Eating disorders are mental health conditions classified by an abnormal relationship to food. In severe cases eating disorders can be life threatening. Some experts are now claiming that as many as one in every four people with an eating disorder is autistic. It is difficult to get precise figures for how many autistic people have eating disorders for a couple of reasons. Firstly, a diagnosis of an eating disorder may not be seen as necessary by some practitioners when autism has already been diagnosed. Secondly most eating disorders are diagnosed based on the presence of a dissatisfaction with appearance. The researchers Keel and Klump in their 2003 paper even go as far as suggesting that Bulimia does not exist at all in places or times that have not been influenced by western ideals of thinness. Given that many autistic people particularly those with intellectual difficulties will be less concerned about body image this aspect of the disorder may not be present. Eating disorders can be serious and understanding how and why they present differently in the autistic population can have important implications for treatment. In this article we will look at three of the most common reasons for disordered eating within the autistic community.
Symptoms of Disordered Eating
To understand the reasons for disordered eating we first need to recognize the symptoms that can be present. Here are some types of disordered eating that you might see.
Restrictive eating: Autistic people may restrict what they eat to only eating certain foods or only eating in certain places.
Overeating: Autistic children and teenagers are 5 times more likely to be obese compared to their peers. This may be linked to a combination of overeating and inactivity.
Pica: Pica is the eating of inedible objects. Nearly a quarter of young autistic children will engage in pica.
Vomiting: Some autistic people will make themselves vomit with a frequency that can cause weight loss and a lack of nutrients in the body.
Three reasons why autistic people may display disordered eating
1. Sensory Differences
Autistic people are often over (hyper) or under (hypo) sensitive to stimulation from the environment as well as internal sensations such as hunger. This experience can lead autistic people to either seek out or avoid different sensations and can affect eating habits in several ways. When a person is hypersensitive, they may find the tastes, smells, or textures of foods aversive and only be able to eat a very restricted diet which is not nutritionally balanced. When a person is hyposensitive they might seek to ingest substances with strong tastes and smells or interesting textures or appearance. These substances may not be edible and could include paints, putty or soap. Some hyposensitive people may induce vomiting for the sensory input it provides. Hyposensitivity can also lead to a lack of awareness to feelings of hunger or fullness leading to under or overeating respectively.
2. Emotional Differences
Studies have shown that difficulties with recognizing and regulating emotions are often linked to eating disorders. This may be because our eating habits change the physical sensations that we experience and can become a maladaptive coping mechanism when other coping mechanisms are not available. Alexithymia is a condition in which one’s own emotions cannot be identified and expressed clearly. You can find a test for alexithymia here: Online Alexithymia Questionnaire | Embrace Autism (embrace-autism.com) Alexithymia In the general population approximately 4% have alexithymia and it is significantly more common in people with eating disorders. The percentage of autistic people with alexithymia is almost 50%.
3. Desire for Control
A core characteristic of autism is the use of routines and repetitive behaviors. These behaviors can help install a feeling of a control in a world that would otherwise feel overwhelming. Restrictive eating including only eating in certain places or certain foods can become ritualized and part of a routine. A desire to control one’s environment can also lead to the consumption of inedible objects that appear out of place such as fluff, spillages or fallen leaves.
It is important to understanding the reason for disordered eating as addressing the underlying cause can result in the symptoms reducing. For example, reducing or increasing the sensory stimulation of food as required can help sensory eaters. Building trusting relationships within a consistent environment can help those who desire control and providing alternate coping strategies can help those who struggle with emotional regulation. It can take time for changes in eating habits to occur. If you or someone you care for are suffering from an eating disorder it is important to seek medical advice to address any nutritional deficiencies and rule out other causes such as gastrointestinal issues.