May 26, 2016

What You Must Know About Eating Disorders and the Autism Spectrum – Lisa Geraud

two young girls Some individuals with autism spectrum disorders (ASD) have eating issues that may become very clinically significant. 

Autism spectrum disorder is a developmental condition that affects the way individuals think and interact with others.

Those with ASD have repetitive or very focused behaviors or interests, and some experience high sensitivity to sensory experiences.

The link between autism and eating disorders

Depending on severity, along a spectrum of varied symptoms, sensory experiences such as smells, tastes, textures, noises and body sensations may be uncomfortable and perceived as harmful to those with ASD.

When these individuals consistently avoid aversive sensory experiences, they may consume a limited variety of foods. This can cause low energy, malnutrition, arrested growth or weight loss.

The result is an eating disorder known as avoidant/restrictive food intake disorder, commonly called ARFID.

Those with ARFID may lose weight to the degree of those with anorexia nervosa and, at times, are even misdiagnosed with anorexia or other medical issues. A key difference between ARFID and anorexia nervosa is that a drive for thinness or fear of body fat is not characteristic of ARFID.

When people with ARFID lose significant amounts of weight or fail to achieve expected weight gains, it is as dangerous for them as it is for the person with anorexia nervosa. Treatment for anorexia and treatment for ARFID may also be similarly challenging.

Treatment of ARFID and anorexia nervosa

Anorexia nervosa and ARFID are both treated with exposure therapy for nutritional recovery:

ARFID — A core component of exposure treatment for ARFID is exposing individuals to varied textures, smells, tastes and sensations (such as the feeling of having a full stomach).

Anorexia nervosa — A core component of exposure treatment for anorexia nervosa is exposure to varied food groups, adequate energy and weight gain.

In both cases, exposure work resulting in improved nutrition both 1) nourishes the brain and 2) permits habituation to the anxiety-provoking stimuli.

A nourished brain is more flexible than a malnourished one, so improved nutrition is central to treatment of both ARFID and anorexia nervosa.

Other important aspects of treatment

As treatment progresses from nutrition rehabilitation, treatment of the person with signs of anorexia will include 1) acceptance of their body’s normal weight and shape and (possibly) 2) addressing perfectionism.

Treatment for ARFID may also include ongoing and varied exposure work for sensory aversions — even extending beyond food-related stimuli — since many sensitivities that are characteristic of autism spectrum disorders are not limited to foods.

Treating eating disorders in children

In children under 12, it can be difficult to distinguish early onset anorexia nervosa from ARFID.

Children at this age are concrete thinkers developmentally. They tend to lack the words for describing a psychological drive for thinness. Instead, children with early onset anorexia nervosa may complain of headaches and stomachaches — rather than describing more abstract psychological dilemmas that are developing and causing stress.

Effective treatment for ARFID and anorexia nervosa in young people under 12, and even in the early teen years, occurs when parents work with with professionals that are experienced in disordered eating, eating disorders and developmental conditions.

As kids with these conditions mature, they can benefit from learning about, and responding adaptively to, their temperament and cognitive features. In this way, they will be able to live full lives free of malnutrition, problem eating behaviors and psychological distress.

April is National Autism Awareness Month, reminding us to be aware of the unique challenges faced by those with autism spectrum disorders, including ARFID and other eating problems.

- Lisa Geraud MA, MS, RD, LMFT

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