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What is the Connection Between Autism and Anorexia?
Autism Spectrum Disorder (ASD) is a developmental disorder that affects the way individuals interact and communicate with others [2, 4]. Those on the autism spectrum have repetitive or restricted behaviors or interests, and can have sensory sensitivities.
Eating disorders can be common among individuals on the autism spectrum.
What is Autism?
In the DSM-V, Autism is defined as persistent deficits in social interaction and communication skills, accompanied by restricted repetitive patterns of behavior, interests, or activities, and by atypical sensory reactivity [2].
They may have highly selective eating requirements or be sensitive to textures, look, smell, or sound of foods. The aspect of sitting with others while eating can be difficult for those with autism and eating disorders. This can include oral struggles, such as chewing and swallowing, as well as gastrointestinal problems which can make eating a non-pleasurable experience.
Eating disorders can take various forms and present in ASD, which can complicate both diagnoses [2]. Females are also presenting to their primary care physicians for symptoms of anorexia more often than symptoms of autism.
One is 68 children in the US is affected by autism [5]. Current research suggests that the current diagnostic methods often overlook females which, once included, could increase the reported number of kids on the spectrum [5].
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Preliminary neuroimaging findings suggest that autism is manifested differently in girls than in boys. Girls are often harder to diagnose for multiple reasons. One reason is that the criteria for autism diagnosis was developed for males. Secondly, the diagnoses of autism and anorexia can overlap with other tendencies, such as obsessive-compulsive disorder (OCD) and rigidity.
Explanation of Anorexia Nervosa
Anorexia Nervosa (AN) is a type of eating disorder which is characterized by weight loss, or lack of appropriate weight gain, in growing children. Those struggling with anorexia will show difficulties maintaining appropriate body weight for age, height, and stature, and have distorted body image.
People with anorexia will typically restrict the number of calories and types of foods they will eat. Some will exercise compulsively, purge through vomiting or laxatives, and may binge eat [7].
Anorexia can affect all people of every age, race, ethnicity, and socioeconomic status. The DSM-5 defines Anorexia Nervosa as:
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
- Intense fear of gaining weight or becoming fat, even though underweight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Research and the Connections
Researchers at the Maudsley Hospital in London have been studying the similarities between autism and anorexia. They have found that both anorexic and autistic patients have a tendency to behave obsessively and suffer from rigid ways of thinking.
Tic disorders, which commonly affect people with autism, are found in 27 percent of people with severe anorexia. In both conditions, patients have difficulty with set-shifting, or changing course mentally [3]. Both autism spectrum conditions and anorexia share a common narrow focus of attention, a resistance to change, and excellent attention to detail.
According to Janet Treasure with the Maudsley Hospital Eating Disorders Unit, 15 to 20 percent of patients with anorexia also have Asperger’s syndrome, which is on the autism spectrum.
According to this research, they found that starvation itself intensifies autistic characteristics like rigidity and obsession. When underweight, people with anorexia get even more like those with autism. It often becomes more difficult to interpret other people’s emotions, they can’t regulate their own emotions, and they might get overwhelmed when they are frightened or angry.
Also, according to this research, underweight individuals with anorexia performed poorly on a classic test of understanding other people’s emotions. Hunger focuses the brain so sharply on the task of getting food that, as with other stressors, it shuts down higher cognitive functions.
According to Dr. Eric Hollander from Montefiore Medical Center in New York City, there is evidence that the repetitive thoughts and behaviors, rigid routines and rituals, and perfectionism that characterize both autism and anorexia may be traced to the same regions in the brain.
At the Autism Research Centre at Cambridge University in 2013, researchers looked at how 66 girls aged 12 to 18 who had anorexia, but not autism, scored on tests to measure traits related to autism [1, 6]. They compared these 66 participants with over 1600 non-eating disorder or autistic peers and measured their autistic traits.
The team found that on the Autism Spectrum Quotient (AQ), girls with anorexia scored in the same range as individuals with autism, when compared to the control group. Also, over 50 percent of the girls with anorexia showed a broader autism phenotype on the AQ, compared to 15 percent of the comparison group.
In the tests on empathy and systemizing, girls with anorexia had a higher Systemizing Quotient (SQ) score, and reduced Empathy Quotient (EQ) score, which are also seen in those with autism. Both the anorexia and autism groups showed a strong interest in details and systems, a tendency to focus on him/herself, and inflexible behaviors and attitudes.
Another study in 2012 by King’s College London compared the prevalence of autism traits and formal diagnoses in over 15,000 twins [5]. The team found that if boys and girls had a similar level of traits, the girls needed to have either more behavioral problems or significant intellectual disability, or both, to be diagnosed. This suggests that clinicians are missing many females who are on the less severe spectrum.
In 2014, Dr. Frazier of the Cleveland Clinic looked at 2,148 autistic children, 304 which were female [5]. They found that individuals with the diagnosis were more likely to have low IQs and extreme behavioral problems. The girls had fewer signs of restricted interests, which is often a key diagnostic factor on the less severe end of the spectrum. This suggests, again, that females are being underdiagnosed.
In conclusion, Autism and Anorexia are most connected through a hyperfocus on specific situations, items, or thoughts, and food-related struggles. When coupled together, it can be difficult to get a diagnosis and effectively manage symptoms.
If you or a loved one is struggling with both Autism and Anorexia Nervosa, know that you are not alone. Resources are available to support you and your family through the recovery process.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References:
[1] https://www.eatingdisorders.org.au/eating-disorders/eating-disorders-a-other-health-problems/eating-disorders-and-the-autism-spectrum[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494624/
[3] http://content.time.com/time/health/article/0,8599,1904999,00.html
[4] https://www.eatingrecoverycenter.com/blog/2016/05/26/must-know-eating-disorders-autism-spectrum-lisa-geraud
[5] https://www.scientificamerican.com/article/autism-it-s-different-in-girls/
[6] http://www.cam.ac.uk/research/news/girls-with-anorexia-have-elevated-autistic-traits
[7] https://www.nationaleatingdisorders.org/anorexia-nervosa
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on May 4, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on May 2, 2017.
Published on EatingDisorderHope.com
