Is There A Link Between Eating Disorders And Autism?

For as long as she can remember, Alex has been what others might call a "picky eater". The list of foods she's comfortable with at the moment is remarkably short — pizza, but only margherita with just a little tomato sauce, fries, and pasta with tomato sauce, but also lettuce, spinach (but only raw), cucumber, cabbage, and eggs (but only fried eggs). Alex's "banned foods" lists is much longer, on the other hand — mushrooms, fried onions, zucchini, eggplant, cooked or fried spinach, boiled egg yolk, chickpeas, beans, anything spicy, banana, asparagus, and basically anything that "slimes around in your mouth or has a chalk-like texture, which induces salivary production that just gives a really bad taste". 

Chronically underweight since she was a child, concerned people in her life have, periodically, been worried that she had anorexia. But, Alex says, "it's not about being thin or being worried about extra calories". In fact, she'd prefer to have a healthy weight.

Alex, it turned out, had Avoidant-Restrictive Food Intake Disorder, a kind of anorexia that used to be called selective eating disorder. People with ARFID restrict the kinds and amounts of food they eat, but not because of anything related to body image. ARFID is, precisely because of their preference for sameness and sensory issues, more common in people on the autism spectrum. It is far from the only eating disorder seen in autistic people, however. 

How common are eating disorders among autistic people? 

Anorexia nervosa seems to be particularly common, with a suspected 18 percent of peope on the autism spectrum suffering from it. As with non-autistic people, anorexia is most prevelant in girls and women. Food hoarding, pica (an eating disorder in which people consume non-food items such as chalk or soap), over-eating (including binge-eating disorder), and ARFID are also more common. 

Even among children with autism who were not diagnosed with a particular eating disorder, research found that they eat a smaller variety of foods than typically developing children, often struggling with particular textures and tastes. 

Why are autistic people more likely to suffer from disordered eating?

Disordered eating is more common among autistic people for a variety of reasons:

• A strong need for routines and sameness can cause a person to fall into a pattern of eating the same foods all the time. 
• Distress caused by change can make it difficult to break this pattern. 
• Sensory challenges can mean that certain foods are not palatable for the person, based on the "feel" they cause in the mouth. The colors of foods can also come into play here, in which case the sensory challenge is visual. More broadly, the very process of eating (anything at all) can cause sensory overload for some autistic people.
• Social difficulties and "scripting" can make it tough to order something new from a restaurant — many autistic people find it hard to choose and then order something new, and much easier to just repeat the same order. 
• The same quality that leads to strong passions ("special interests") can cause an autistic person to develop a strong focus on calorie-restriction, almost obsessively counting every calorie. 
• Over-eating or eating non-food items can also have an entirely different reason — sensory stimulation. The repeated eating of certain foods, or even non-food items, can be a form of "stimming". 

How can disordered eating be treated in autistic people?

Despite emerging scientific evidence revealing the high rates of eating disorders among autistic people, surprisingly little exists in the way of treatment guidelines.

Parents of autistic children who have trouble eating very much should always discuss this with their healthcare team to decide how to move forward. However, you could also try some strategies at home:

• The same foods that are completely repulsive in one form may be fine in another — if your child prefers soft textures, pureed apples, carrots, or avocados, for instance, may work well. Or, like Alex, they may be able to eat fried eggs, but not boiled eggs, and raw but not cooked spinach. Increasing the variety in your child's diet will increase their health and help prevent nutritional deficiencies. 
• Some children (and adults!) will be able to stomach foods if they add a favorite condiment, like ketchup or barbecue sauce. 
• The way in which the food is presented matters, too. An autistic child may refuse to eat something because it is arranged differently on the plate, or because you offer it on a different kind of plate. 
• Making a child more familiar with a food by having it around the house, eating it yourself, and allowing them to get used to its smell may help.