Eating disorders and autism

Eating disorders and unusual eating habits are common among autistic individuals, with studies showing that around 70% of autistic children face these challenges, and these issues often persist into adulthood. 

Adults with autism might experience things more intensely or differently, which can make eating habits challenging. Sensory issues, feeling anxious in social situations, and rigidity in routines can lead to being picky with food or having trouble with meals.

Risk factors

Sensory sensitivities

Sensory sensitivities are a major factor affecting the eating habits of autistic adults. The texture, smell, and appearance of food can be overwhelming. For example, the crunchiness of a carrot might be too intense for some, while the mushiness of mashed potatoes might be equally off-putting for others. These reactions are not just preferences but genuine sensory responses that can make certain foods unbearable. As a result, many autistic adults might have a very limited diet, sticking to foods that they find sensory-friendly and avoiding those that cause discomfort.

The social side of eating

Eating is a social activity, and this aspect can be particularly challenging for autistic adults. Social norms around eating, such as dining with others, engaging in conversation during meals, or waiting for everyone to be served before starting to eat, can be sources of stress and anxiety. The pressure to conform to these social expectations can make mealtime an uncomfortable experience. Many autistic adults may prefer to eat alone or in a familiar setting where they can control their environment and reduce social stressors.

Rigid routines and eating patterns

Routine and predictability are often important for autistic individuals. Many autistic adults have specific mealtime routines, including repeatedly eating the same foods or sticking to strict schedules. Disruptions to these routines can cause distress and may result in refusal to eat or increased anxiety. Understanding these routines can help create a more comfortable eating environment for individuals with autism. Collaborating with them to adjust the routine should be done gradually and at a slow pace.

Social and emotional challenges

Eating disorders among autistic people often arise from social and emotional struggles. Some might limit their diets to fit in socially or manage anxiety. Trying to be accepted by peers can lead to striving for a certain body type. Additionally, many autistic people might restrict food to cope with their emotions.

Alexithymia, a common issue for autistic individuals, involves difficulty recognising or expressing emotions. This can make it hard for them to communicate their struggles and seek help. In such cases, an eating disorder might develop as a way to manage these unexpressed emotions.

Behaviours like calorie counting and excessive exercise can become repetitive or obsessive actions that are common in autism. These behaviours can be a way to express control and manage anxiety in a world that often feels unpredictable.

Myths and misconceptions

There are many myths and misconceptions about autism and eating disorders. It's crucial to separate fact from fiction to provide better support for autistic individuals with eating disorders. Research shows that eating disorders in autistic people are often not driven by body image issues but by sensory sensitivities, emotional challenges, and repetitive behaviours.

Eating disorders can affect anyone, regardless of age, gender, culture, sexuality, or size. Often, symptoms are hidden, so it's important not to assume that someone isn't struggling just because they don't fit the typical profile of an eating disorder.

Common eating disorders

Anorexia nervosa

Anorexia nervosa is a psychological condition characterised by an obsession with weight, eating, and avoiding weight gain. It commonly develops during adolescence but can affect individuals of any age. Research has found that approximately 20-35% of women with anorexia are also autistic. Common signs of anorexia nervosa include:

• Obsession with body shape, appearance, weight, food, and food-related activities.
• Obsession with body-checking behaviours, repetitive dieting, and rituals involving food.
• Fear of social situations involving food and anxiety around mealtimes.
• Sensitivity to comments about weight, appearance, or eating habits.
• Rigid thinking about ‘good and bad’ foods.
• Major changes in clothing style or food preferences.
• Negative body image and intense fear of gaining weight.
• Lying about or hiding food and eating habits.
• Low self-esteem, mood swings, anxiety, or depression.

Anorexia can lead to physical, emotional, and social challenges and has a high mortality rate among psychiatric illnesses. However, recovery is possible with the right treatment and support from professionals such as psychologists and dieticians.

Studies suggest there may be genetic or familial links between autism and anorexia. For autistic individuals, body image might be less of a concern. Instead, restrictive eating may be a way to manage emotions and anxiety. Repetitive behaviours, such as calorie counting or excessive exercise, can also develop into anorexia. Autistic individuals who restrict food without focusing on weight might be diagnosed with avoidant/restrictive food intake disorder (ARFID).

ARFID

Avoidant/restrictive food intake disorder (ARFID), previously known as selective eating disorder, is defined as a pattern of disturbed eating that leads to a failure to meet nutritional or energy needs. ARFID symptoms include significant weight loss, nutritional deficiencies, struggles with daily activities, and dependence on nutritional supplements.

Many autistic individuals are labelled as ‘picky’ or ‘fussy’ eaters, but some may be experiencing ARFID. Factors contributing to ARFID in autistic people include sensory sensitivities, lack of interest in food, and food-related fears.

Managing and improving ARFID is possible with professional help and therapy. ARFID differs from anorexia in that the food restriction is not driven by a desire to control weight or body shape. They are often driven by sensory sensitivities, anxiety or rigidity in thinking. 

Pica

Pica is a condition characterised by an uncontrollable urge to consume non-food items such as ice, clay, soil, paint chips, paper, and hair, all of which lack nutritional value. Unlike the exploratory behaviour seen in toddlers, pica persists beyond early childhood and can continue into adulthood.

The management of pica typically involves consulting with mental health professionals such as psychologists or psychiatrists, who may prescribe medications to help manage the impulses. Support from family and friends is also crucial; they can help by ensuring that items commonly craved are kept out of reach or securely locked away.

Addressing pica is crucial not only to stop harmful eating behaviour but also to prevent associated health risks. These risks include dental damage, iron deficiency anaemia, digestive disturbances such as constipation or diarrhoea, intestinal infections and obstructions, and lead poisoning. Effective management and supportive care are essential to improving the health and wellbeing of individuals with pica.

Overeating

Overeating in autistic individuals can have various causes, and understanding these can help effectively manage their eating behaviours. Some may experience increased appetite due to medications, so consulting a GP or paediatrician is recommended if this is an issue. Others might overeat due to habits such as snacking during screen time or boredom.  Compulsive behaviours, irregular meal times, sensory sensitivities, and emotional triggers can also contribute to overeating.