Autistic Traits and Eating Disorders

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Due to researchers' increasing attention and interest in exploring neurodivergence, there is a constant influx of new information pertaining to the commonalities between autism and eating disorders. In particular, the research is beginning to demonstrate a link between autism and avoidant restrictive food intake disorder (ARFID) and anorexia nervosa.

Autism and Anorexia

The overlap between repetitive and rigid behaviors is one example of the commonalities between anorexia nervosa and autism. Anorexia is an eating disorder characterized by rigid attitudes and behaviors surrounding food, weight, and body image. These narrow interests and repetitive behaviors mirror the preoccupation with certain objects and/or topics in autism.

Research shows that the prevalence of autism in anorexia populations is between 8% and 37%, with an average of 22.9%. These rates are dramatically higher than the reported autistic prevalence in the general population, which is about 1%.

If you are interested in reading more about the overlap of autism and anorexia, you can read my previous post, which was dedicated solely to this topic.

Autism and ARFID

The overlap in hyperreactivity to sensory input is one example of the commonalities between ARFID and autism. In fact, the overlap is so significant that research shows up to 30% of individuals who struggle with ARFID also have an autism spectrum disorder diagnosis.

A common attribute of ARFID is a hyperreactivity to the sensory components of foods leading individuals to avoid new foods or only eat a small variety of options. One diagnostic feature of autism is repetitive or restrictive patterns. Within this diagnostic category are several examples, including the need to eat the same food every day and/or a hypersensitivity to sensory input. Both diagnostic features can be traits of individuals diagnosed with ARFID.

Unique Considerations for Female-Identifying Individuals

It has largely been believed that males are four times more likely to be diagnosed with autism spectrum disorder than females. However, new research suggests that this fact may not be fully accurate, as many females go undiagnosed.

Many females go undiagnosed due to parents', family members', and professionals’ lack of knowledge for how autism can present in females. Most people’s assumptions for signs of autism come from stereotypical portrayals of characters in media, such as Dr. Sheldon Cooper in "The Big Bang Theory."

It is important to begin to expand our understanding of autism to include a more nuanced and broader spectrum of presentations. This is especially because many societal assumptions of what autism looks like tends to exclude traits more closely associated with females.

Characteristics more prevalent among females with autism include the following:

• Masking: Females with autism are more likely to mask, or hide, their autistic traits by mirroring the behavior of peers.
• Selective mutism or extreme quietness: Females with autism are more likely to respond to their lack of social comfortability through silence, extreme quietness, or selective mutism.
• Special interests in “socially accepted” topics: Media leads many individuals to assume that individuals with autism show an extreme interest in topics surrounding automobiles, astronomy, or mathematics. However, it is common for females with autism to have special interests that more closely relate to what is “socially accepted” for girls or women. For example, young girls may have intense interests in dolls or unicorns. As an adult, women may be interested in literature, arts, or psychology.
• Misdiagnosis: Nearly 50% of all females with autism are misdiagnosed at least once in their lifetimes. Common misdiagnoses given to females with autism are borderline personality disorder or bipolar disorder.
• Food aversions and sensitivities that progress into eating disorder behaviors: Due to societal pressures surrounding beauty standards and how to behave, females with autism are more likely to develop eating disorders, such as anorexia or ARFID.

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Female Autistic Characteristics and Risk of an Eating Disorder

There are several factors contributing to the increased risk of female individuals with autism going on to develop an eating disorder:

• Misdiagnosis leading to internalized shame: Females with autism are far more likely to go misdiagnosed, which leads to treatment interventions unrelated or damaging to their actual challenges. Misdiagnosis and improper treatment lead many individuals to hold on to shame regarding who they are rather than an understanding of how to celebrate their unique interaction with the world.
• Social ostracization: Social ostracization and bullying aren’t only experienced by females with autism. However, due to improper or a lack of diagnosis, social ostracization among females can lead teachers, parents, and professionals to respond in ways that are unsupportive. For example, an undiagnosed autistic female is mute in the classroom due to social confusion and extreme social anxiety. A parent may respond by saying, “You need to talk to more people.” Though the parent is trying to offer advice and support, this statement may lead to further social confusion and internalized shame for not being able to “just talk more.”
• Societal pressures: Females have the unique challenge of managing intense societal pressures. Society has strong expectations for how females should act and appear. These expectations, in addition to the social confusion and rigidity experienced by autistic females, may lead to rigid patterns and repetitive behaviors with food.

Conclusion

Increasing research is supporting the correlation between autism and eating disorders. Research is also showing how preconceived notions about what autism looks like lead to many misdiagnoses in females with autism.