Why So Many Children With Autism Struggle With Eating Disorders
Eating disorders are serious mental health disorders involving significant issues with eating behaviors and thoughts about food that can affect the body’s ability to obtain proper nutrition. Nearly three-quarters (70%) of all children with autism exhibit atypical eating behaviors — 15 times more than that of neurotypical children. People with autism have a higher risk of having an eating disorder than the general public.
Children with autism often experience sensory issues and hyper-focus on specific foods, which can lead to picky eating, food avoidance, and food refusal. This is different from an eating disorder; however, these issues can still lead to nutritional deficiencies.
Comorbid eating disorders and autism should be treated simultaneously through a comprehensive treatment plan to manage both conditions for the healthiest outcome.
The Overlap Between Eating Disorders & Autism
While people with autism are at a higher risk of having an eating disorder, the reverse is also true, with an estimated 20% to 30% of people with an eating disorder showing signs of an autism spectrum disorder (ASD). Autism and eating disorders commonly overlap. This is likely related to a combination of factors, including genetics, biology, and environmental aspects.
Autistic traits could potentially predispose someone to develop an eating disorder. Higher rates of anxiety and depression in people with autism could possibly contribute to unhealthy coping mechanisms regarding food and eating.
Additional risk factors for people with autism developing an eating disorder include:
- Issues regulating emotions. One of the main traits of autism is difficulty regulating emotions and alexithymia (problems identifying and describing emotions) can be a factor contributing to the overlap of eating disorders with autism. Certain foods or unhealthy eating habits can become coping mechanisms for emotional dysregulation common with autism.
- Obsessive focus and interests. People with autism are often hyper-focused on tasks that include restricted eating and caloric intake. A person with autism can become obsessed with counting calories. Controlling their food intake can be a method of controlling an aspect of their life.
- Social pressures. People with autism commonly struggle to fit in with peers. This can lead to low self-esteem and a distorted body image. It can then progress into an unhealthy relationship with food and eating in an attempt to find acceptance.
- Food restriction. Children with autism often have restrictive eating patterns and only want to eat one kind of food. This can lead to a negative relationship with food, ultimately contributing to an eating disorder. Negative food experiences can also cause a fear of eating, leading to a person with autism starving themselves to avoid eating.
- Rigid thinking. Cognitive flexibility can be an issue for people with autism who have problems with executive functioning. This can mean that once someone with autism has decided to eat (or not eat) in a certain way, it becomes routine. This potentially unhealthy pattern of eating can trigger an eating disorder.
Common Eating Disorders in Autism
Some of the most common eating disorders that overlap with autism are:
- Anorexia. Anorexia nervosa is one of the most commonly recognized eating disorders. It exhibits as a compulsive drive to lose weight, characterized by self-starvation and severely limiting calorie intake. People with anorexia have a distorted body image and constantly view themselves as fat regardless of how thin they are. The extreme controlling of food and calorie intake can be a method of establishing some form of control or a coping mechanism for autistic traits.
- Bulimia. Bulimia nervosa is a pattern of uncontrollable binge eating followed by a compensating behavior such as purging, fasting, excessive exercise, and overuse of diuretics and/or laxatives. People with bulimia can be average weight or either under- or overweight.
- Pica. This is an appetite for nonfood items that can cause a person to want to eat things such as paper, soap, clothing, and pebbles. It is a common issue for children with autism, often related to a need for sensory feedback and the sensory stimulation eating nonfood items can cause. Pica can also be connected to a craving for a specific nutrient in which the child is deficient.
- Binge eating. Binge eating involves eating large quantities at once without the purging behaviors of bulimia. As a result, most people with binge-eating disorders are overweight. People with autism often have ingrained habits and an unhealthy relationship with food, including binge eating.
- Avoidant/restrictive food intake disorder (ARFID). This disorder involves restricting and limiting food but is not related to a distorted body image. This type of food restriction is common in children with autism and children that have this disorder are not eating enough calories to grow and develop properly.
Eating Disorders vs. Picky Eating
Eating disorders involve issues with body image, whereas feeding issues, which are common in people with autism, are not always cognitive decisions involving body image and the relationship with food and eating. Instead, they are often motivated by previous negative experiences, sensory issues, or gastrointestinal problems. Being a picky eater is not the same as having an eating disorder although many of the signs can look similar.
The differences to watch for with an eating disorder involve a preoccupation with body image, food, and controlling eating habits. An eating disorder can significantly impact a person’s daily life. If food and eating seem to be invading their thoughts and behaviors more than just at mealtime, this can cause concern.
Children with autism are commonly picky eaters and will refuse foods for various reasons. Food can often trigger pain, for instance, as children with autism often suffer from gastrointestinal issues related to specific foods. This can lead to food refusal and avoidance of many types of foods. Both feeding issues and eating disorders can cause medical issues. Treatments can often help manage these conditions and ensure your child is taking in the necessary nutrients.
Treatments for Eating Disorders in Children With Autism
Comorbid conditions such as autism and an eating disorder can amplify the symptoms of each disorder and complicate treatment methods. A comprehensive treatment plan will often include a team of medical and mental health professionals working together to help manage both conditions at the same time.
Treatment methods will depend on the severity of each condition. Eating disorders, for example, can lead to serious medical conditions that may require hospitalization or an in-patient stay. Most eating disorder treatments also involve some form of individual or group therapy. Both of these options can present some difficulties for people with autism who like structure and routine and may have social difficulties and sensory issues. In this way, the treatment needs to be tailored to the individual to support these needs.
Treatments often include behavioral therapies and interventions to help individuals learn how to develop a healthier self-image, relationship with food and eating, and learn coping mechanisms for anxiety, depression, and autistic traits. Treatment programs also often include family therapies to help families learn how to support each other and educational programs to learn about the disorder(s) and how to best manage it.
Eating Disorders. (May 2020). U.S. National Library of Medicine (NLM).
Unusual Eating Behaviors May Be a New Diagnostic Indicator for Autism. (July 2019). ScienceDaily.
Why So Many People With Autism Have Eating Disorders. (September 2021). Psychology Today.
Co-Occurrence of Autism and Eating Disorders. (October 2021). Autism Parenting Magazine.
Alexithymia May Explain the Relationship Between Autistic Traits and Eating Disorder Psychopathy. (August 2020). Molecular Autism.
The Pica-Autism Connection: Help & Perspective. (September 2018). Autism Speaks. Feeding and Eating Problems in Children and Adolescents With Autism: A Scoping Review. (August 2021). Autism.