Autism linked with eating disorders
Autism spectrum disorder (ASD) 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.
Some individuals living with autism spectrum disorders also have eating issues that become very clinically significant. In these cases, eating disorder treatment may help.
Autism, ARFID and anorexia
Sensory experiences such as smells, tastes, textures, noises and body sensations may be uncomfortable and even perceived as harmful to those with ASD. This varies widely among people with autism. Some experience this in mild ways and others in very severe ways.
Individuals with more severe sensory reactions may consistently avoid unpleasant sensory experiences. This may lead them to eat a very limited amount of foods. The result? Low energy, malnutrition, delayed growth or weight loss.
In these cases, individuals may be diagnosed with an eating disorder.
Avoidant/restrictive food intake disorder, commonly called ARFID, impacts around 11% of children with autism.
Signs of ARFID include:
- Losing a significant amount of weight (to the degree that a diagnosis of anorexia nervosa may be suspected)
- Failing to achieve expected weight gains during periods of growth
- Being misdiagnosed with anorexia or other medical issues
Individuals with autism can also be diagnosed with anorexia. A key difference between ARFID and anorexia nervosa is that a drive for thinness or fear of body fat is not characteristic of ARFID. However, ARFID is just as dangerous as anorexia nervosa.
Eating disorder diagnosis in kids with autism
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.
Treatment for ARFID and anorexia nervosa in young people under 12, and even in the early teen years, is most effective when working with professionals experienced in disordered eating, eating disorders and developmental conditions.
As kids 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.
Treating eating disorders in kids with autism
For nutritional recovery, anorexia nervosa and ARFID are both treated with exposure therapy. Here is what that might look like.
ARFID — Exposing individuals to varied textures, smells, tastes and sensations (such as the feeling of having a full stomach)
Anorexia nervosa — Exposure to varied food groups, ensuring adequate energy
In both cases, exposure work results in improved nutrition by 1) nourishing the brain and 2) permitting habituation (a reduction of anxiety) 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.
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.
Anorexia treatment will focus on accepting one's body weight and shape and (possibly) addressing perfectionism.
Weight restoration may also be recommended for both conditions.
Specialized care for neurodiverse children
Eating Recovery Center houses several programs designed specifically to meet the needs of children and teens with autism and ARFID.
Centers in Baltimore, MD and Oakbrook, IL offer tailored ARFID treatment in a neurodiversity-informed clinical space. Caregivers are encouraged to stay close in nearby housing and participate in treatment. Experienced education specialists help patients stay up to date with school work on weekdays.
To learn more about these specialty programs, please fill out this form or call us at (866) 622-5914 to reach a master's-level clinician.
Find a treatment center near you.
We thank Lisa Geraud, MA, MS, RD, LMFT for providing clinical insights for this piece.