Autism increases vulnerability to both mental and physical health challenges, including eating disorders like anorexia nervosa (AN), Avoidant Restrictive Food Intake Disorder (ARFID), and Pica, which is consuming non-food items. Research shows that up to 35% of women in inpatient units for AN may be autistic, yet autism occurs in only 2% of the general population (Tchanturia, 2021). Sensory sensitivities, emotional regulation challenges, and unique thinking styles in autism often lead to eating behaviours as coping mechanisms.
Autistic individuals frequently experience heightened sensory sensitivities to the taste, texture, smell, or appearance of food (APA, 2022). This can result in restrictive eating habits, such as avoiding foods with intolerable textures or overeating sensory-preferred foods like sweet or crunchy items.
Challenges with interoception—the ability to sense internal bodily states—are also common. Difficulty recognizing hunger and fullness can lead to irregular eating patterns, aversions to bodily sensations linked to digestion, or an intense preference for the feeling of "emptiness" by avoiding food altogether (Inouye et al., 2021).
Social challenges, including loneliness and bullying, can make eating disorders a way to self-soothe or regain control. Restrictive eating may distract from emotional pain, while comfort eating can provide temporary relief from social stress (Henriksen et al., 2017; Rumball, 2019).
In adolescence, changes in social dynamics and body development during puberty may intensify these struggles. Autistic teens may feel disconnected from peers, using dieting as a way to fit in or gain a sense of identity. Restrictive eating can also reflect a desire to remain childlike, asexual, or androgynous, often linked to fears of adulthood or gender dysphoria (Kerns et al., 2016). In some cases, weight changes may serve as a defence mechanism against future harassment or abuse (Rumball, 2019).
Autistic individuals’ tendencies toward rigid thinking and preference for structure can reinforce eating disorder behaviours. Fixed ideas about weight or calories, coupled with ‘black-and-white’ thinking, may lead to unhealthy rules, such as associating a single weight with acceptability, even at life-threatening levels (APA, 2022).
Passionate interests can also play a role. The focus on calories, schedules, and progress tracking may become a source of intense intellectual satisfaction, particularly with Apps or spreadsheets. Social media may amplify this interest, providing validation through ‘likes’ and ‘shares’.
Autism and eating disorders often overlap, making it critical to screen autistic individuals for eating disorders and vice versa. Early identification can improve outcomes by tailoring interventions to meet the unique needs of autistic individuals. For example, sensory needs and thinking styles can inform treatment plans, enhancing recovery and reducing inpatient costs (Tchanturia et al., 2021).
Eating disorders like AN carry the highest mortality rates among mental health disorders, with suicide and the effects of starvation on heart functioning as leading causes of death (Bernstein, 2023). Timely diagnosis is essential to saving lives and alleviating the burden on families (Van Hoeken & Hoek, 2020).
Professor Kate Tchanturia, Lead Clinical Psychologist for the National Eating Disorder Service, UK, and Professor in the Psychology of Eating Disorders at Kings College, London, emphasizes that recognizing autism in eating disorder treatment is essential. Understanding a patient’s neurodivergence enables clinicians to adapt strategies effectively. One individual shared how their diagnosis allowed their treatment team to “turn the typical approach on its head,” leading to progress and greater self-understanding (Tchanturia, 2021).
Acknowledging the connections between autism and eating disorders can lead to better outcomes for individuals and their families. Screening in both neurodivergent and eating disorder clinics enables holistic, compassionate care, helping patients lead happier, healthier lives.
We are excited to be presenting a half-day training on Autism and Anorexia Nervosa which we will host as a live webinar on Friday 21st February 2025. The training will be helpful to parents, professionals and autistic people with anorexia nervosa.
APA (2022). Diagnostic and Statistical Manual of Mental Disorders 5th Edition Text Revision (DSM-5-TR).
Bernstein, B. (2023). Anorexia Nervosa. Medscape. Retrieved from Medscape.
Henriksen, I. O., et al. (2017). The role of self-esteem in psychiatric problems: Child and Adolescent Psychiatry and Mental Health, 11, 68.
Inouye, T., et al. (2021). Prevalence of autism and ARFID in children. BioPsychoSocial Medicine, 15.
Kerns, C. M., et al. (2016). Autism and adverse childhood experiences. Journal of Autism and Developmental Disorders, 47, 2275–2281.
Rumball, F. (2019). PTSD in autism: Rev J Autism Dev Disord, 6, 294–324.
Tchanturia, K. (2021). Supporting Autistic People with Eating Disorders. London: JKP.
Van Hoeken, D., & Hoek, H. W. (2020). Burden of eating disorders: Curr Opin Psychiatry, 33(6), 521–527.
