Many challenges face clinicians and patients alike.
Feeding and eating disorders (FEDs) and autism share a number of similarities: fear of weight gain, anorexic behavior, and binge eating, for example. And, as with some eating disorders, autism has multiple causes, from biological (genetic and hormonal) to environmental (peer pressure and society’s standards of beauty).
Women with autism and high degrees of autistic traits have lower recovery rates, are ill longer, and require more intense treatment than non-autistic patients. In addition, many autistic women report that their autism is generally not taken into account by eating disorder services (Eur Eat Disord Rev. 2022. 30:616).
Autistic patients may have eating disorders that go undiagnosed, for example, restrictive eating disorders, such as atypical anorexia nervosa, and avoidant restrictive intake food intake disorder (ARFID). This fact and a general lack of studies of patients with eating disorders who have undiagnosed autism led Dr. Janina Brede, a psychologist at the University College, London, and her colleagues to design a study of these two groups. Their participants included four groups of women: those who reported having autism with restrictive eating disorders (n=57), those with autism alone (n=69), and women with restrictive eating disorders but not autism (n=80). The study group also included women with high autistic traits and restrictive eating but no formal diagnosis of autism (n=38).
The study format
Dr. Brede and her team recruited the women for their study through the National Health Service, eating disorder and autism services, social media, and charities. Body mass index (BMI) was calculated from the participants’ self-reported current height and weight. Because it was conducted during the COVID epidemic, the researchers had to rely on online responses and were unable to interview the women in person.
Participants completed a number of online questionnaires used to better define and differentiate autism and eating disorders. In addition, levels of depression and anxiety were measured with the Hospital Anxiety and Depression Scale. The study group completed the Rivto Autism Asperger Diagnostic Scale-14, the Adult Repetitive Behaviours Questionnaire, and the Camouflaging Autistic Traits Questionnaire. Disordered eating was measured with the Eating Disorder Examination Questionnaire (EDE-Q), the Body Shape Questionnaire, the Pride in Eating Pathology Scale, and the Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA).
Similarities between autism and eating disorders
The authors reported several similarities in BMI, levels of general anxiety, depression, and some symptoms of disordered eating among autistic and non-autistic individuals with restrictive eating disorders. One major difference was that autistic individuals scored much higher on a measure of autism-specific eating behaviors (the SWEAA). Those with autism and restrictive eating disorders had higher levels of these behaviors than did those with autism alone. The authors also noted two limitations of their study were that their study participants were mostly White (84%) and highly educated. Most participants reported first being diagnosed with autism in their mid-teens, and the eating disorder diagnoses were made slightly later, when the individuals were from 20 to 22 years of age.
Self-report measures were supported
The authors supported the use of self-report autism measures, including those that include camouflaging and autism-specific unusual eating behaviors, while also pointing out that conducting formal assessments in individuals with restrictive eating disorders is often difficult and made more so by long waiting times at autism diagnostic centers. The authors note that despite the challenges, “Treatment should be offered to accommodate autistic characteristics and related needs.”
Janice Goldschmidt
Has worked with individuals with IDD for the last decade, and written and presented her work in a range of professional formats. She received her Master’s degree in Nutrition from the University of Maryland-College Park, where she initially developed her program for development of food preparation skills, Active Engagement. As Director of Nutrition Services at Community Support Services, Inc. (Gaithersburg, MD), she has continued to build on Active Engagement, which now includes many differing contexts for guiding individuals with IDD and autism to independent cooking skills. She has also worked on the identification, classification, and treatment of eating disorders for this population.