As parents, you want your children to be at their happiest and healthiest, and that includes their diet. Unfortunately, kids on and off the autism spectrum can have problems with food, appearance, and self-esteem.
Eating disorders are some of the most complex and dangerous mental health concerns. How common is it for autistic people to have an eating disorder? Are the two conditions related? In this article, we’ll explore these questions and more.
What is an eating disorder?
According to the American Psychiatric Association, eating disorders are “characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.” In other words, they’re mental health conditions that produce unhealthy emotions and habits around food.
These behaviors include restricted eating, avoiding certain foods, excessive exercising, over-eating, and vomiting, or using laxatives to expel food.
It’s estimated that about 5% of the population struggles with an eating disorder. Female teenagers and young adults are most prone to disordered eating, but they can affect any age group or gender.
Is there a link between autism and eating disorders?
Psychologists have noted that people with autism spectrum disorder and people with eating disorders share many characteristics, including: inflexible thinking, repetitive behavior, sensory processing issues, insistence on routines, limited executive functioning, etc. It’s estimated that 20-30% of adults and 3-10% of minors with eating disorders have autism.
What’s less clear is whether the eating disorder produces traits similar to autism, or whether autism predisposes someone to eating disorders. Some research points to the latter—a 2020 study from the University College London (UCL) found that autistic traits in childhood predated an eating disorder.
UCL examined around 5,000 teenagers who had participated in a study called Children of the 90s since birth. They kept track of whether the young people showed autistic traits at ages seven, 11, 14, and 16, and whether they began to have disordered eating at 14. The participants weren’t necessarily diagnosed with autism, but similar traits had been reported by their parents.
Those who showed autistic traits at age seven were 24% more likely to have weekly disordered eating at 14. The eating disorders didn’t increase autistic traits by age 16, suggesting that autism—or difficulties similar to autism—may make developing an eating disorder more likely.
The researchers didn’t reach any conclusions about why but speculated that higher rates of depression and anxiety in autistic people may lead to unhealthy coping mechanisms like eating disorders.
What are the different types of eating disorders?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes seven eating disorders.
Anorexia nervosa, often shortened to “anorexia”, is perhaps the most well-known eating disorder. People with anorexia have a compulsive desire to lose weight. It has the highest mortality rate of any mental condition besides opioid use disorder, as some patients reach the point of starvation.
The DSM-5 divides anorexia into two subtypes: restricting type and binge-eating/purging type. In the first type, people diet, fast, and exercise. In the second, they occasionally “binge”, or eat large amounts of food in a short time, then purge through vomiting, laxatives, or other medications.
Aside from weight loss, symptoms include:
- Dizziness and fainting
- Muscle weakness
- Severe constipation
- Bloating after meals
- Bone thinning and possible stress fractures
- Fatigue and confusion
- Loss of menstrual periods in girls
- Brittle hair and nails
- Cold intolerance
- Cardiac problems
- Cognitive decline in long-term sufferers
People with bulimia cycle between periods of dieting and periods of bingeing and purging. They may feel out of control when they binge and continue eating even if they become uncomfortable or nauseated.
According to the DSM-5, binges should occur at least once a week for the person to qualify for a bulimia diagnosis. Patients will usually try to “compensate” for their binges by fasting, exercising, or purging the food.
If someone with these behaviors is underweight, they’re considered to have the binge-eating/purging type of anorexia.
People with bulimia may have similar symptoms as people with anorexia, as well as symptoms more specific to purging such as:
- Sore throat
- Swollen salivary glands in the cheeks
- Heartburn and acid reflux
- Dental decay
- Esophageal tears
- Gastric rupture
Bingeing also constitutes an eating disorder of its own. Like bulimia, this diagnosis requires a binge at least once per week. Unlike bulimia, patients don’t regularly try to compensate for the binges.
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People with this disorder eat compulsively, even if they don’t feel hungry. They often feel depressed and ashamed afterward. The condition can cause obesity, diabetes, heart complications, and other health issues.
Pica is when someone regularly eats objects that have no nutritional value, such as hair, pebbles, carpet, etc. The behavior usually begins in childhood and is most often seen in people with autism, schizophrenia, or intellectual disabilities.
See our article Pica and Autism: What Should You Do? for more information about this eating disorder in kids on the autism spectrum.
Avoidant/Restrictive Food Intake Disorder
This disorder, also known by the acronym ARFID, involves extreme picky eating or general avoidance of food. People with ARFID may reject certain foods because of texture, smell, color, etc. They may also have unusual anxiety about choking, vomiting, constipation, or having an allergic reaction. Unlike people with anorexia, they aren’t preoccupied with their appearance.
The American Psychological Association notes that it’s normal for people with autism to be picky eaters because of sensory issues or difficulties with motor skills. Pickiness only reaches the level of ARFID if it has one or more of these consequences:
- Significant weight loss
- If they’re a child, they aren’t reaching weight milestones
- Significant nutritional deficiencies
- Need for nutritional supplements or a feeding tube
- Interference with social functioning—for example, the patient will be afraid to eat in front of others
Rumination disorder is a rare problem in which undigested food will be regurgitated back into the mouth about an hour after eating. The person will either rechew and re-swallow the food, or spit it out.
Regurgitation is caused by relaxation of the diaphragm, which is similar to the belching reflex. Professionals think that rumination disorder occurs when diaphragm relaxation becomes a learned habit after eating.
This disorder can cause acid reflux and minor weight loss, but its effects aren’t as severe as others. Still, patients can work with a behavioral psychologist to relearn diaphragmatic breathing.
Other Specified Feeding and Eating Disorder
This category is for eating disorders that cause distress but don’t fit the other types. For example, the DSM-5 specifies that “low body weight” is crucial for an anorexia label. People who have anorexic behaviors but aren’t yet underweight may be diagnosed with Other Specified Feeding and Eating Disorder.
What causes eating disorders?
Eating disorders are complicated conditions. They’re usually caused by a combination of biological, environmental, and psychological factors.
Body image issues are a major risk factor, especially for bulimia and anorexia nervosa. It’s common for people to be insecure about their appearance, but when someone ties their self-worth to their weight, insecurities can spiral out of control into an eating disorder.
Girls traditionally face more pressure from society about…
Read More:Co-occurrence of Autism and Eating Disorders