Autism and Eating Disorders
11/12/25 | By: Carissa Hannum
What is Autism?
Autism, like ADHD, is considered a neurodevelopmental disorder called Autism Spectrum Disorder (ASD) which affects an individual's daily life and daily functioning. Like its diagnostic name suggests, Autism exists on a spectrum of different daily issues and functioning, such as language, social skills, emotional dysregulation, repetitive behaviors, communication, sensory processing, motor skills, and/but not limited to executive functioning (link to source) Because this neurotype exists on a spectrum, each individual that is diagnosed with ASD can have very different strengths and areas of difficulty. Just because you have met one person living with ASD, does not mean that their unique diagnosis should be generalized to other individuals. ASD affects 1 in 31 children and 1 in 45 adults in the United States today (link to source).
Autism knows no boundaries, and anyone can be diagnosed with ASD no matter their race, ethnicity, gender, or sexuality. It is worth noting that diagnosis can be more difficult for females and autistic adults as these individuals have learned how to mask or hide certain symptoms and appear more neurotypical to society around them. Masking is the ability to shield certain characteristics of a disorder or the ability to seem “normal” to the world around them. However, this trait of masking can be highly exhausting and cause more mental health concerns.
Autism can co-occur with several other mental health conditions. Individuals with ASD can suffer with major depressive disorder, bipolar disorder, generalized anxiety disorder as well as eating disorders. In addition, those with ASD are also more likely to experience medical conditions such as chronic health/chronic pain conditions like GI and sleep disorders (link to source).
Diagnosis of Autism
Autism is diagnosed by the DSM through severity levels from level 1 to level 3, depending upon how much support and daily functioning difficulty an individual experiences. In addition, an individual with ASD must meet a certain set of criteria from two core areas (link to source):
Social Communication and Interaction Skills
Examples of these skill deficits can include difficulty understanding how social interactions work. Many individuals with ASD discuss difficulties with turn-taking in conversations, understanding what to discuss/how to ask questions, understanding the emotions of others, or sharing emotions with others. In addition, body language and communication skills that seem “respectful” to a neurotypical society may be more difficult. For instance, those with ASD endorse difficulty understanding the intent behind others' hand motions, facial expressions, or body language. Those with ASD may have difficulty maintaining eye contact or, at times, engage in behaviors that may seem rude, like turning away or regulating their vocal pitch and tone to match the emotion of the conversation. Those with ASD may talk very quietly or loudly. Other examples of this core area include developing, understanding, and maintaining relationships with others. Those with ASD may need special care navigating emotions in social situations, such as anxiety, understanding boundaries, and how to appropriately communicate emotions to others.
2. Restricted and Repetitive Behaviors
The second core area for a diagnosis of ASD revolves around behaviors, which again can look very different across individuals. Two are required for a diagnosis.
Repetitive movements or speech
Individuals may utilize stimming behaviors or make repetitive movements to help with emotional regulation. These stimming behaviors can look like rocking back and forth, pacing, spinning, etc.
A sense of order can also be an example of a repetitive pattern, such as lining up things in a way that is soothing to the individual.
Speech patterns may also be an example of repetitive behaviors, such as repeating phrases or words that others say, or trying to speak like another individual.
The need for a routine or keeping things the same
Routine can feel extremely safe and emotionally regulating to those with Autism. Any change in a routine can be highly distressing and cause fear of the unknown. Many individuals with ASD tend to watch the same videos, eat the same thing each day, or even keep the same daily rituals to regulate their mood and anxiety.
Highly Focused Interests
This can look like a fixation on a specific topic or knowledge, i.e., knowing the date of certain baseball games, which can become a topic of conversation for these individuals. Another highly focused interest can also be a strong attachment to a specific item, such as a stuffed animal.
Sensory Stimulation
Individuals with ASD may experience differences in sensory stimuli, such as light, sound, touch, taste, or texture, to name a few. In addition, to regulate emotions, individuals may gravitate towards sensory stimuli to meet certain sensory needs, such as certain sounds, textures, or movements. This can be highly regulating or dysregulating, depending upon the individual's sensory needs.
Those with ASD may not be able to feel physical sensations as strongly, i.e., sometimes not be able to feel hunger or physical sensations associated with certain emotions or pain.
3. Other Possible Characteristics of Autism
Due to language or communication differences, these individuals may need to use other forms of communication i.e. tablet, typing, etc.
Emotional regulation difficulties lead to overwhelming or ineffective coping mechanisms such as shutting down, eating disorders, avoidance, substance use, or self-injurious behaviors.
