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Autism spectrum disorder (ASD) can affect many aspects of a person’s life, including their eating behaviors or how they respond to certain foods.
In some cases, food-related behaviors common with ASD are also commonly seen in people with eating disorders, and researchers have discovered a number of links between the conditions.1
Still, ASD and eating disorders are very complex. It can be difficult to determine which condition certain behaviors stem from or how the conditions—or any co-occurring disorders—influence each other, making diagnosis and treatment challenging.1
Learning more about the connections between eating disorders and ASD can help you recognize signs of disordered eating in a loved one and help them find the appropriate type of care.
Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people communicate, interact with other people, learn, and behave.
Autism spectrum disorder is a neurological and developmental disorder that affects how people communicate, interact with others and their environment, learn, and behave.
As it’s medically defined today, the condition incorporates symptoms previously prescribed to four separate disorders:2
Autistic disorder
Asperger’s disorder
Childhood disintegrative disorder
Pervasive developmental disorder not otherwise specified
It was changed to a “spectrum disorder” in the latest edition of the Diagnostic Statistical Manual of Mental Disorders (DSM) to help explain not just the wide variety of characteristics that can present as part of the condition but the different levels of severity with which these characteristics can manifest.2
The new definition also stipulates that someone diagnosed with ASD be showing symptoms since early childhood, even if the symptoms weren’t recognized as part of ASD until later on in life.2
Failure to initiate or respond to social interactions
Responding inappropriately in conversation
Misreading or missing nonverbal interactions
Having difficulty building or maintaining friendships
Poor eye contact or abnormal body language
Difficulty in sharing interests or emotions
Behavioral characteristics of autism
Behavioral characteristics may include:2,19
High dependency on routines
High sensitivity to environmental changes
Extreme focus on niche subjects
Indifferent or adverse reactions to certain smells, sounds, textures, and other
sensations
Fixation on certain sensations (e.g., excessive touching of particular objects, staring at certain lights)
Autism, sensory sensitivity, and food
One ASD symptom that can lead to many food-related issues is sensory sensitivity.
People with autism spectrum disorder can be either hypersensitive or hyposensitive to outside stimuli.19 If they’re hypersensitive, they’re more affected by specific sensory experiences, like sounds, tastes, and smells. If they’re hyposensitive, they’re less impacted by these things.
When someone is hypersensitive, they can experience psychological distress when they encounter something they’re sensitive to, resulting in avoidant tendencies.20 Certain foods may trigger these reactions, including foods considered too hot, cold, slimy, mushy, or spicy.
When someone is hyposensitive, they have less of a response to certain stimuli. This can result in behaviors attempting to “make up” for this deficit, such as constantly exploring textures with their hands or seeking other sensory experiences.20 Food-wise, someone with hyposensitivity may like to chew gum or specifically seek out crunchy or spicy foods, among other preferences.
Autism, cognitive rigidity, and eating disorders
Another common symptom of both autism spectrum disorder and many eating disorders is cognitive rigidity.
In ASD, this often manifests as a high dependency on routines or difficulty with environmental changes.19 In eating disorders it’s been connected to everything from perfectionist tendencies to attention to detail.21,22
In either group, it can also manifest as specific rules and rituals around food and eating. People with ASD, eating disorders, or both may display behaviors such as not letting the foods on their plate touch, eating foods in a specific order, or eating certain things at certain times. And they may become agitated if these routines are disrupted.
Cognitive rigidity may also be behind the highly selective food preferences exhibited by people with both ASD and certain eating disorders.23 This is sometimes what leads to dangerously restrictive or limited diets.
Autism, eating disorders, and trauma
Autism spectrum disorder and eating disorders may have more than biological traits in common. Unfortunately, it seems like trauma may be another factor shared by both conditions.
Eating disorders have long been tied to trauma—particularly childhood trauma—and have a high rate of comorbidity with post-traumatic stress disorder.24 Research shows that those with autism spectrum disorder tend to encounter higher rates of trauma and stress and have higher rates of PTSD than their neuronormative peers.25
Bullying, whether related to weight, someone’s ASD diagnosis, or both, can frequently play a role. The social difficulties encountered by many people with both ASD and eating disorders can also contribute to the situation, leading to the type of social isolation that often allows eating disorders to go undetected for so long.
Autism and commonly co-occurring eating disorders
The connection between autism and eating disorders is still a relatively new discovery, and scientific research is ongoing, but some studies have already found significant connections, with the comorbid rate predicted to range anywhere from 8% to 37%.4
Atypical eating behaviors are especially common among children and adolescents with autism.
