The Overlap Between Anorexia and Autism

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Research is beginning to prove the overlap between the cognitive profiles of individuals with anorexia nervosa and autism spectrum disorder (ASD). By understanding the correlation between these two disorders, professionals can be better suited to treat and support clients recovering from anorexia.

What Is Anorexia?

Anorexia nervosa is an eating disorder characterized by a restriction of energy intake requirements, leading to a significantly low body weight for someone’s age, sex, developmental trajectory, and physical health. Individuals struggling with anorexia have an intense fear of gaining weight and a distorted perception of weight. To control their weight, individuals with anorexia use different behaviors such as restricting intake, overexercising, or purging.

Anorexia is a complex mental illness that can lead to life-threatening complications. However, with proper mental health treatment and medical monitoring individuals can overcome their disorder and reverse many of the complications resulting from malnourishment.

What Is Autism?

Autism spectrum disorder (ASD) is a developmental disorder characterized by difficulties with social communication and interaction as well as restricted and repetitive behaviors. ASD can be diagnosed at any time during a person’s life, but it is considered a developmental disorder because symptoms typically occur within the first two years of a person’s life.

To receive a diagnosis of ASD, an individual must demonstrate deficits in three areas of social communication and interaction and two types of restricted, repetitive behaviors.

Examples of deficits in social communication and interaction may include, but aren’t limited to:

• Failure to maintain normal back-and-forth conversation
• Failure to initiate or respond to social interactions
• Abnormalities in eye contact
• Unable to understand or use non-verbal communicative gestures
• Absence of interest in peers

Examples of restricted or repetitive patterns may include, but aren’t limited to:

• Repetitive motor movements
• Inflexibility with routine
• Rigid thinking patterns
• Need to eat the same food every day
• Highly restricted and fixated interests
• Preoccupation with unusual objects
• Hyper or hypo reactivity to sensory input

Overlap Between Anorexia and Autism

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There are many reasons why researchers are becoming increasingly interested in the overlap between anorexia and autism. A research study published in May 2022 proved that the overlap between anorexia and autistic traits is not synonymous with individuals who are malnourished.

This study looked at the cortical levels of individuals with anorexia who were malnourished and those who were weight restored, and then examined the reported levels of autistic traits between these groups. There was no change in the level of autistic traits for individuals who were weight restored versus not. This is an indicator that the overlap between anorexia and autism is due to similar cognitive types, not the eating disorder itself.

Here are four examples of similarities between anorexia symptoms and autism:

1. Anorexia is categorized by rigid attitudes and behaviors surrounding food, weight, and body. These narrow interests and repetitive behaviors mirror the preoccupation with certain objects and/or topics in autism.
2. Individuals with anorexia are commonly consumed with their own behaviors, weight, and body without being able to recognize the severity of their illness or the stress their illness is causing their families. This difficulty in understanding another person’s perspective is a trait associated with individuals with autism.
3. Individuals with anorexia and autism both show traits of social anhedonia—deficits in emotional intelligence—and alexithymia—difficulties reflecting one’s emotions.
4. Individuals with anorexia and autism show atypical structures in the social parts of their brains, such as the superior temporal sulcus, fusiform face area, amygdala, and orbitofrontal cortex.

How Did Researchers Prove the Overlap?

To uncover the overlap between anorexia and autism, researchers had participants diagnosed with anorexia take various dimensional questionnaires. These questionnaires included an Empathy Quotient (EQ), Systemizing Quotient (SQ), and Autism Spectrum Quotient (AQ). These test results were then compared with the results of individuals with autism. Individuals with autism typically score low on the EQ and high on the SQ and AQ.

Here is what was discovered. Individuals with anorexia scored significantly higher than the general population on the systemizing (SQ) and the autism spectrum questionnaire (AQ). However, only young adolescents with anorexia scored low on the empathy questionnaires (EQ) whereas older clients didn’t demonstrate any remarkable difference in their empathy score with the general population.

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Basically, what these tests showed is that individuals with anorexia have elevated autistic traits. Especially, when it comes to the systemizing quotient (SQ).

What Is a Systemizing Cognitive Type?

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Systemizing is defined as the desire to analyze or build a system. The system can be mechanical, abstract, natural, taxonomic, or any other kind. The above-mentioned research proved that individuals with anorexia and autism typically have a systemized cognitive type—or S type—meaning they favor systemized thinking patterns.

The way individuals may relate to systemized thinking in their everyday life includes school subjects such as math and science, keeping a specific daily routine, obsessing over specific topics, and searching for a formula or pattern within communication or relationships. Think of it this way: Systems follow rules. When a person systemizes, they identify the rules of the system to understand it and predict how it will work.

Individuals with anorexia appear to direct their strong systemizing toward food and weight through behaviors such as calorie counting, a strict exercise regime, body checking, and weight tracking. However, if their systemizing thinking had latched onto another part of their brain, they may have demonstrated a different obsessive focus that was less destructive. Researchers are even beginning to believe that the other focus may mirror the special interests seen within individuals with autism.

Takeaway

Research is beginning to show the overlap between the cognitive profiles of individuals with anorexia and autism. Mental health professionals can begin to use this research to inform treatment courses for individuals with anorexia.

By understanding the individual client’s cognitive profile, professionals can move the focus of treatment away from battling over food, weight, or behaviors. Instead, professionals can discuss how the client’s brain work and begin to brainstorm with the client how to best utilize their potentially systematic programming in a productive, non-destructive way.