More support with daily activities
Fine motor or coordination difficulties
Executive functioning skill difficulties
For more on the diagnostic criteria visit this link.
Autism and Eating Disorders
Research shows that a significant number of individuals diagnosed with Autism also suffer from eating disorders. The National Eating Disorder Association (NEDA) reports the following statistics about ASD and eating disorders (Link to Research).
Some research states that 23% of individuals who are diagnosed with an eating disorder are also diagnosed with ASD. However, this number could be more.
At this time, most of the research around ASD and eating disorders has been conducted with anorexia nervosa and avoidant/restrictive food intake disorder (ARFID).
Anorexia Nervosa
Those diagnosed with anorexia may be more likely to experience behaviors related to ASD, such as rules for various situations, difficulty with relationships, hyperfixated interests, and difficulty changing daily patterns.
Because of this, girls diagnosed with ASD may be more likely to develop anorexia due to the above information, as well as the tendency for rules and hyperfocus to develop around food or weight.
One study found that adolescent girls with anorexia found that 10% of girls met diagnostic criteria for ASD and 40% showed autistic traits, although they didn’t necessarily meet full diagnosis.
Those diagnosed with both ASD and Anorexia are more likely to develop more severe eating disorder symptoms than those diagnosed with anorexia.
Some research shows a similar overlap of shared endophenotypes and other brain-related structures with both anorexia and ASD, which may contribute to the development of both disorders.
Avoidant/Restrictive Food Intake Disorder
Some research indicates that 21% of individuals with ASD are also diagnosed with ARFID, although that number may be higher.
Some overlap of symptoms may be related to increases in both diagnoses, including a limited diet, difficulty with certain food textures, difficulty swallowing, rigid mealtime rules, or eating only one brand or one type of food.
Currently, research is exploring a genetic link between ASD and ARFID.
How does ASD Affect Eating Disorder Symptoms?
Again, it is important to state that all symptoms experienced within ASD are unique to each individual. Although the following are examples as to how ASD can affect eating disorder recovery, symptoms, and treatment, there can be many more possibilities. Working with a specialized treatment team that understands both issues is important for treatment, prognosis, and recovery.
Sensory Issues
As stated above, one common issue that is experienced with ASD is sensory processing struggles. Many clients endorse issues around the taste and textures of certain foods. These foods and texture issues can cause extreme anxiety, discomfort, and ultimately total avoidance of the food items. This can lead to restriction and weight loss. Finally, sensory issues can also include sensitivity to stimuli within one’s environment. Many clients with ASD can struggle with loud environments or bright lights, so eating in a cafeteria for example, may be highly overstimulating and anxiety-provoking, again leading to the avoidance of the situation and therefore eating entirely.
Routines and Difficulty with Transitions
As a means of coping with underlying emotions and developing a sense of safety, strict routines that can cause anxiety to change can be developed. At times, these routines can be developed around food or food items. This can look like only eating a certain food item for a mealtime or timing around meals. At times, some individuals may also develop strict routines around exercise schedules.
Interoception Difficulties
Interoception is the ability to understand cues from one’s own body. Many clients with ASD can develop an eating disorder due to difficulty feeling bodily sensations. Many clients report struggles with feeling hungry or full, which can lead to possible restriction, or at times even overeating.
Alexithymia
Those with ASD can have difficulty understanding, identifying, and processing the needs behind their own emotions. This can also lead to having difficulty understanding the emotions of others and ultimately developing/maintaining relationships. Several clients have reported that due to difficulty interpreting their emotions, many times every emotion just feels like anxiety and an overwhelm of their nervous system. As a way of coping with emotional dysregulation, individuals may turn to food, body image, and an eating disorder as a coping mechanism.
Highly Focused Interests
Highly focused interests can at times revolve around food, exercise, or counting calorie,s possibly leading to an eating disorder.
Treatment Considerations
Due to the unique struggles of those diagnosed with ASD and an eating disorder, a highly specialized treatment team should be developed that can manage and provide treatment for both conditions. Working with providers who do not understand the complexities associated with ASD can prolong the eating disorder and cause unnecessary stress. Traditional eating disorder treatment has not long provided inclusive environments for those with ASD, such as bright lights, changing routines drastically, changing food items right away, etc., which may not always be possible for individuals with ASD.
Working with a team of professionals that can slowly integrate changes can be ideal. A therapist, psychiatrist, dietitian, and sometimes group therapy could be ideal. Discovering the underlying aspects of ASD that affect the eating disorder may be helpful. For instance, this could look like interoceptive and emotional literacy training, social skills training, and building emotional tolerance skills. Everyone is unique and deserves unique, specialized treatment.
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