Autism & Eating Disorders: Understanding the Connection

What Is Autism?

Autism is a neurotype in which the ways that someone thinks, processes, and relates to the world are different from neurotypical people. Behavioral symptoms often emerge when a child is around 1-2 years old. However, most children are not diagnosed until after age 3.² Common autistic characteristics include language delays, avoidance of make-believe play, lack of social interactions, repetitive stimming behaviors, and difficulties with transitions. However, it’s important to note that symptoms and characteristics exist on a wide spectrum.

Research shows that about 1 in 44 children has autism. It’s diagnosed four times more frequently in boys than girls.³ While once perceived as a disability, there is an ongoing conversation about destigmatizing autistic behaviors and acknowledging neurodiversity. From this framework, an autistic person simply operates differently from a neurotypical person.

What Are Eating Disorders?

Eating disorders are mental health conditions characterized by issues with food, weight gain, exercise, and control. While eating disorder symptoms vary based on the type of eating disorder and its intensity, people with eating disorders generally fixate on how, when, and what they eat. They often struggle with poor body image and low self-esteem and have a marked fear of gaining weight.

Research shows that approximately 9% of the U.S population will have an eating disorder in their lifetime. And while many people assume people with eating disorders are underweight, fewer than 6% actually are. Next to opioid overdose, eating disorders are considered the most deadly mental illness, contributing to one death every 52 minutes.⁴

5 Connections Between Autism & Eating Disorders

Although research isn’t sure exactly why autism and eating disorders overlap, there appears to be a strong correlation between both conditions. It’s probable that they share certain risk factors and comorbidities. For instance, obsessiveness, rigidity, and themes of perfection coincide with both conditions.⁵

Here are five commonalities between autism and eating disorders:

1. Emotional Regulation Difficulties

Struggles with emotional regulation are a common symptom in both eating disorders and autism. Problems with emotional dysregulation can exacerbate stress, and people may turn to restricting food or emotional eating to cope.

2. Obsessive Interests

Autism and eating disorders both entail repetitive tasks like counting calories, tracking steps, or avoiding certain types of food, which can become ritualistic. In a sense, a person with either condition may use these behaviors as a way to cope with stress and maintain a sense of control.

3. Rigid Thinking

All-or-nothing thinking is a classic symptom of both autism and eating disorders. Those with either or both diagnoses perceive certain foods or situations as ‘safe’ or ‘unsafe.’ Something is ‘good’ or ‘bad.’ The body is either ‘perfect’ or a ‘failure.’ This rigid thinking is often a result of executive dysfunction.

4. Social Difficulties

Eating disorders and autism can both include relationship problems and poor connectivity to others. Autistic people often report difficulties with intimacy and forming friendships. Subsequently, people with eating disorders often struggle with fitting in or worrying about others judging them.

5. Repetitive Behaviors

Both autism and eating disorders entail ongoing, repetitive behaviors that cause significant distress when interfered with. Someone with anorexia may count calories due to poor body image and a desire to lose weight. Similarly, an autistic person may ritualistically count calories or compulsively exercise, even if weight loss isn’t the intended goal.⁶

Common Eating Disorders in Autism

Autism can correlate with any eating disorder, but comorbidity appears to be highest with anorexia and ARFID. For instance, although only 1% of the population is autistic, and 0.3% have anorexia, 20-35% of people with anorexia are autistic.¹ Some research suggests that those with autism are five times more likely to be diagnosed with anorexia than non-autistic people.⁶ Furthermore, statistics on co-occurring autism and ARFID are around 33%.⁷ Children and young adults appear to have the highest rates of comorbidities.

It’s important to keep in mind that these studies and statistics are likely misrepresented. Most eating disorder research focuses on girls and women, and most autism research focuses on boys and men. Therefore, there may be some inconsistencies and missing data.

Autism & Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by chronic and consistent food restriction and a preoccupation with body image. People with anorexia are hyper focused on avoiding weight gain. However, the eating disorder symptoms often represent themes of control, perfectionism, and fear. Anorexia may be a coping mechanism to avoid stress or interpersonal difficulties. These symptoms often overlap with autistic symptoms of rigidity, control, and a preference for having a strict routine.

Autism & ARFID

ARFID refers to having little to no interest in eating food. People with ARFID aren’t worried about their weight or body size, but they do experience disgust and apathy towards eating. This overlaps with autism, as autistic people often experience sensory issues and difficulties with certain food textures, smells, or tastes. This is particularly pervasive among children, and it can cause ongoing food battles.

Autism & Pica

Pica is an eating disorder characterized by compulsively consuming non-food items (such as clay, dirt, paint, or glue) that have no nutritional value. Research shows that one in four parents report their young autistic child ‘sometimes’ eats non-food items.⁸ This pattern likely stems from limited food preferences, sensory processing difficulties, and intellectual disabilities that make it challenging to distinguish edible food from non-food items.

Autism & Bulimia Nervosa

Bulimia refers to patterns of binge eating (eating large amounts of food rapidly) and purging (self-induced vomiting, excessive exercise, abusing diuretics or laxatives). A person with bulimia can be rigid in their thinking (i.e., having safe and unsafe foods), although they also experience the perception of “losing control.” These patterns may also be present in autism, as autistic people often experience significant distress when a situation feels out of their control.

