice, clay, soil, paint chips, paper and hair. A person will sometimes consume these items.

Many young children (usually under the age of two) will try to eat or put non-food items in their mouth out of curiosity. However, for someone with pica, this will occur frequently and uncontrollably. If a person over the age of two (including adults) begins or continues to chew or consume non-food items regularly, they may have pica.

Managing pica can occur through a range of strategies. Those affected may benefit from seeing a psychologist or psychiatrist, the latter of whom can prescribe medications to support with pica-related behaviours. Family, friends and loved ones can also support this person by:

• Shelving commonly craved items out of reach
• Locking commonly craved items in cabinets, deep freezers, etc.

Managing pica is important, as it can prevent those affected from developing the following health problems:

• Injuries to the mouth or teeth
• Iron-deficiency anaemia
• Constipation or diarrhoea
• Intestinal infections
• Intestinal obstructions
• Lead poisoning

If you believe someone has ingested something harmful, contact your GP. In an emergency, contact 000 or one of the Poisons Information Centres below:

• ‍NSW 
• ‍VIC‍
• QLD
• SA
• WA
• NT

Your next steps

Finding support for yourself or someone you know experiencing an eating disorder can be incredibly daunting, particularly when many services are challenging to access for neurodivergent people. Visit the sites below for comprehensive and evidence-based eating disorder information, resources and support:

• The Butterfly Foundation
• Eating Disorders Victoria
• ReachOut

For more information on autism, you might like to visit the following articles:

• Eating disorders and autism
• Looking after yourself (autistic adults)
• Looking after yourself (parents and carers)
• Therapies and supports (autistic people and their parents/carers)