One study found up to 70% of children with ASD had atypical eating patterns, compared to 13.1% of children with other disorders and 4.8% of neurotypical children.3
More specifically, connections have been found between autism spectrum disorder and certain common eating disorders, including:
Autism is perhaps most frequently linked in academic research to anorexia nervosa. That may be due to the high rate of co-occurrence between the conditions. Although both disorders occur rarely within the general population—at rates of around 1% for ASD and 0.3% for AN—they co-occur at a rate estimated to be as high as 16.3%.4,5
Although autism and anorexia occur rarely individually–around 1% for autism and 0.3% for anorexia–they occur together at an estimated rate of 16.3%.4,5
Further research into the matter has uncovered a number of potential reasons why. People with these conditions have been found to share traits such as issues with emotion regulation, introspection, empathy, and difficulty making or maintaining close relationships.6
Rituals around food and eating and extreme food selectivity are also common in both groups.6 And cognitive rigidity and sensory sensitivities are other major aspects of both conditions.7
Common traits and behaviors in autism and anorexia:6,7
Cognitive inflexibility
Sensitivity to textures, tastes, or smells
Rituals around eating and extreme food selectivity
Difficulty making or maintaining relationships
Issues with emotion regulation, introspection, and empathy
Autism and ARFID
Avoidant restrictive food intake disorder, or ARFID, is also closely tied to autism. One seminal study on the subject found a comorbidity, or co-occurring, rate as high as 21%.8
Autism and ARFID commonly occur together, with an estimated comorbidity rate of up to 21%.
ARFID is characterized by a persistent pattern of food avoidance, which leads to nutritional deficiencies and dangerously low weight. But what may particularly tie ARFID to autism is the motivation behind these eating patterns.
Those struggling with ARFID exhibit a general disinterest in food or eating, extreme aversions to food based on sensory factors like smell or texture, and/or a fear of choking or vomiting after eating. These motivations mirror many experiences people on the autism spectrum may have if they’re hypersensitive or hyposensitive.
ARFID features:
Disinterest in food and eating, often getting full quickly
Sensory avoidance of tastes, textures, smells, and temperatures
Fear of negative consequences, such as choking, vomiting, or allergies
Sensory sensitivities in those with ASD have been found to be a leading risk factor for developing a restrictive diet.8
Autism and binge eating disorder
Binge eating disorder has also been associated with higher rates of ASD traits, though much more research is needed to flesh out the reasons why.9
People with BED may share some of the same social difficulties as people with ASD and use food as a maladaptive comforting mechanism.11 Autism can also cause states of hyper fixation or obsession, which could manifest in someone with BED as a fixation with food.10
What autistic traits can look like when they relate to food and how they can lead to binge eating disorder:
Cognitive rigidity: Being hyper-focused on what, how, and when to eat
Sensory-seeking behavior: Overeating foods with certain textures, tastes, and flavors
Social skills challenges: Preferring to eat alone
Anxiety: Overeating to soothe mood
Autism and pica
Pica is an eating disorder involving persistent consumption of substances other than food, including soap, paper, cloth, hair, pebbles, paint, wood, chalk, and other materials.
This disorder has a high co-occurrence with autism spectrum disorder, with one study finding a comorbidity rate anywhere from 9.7% to 28.1%, and another report on the subject noting that 1 in 4 parents of autistic children said their child ate non-food items sometimes or often.12,13
Research into the exact connection between the two conditions is still emerging. However, hyposensitivity to certain textures, sensory processing difficulties, and the inability to cognitively understand the difference between food and non-food are potential theories.13
Autism and pica have a comorbidity rate between 9.7%–28.1%. More research is needed to help us understand the exact connection between the two.
Treatment for people with ASD and a co-occurring eating disorder
Autism spectrum disorder is not a condition that needs to be “cured.” It describes a different set of neurological wiring that impacts how someone perceives and interacts with the world. Treatments for the condition can help people with ASD find helpful tools to navigate the world with less stress or anxiety.
Eating disorders, however, are dangerous conditions and need to be treated appropriately.
In many cases, an ASD diagnosis can impact the way someone responds to certain types of therapy, so both conditions should be considered when determining someone’s treatment plan for eating disorder recovery.
Still, some therapeutic methods have proven beneficial for people struggling with eating disorders that may be particularly helpful for people with ASD.
Cognitive behavioral therapy (CBT) has long been the leading therapeutic method for treating many eating disorders. The concept revolves around helping patients recognize patterns of unhelpful thoughts and behaviors and then changing their responses to those thoughts by adopting more helpful coping mechanisms.14
The idea is flexible and foundational enough to address multiple conditions at once. And it’s also found some success in helping people with autism. Specifically, CBT has been found to help patients with ASD reduce feelings of anxiety, cope better with social situations, and better recognize emotions.14
When a member of the family has autism, it can often affect the dynamic of the entire household. The same can be said for most eating disorders. That’s why someone struggling with both conditions—particularly younger children—may benefit from family-based therapy (FBT).