Autism & Binge Eating Disorder

Binge eating disorder is an eating disorder characterized by routinely bingeing without taking compensatory measures. People with this condition often use food as a way to cope with stress or numb their feelings. Some research has shown that autistic people can sometimes exhibit overeating tendencies in childhood. This pattern may be due to hypersensitivity and pleasure to certain textures.⁹

Eating Disorders Vs. Picky Eating

Autism and picky eating often go hand-in-hand. But, being picky is not inherently synonymous with disordered eating. Someone who is picky may have strong preferences about what they like (and don’t like) to eat. However, their food choices aren’t directly related to body image or weight control.

A picky eater may unintentionally restrict because they feel uncomfortable eating specific foods. In serious cases, young children go through entire periods of food refusal. But the restriction isn’t about controlling intake. Picky eating is also a common symptom of sensory processing disorder (SPD), a condition associated with being very particular about certain textures, smells, or tastes.

Are the Causes of Autism and Eating Disorders Connected?

Mental illness is multifaceted, and there are no definite causations for either autism or eating disorders. Instead, a complex constellation of variables may increase someone’s chance of developing one (or both) of these conditions.

Possible causes for autism and eating disorders include:

• Genetics: Specific gene combinations may affect brain development and impact how cells communicate, determining the severity of specific symptoms. We are likely in the early infancy stages of this neuroscience, and researchers are still examining these relationships.
• Family history: Families with one child with autism or an eating disorder have an increased risk of another child having those disorders. Similarly, there are links between parents having these conditions and their children having them.
• Preterm birth: Some research shows that babies born prematurely (before 32 weeks gestation) have a greater risk of developing autism and anorexia.^10,11
• Advanced paternal age: Although there hasn’t been extensive research on this topic, some data suggests that older paternal age is associated with an increased risk for various mental health disorders, including autism and eating disorders.¹²
• Environmental factors: Researchers are examining the relationship between autism, eating disorders, and different environmental risk factors, including low birth weights, prenatal exposure to pollution and pesticides, and early birth difficulties.

How Are Co-Occurring Eating Disorders & Autism Treated?

Comprehensive treatment needs to consider both the distinction and overlap of the eating disorder and any relevant autistic symptoms. Effective treatment should be multifaceted, and a thorough mental health assessment is essential. For instance, many people with eating disorders may have undiagnosed autism, and vice versa.

If you’re ready to get treatment, consider asking your primary care physician for a referral, using an online therapist directory where you can sort by specialty and insurance coverage, or using an online eating disorder treatment platform like Within Health or Equip Health.

Options for treating eating disorders in people with autism include:

• Play therapy: Play therapy provides interactive support, and it can be especially helpful for younger clients. It can help people understand their thoughts and feelings without direct talk therapy.
• Cognitive-behavioral therapy (CBT): CBT offers guidance in modifying negative or unhelpful thinking patterns, and replacing them with healthier ones. It also introduces adaptive coping skills for coping with triggering situations.
• Enhanced cognitive-behavioral therapy (CBT-E): CBT-E is specifically designed for eating disorders. It blends concepts of psychoeducation, cognitive restructuring, and changing problematic eating disorder symptoms.
• Acceptance and commitment therapy (ACT): ACT blends mindfulness and behavioral interventions. This therapy ultimately helps people identify their values and live congruently with them.
• Family therapy: Family therapy can empower people to provide support to their loved ones with an eating disorder and autism. This therapy also teaches healthy communication and reinforces boundaries and safety.

How to Cope With Autism & Eating Disorders

At times, having comorbid autism and an eating disorder may feel challenging. Depending on the severity of your symptoms, it might also seem like things will never get better. Implementing healthy lifestyle habits and considering professional treatment can make a significant difference in improving how you feel.

Here are some ways to cope with an eating disorder when you’re also autistic:

• Build a healthy peer support system: It’s important to have reliable friends and family who can validate you. If talking to people feels overwhelming, consider finding an online group or forum.
• Keep your hands occupied: Sensory and fidget toys can help with the restlessness that coincides with both disorders. These objects can also encourage mindfulness.
• Practice positive affirmations: Remind yourself that you can cope with challenging circumstances and learn from your hardships.
• Stick to a routine: Autistic people tend to thrive with routine. Aim to build a healthy routine that balances self-care with your typical responsibilities.
• Change your environment: If you feel stressed in a particular setting, consider leaving altogether. Before you attend an event that may feel triggering, consider brainstorming an exit strategy.
• Hold onto grounding items: Designate a small rock, coin, or other tangible item that promotes a sense of calm. The next time you feel triggered or overwhelmed, hold onto that item as a reminder that you can get through this moment.
• Take a few deep breaths: Close your eyes and inhale as deeply as you can. Then, exhale as deeply as you can. Repeat at least five times.
• Find a creative outlet: Consider journaling, painting, drawing, or taking photos as part of your wellness plan.
• Celebrate small successes: Recovery from an eating disorder is rarely linear. Make it a point to acknowledge all steps taken in the right direction, no matter how small they may seem.