[Posted on 11 September, 2018 by Louise Karjalainen]
Ever since the 1980’s, discussions around autism and anorexia nervosa (AN) have often linked the two in terms of not only cognitive skills but certain types of behaviour as well. For example, many studies have shown that both AN and autism might involve impairment of neuropsychological functions like flexibility and central coherence.
But what about other behaviours? Eating disorders are obviously associated with changes in eating behaviour. Friends and family of people with autism also tend to report strange eating behaviours – but what are the actual similarities and differences between autism and AN in this regard? Studies of eating behaviour among adolescents and young adults with autism indicate that their difficulties with food and eating have less to do with the negative body image and weight phobia typically associated with traditional eating disorders, and all the more to do with their (lack of) ability to multitask and the social situation around meals.
Looking instead toward which typical autistic difficulties also occur among individuals with AN, one must also consider the low weight/starvation that comes with AN. The brain and the body are affected by the low weight that comes with AN, which means that eating behaviour in autism must also be compared with eating behaviour among people of normal weight. The more generally disturbed eating behaviour in AN usually decreases after a year, once the person in question has received treatment and more or less brought their body weight back to normal. However, some problems still remain, namely the same ones that many with autism face: difficulties with multitasking (like cutting and chewing simultaneously) and the social situation around meals.
Clinical professionals are rarely aware of the potential overlap between these two conditions, and the upshot is that most patients tend to get a standardised treatment plan. Whenever patients fail to respond to treatment, every clinic must evaluate what the underlying issues might be and how they can be addressed. For example, in many cases of AN there may be underlying autistic traits that necessitate a different treatment strategy. Given that the “autism specific” eating behaviours also seem to remain in certain individuals with AN even after their weight has been normalised, this is something that needs to be addressed throughout the entire treatment process, even after weight recovery has taken place.
Do autism and anorexia nervosa have any eating behaviours in common? Yes, absolutely. There are both similarities and differences, but the behaviours frequently seen in the autism spectrum are generally more common in AN than previously believed, and they remain even after the affected person’s weight has normalised. One must also remember that while the difficulties might have different causes and significance for the people involved, they might still be equally cumbersome and impairing in everyday life. These days we are also more aware that underlying autistic traits can have an impact on the treatment of eating disorders, and this knowledge enables us to create a customised, more effective, hopefully successful treatment.