The practice is centered on facing immediate issues that may be threatening someone’s well-being, rather than focusing on the past, and helping parents or caretakers and patients together create a safe space for recovery at home.15
Throughout the process, parents will be educated and empowered to help their children make better choices around food and eating. FBT also takes the stance that an eating disorder is a separate entity from the child, which is a helpful perspective for many families struggling with these issues.15
Importantly, family-based therapy has also been successful at helping people with anorexia nervosa, which, aside from sharing high rates of comorbidity with autism, is typically considered one of the more challenging eating disorders to treat.15
People with autism often have difficulty communicating verbally but frequently excel at other types of expression, including fine and performing arts. And those are the same channels many art or experiential therapies use.
Drawing, acting, painting, sculpting, dancing, playing music, or other artistic skill sets are used in these therapeutic approaches to help people more freely express their feelings. This can help them bypass the need to communicate verbally with a therapist, and allow patients to tap into deep currents of emotion, possibly even discovering thoughts or feelings they weren’t consciously aware of.16
The method is particularly well-suited for many people with ASD, as many may struggle with more “traditional” forms of communication or expression.
Potential barriers to treatment
Comorbid conditions, particularly when one is ASD, can also, unfortunately, make finding or receiving proper treatment more difficult for several reasons.
Eating disorders, in general, can be challenging to spot. These conditions tend to thrive in isolation, and many people living with them are in denial or try to actively hide their symptoms.
For someone with autism or a caretaker of someone with autism, there are additional concerns that can make it hard to recognize an eating disorder.
Many people with ASD have difficulty recognizing emotional states in themselves or others, which can make it challenging for them to assess when and whether help may be needed. Autism spectrum disorder can also make it difficult for someone to clearly communicate their needs, even if they do recognize a problem.
Unfortunately, the complex and overlapping relationships between autism, eating disorders, and other mental health conditions can also make it difficult to parcel out which behaviors may stem from which condition or whether a separate eating disorder is present at all.1
This type of challenge is demonstrated in people with anorexia nervosa who also have ASD. The two can share many common symptoms, including limited food intake and fixation on certain topics. It can be difficult, if not impossible, for a physician to know which condition is the primary cause of these issues, impacting treatment approaches.
It can also be challenging to tell the difference between behaviors related to autism and those stemming from a comorbid eating disorder. The type of anxiety around certain foods that’s so prevalent in ARFID, for example, can be mistaken for how someone’s autism is expressed, allowing the eating disorder to “hide” in plain sight and remain undiagnosed.
Medication is not always a preferred method of treatment for either autism or an eating disorder. But it’s sometimes used as a secondary treatment for symptoms of co-occurring conditions, such as ADHD, anxiety, or depression.
In these cases, physicians must consider many potentially conflicting factors before writing out prescriptions.
For example, a class of drugs called antipsychotics can help improve someone’s temperament, but they can also work to stimulate appetite, potentially triggering overeating tendencies.17 Certain stimulants, on the other hand, may help improve ADHD behaviors, but they generally suppress appetite, which can help curb binging behaviors but worsen restrictive eating disorders like ARFID.18
Treating both autism and eating disorders can be challenging, with each condition coming with its own set of concerns. Generally, these conditions are treated separately. Although, for a person with co-occurring disorders, this may not be the most effective road to recovery.
Further, depending on the severity of the condition, some people with eating disorders may need more intensive care, which can involve living away from home for periods of time. This separation and departure from familiar environments, people, things, and routines may be a particular source of anxiety for people with autism.
And, while some types of treatment may lend themselves better to addressing both conditions at once, it could be more difficult to track down these specific therapeutic practices in a location and price range that are both comfortable for the person organizing this care plan.
Finding help for an eating disorder with ASD
If you or a loved one are struggling with an eating disorder, or you suspect someone you care about may be, it’s essential to seek help. These conditions are dangerous and can even be deadly if left untreated. And especially for people with ASD, they often affect people long before symptoms are noticed.
Reaching out to your primary care doctor, therapist, or another trusted medical professional is a great place to start. These experts are often at least informed about different eating disorders and autism spectrum disorder symptoms and may be able to help you gain an official diagnosis or find a doctor or program that is better suited to help.
Just remember that it’s important for therapeutic approaches to be informed by a thorough knowledge of both autism and eating disorders. And don’t give up hope.
Anyone can make a full recovery from an eating disorder, especially when the condition is addressed early. The road to recovery is rarely a straight line, but it leads to a happier and healthier future.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
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