“For Me, the Anorexia is Just a Symptom, and the Cause is the Autism”: Investigating Restrictive Eating Disorders in Autistic Women

Abstract

Autistic women are overrepresented among people in treatment for Anorexia Nervosa (AN). The current study aimed to: (1) better understand how AN develops and persists in autistic individuals from the perspective of autistic women, parents and healthcare professionals; (2) derive a theoretical model of restrictive eating difficulties in autism. We conducted 44 semistructured interviews and used Thematic Analysis to identify patterns of meaning across the data. Themes related to sensory sensitivities, social interaction and relationships, sense of self and identity, difficulties with emotions, thinking styles, and a need for control and predictability. We developed a model of potential autism-specific mechanisms underlying restrictive eating difficulties. This study generated novel insights, which have the potential to inform treatment adaptations following empirical testing.

A peer interview qualitative study exploring support for carers of people with comorbid autism and eating disorders

“…In this context, carers made a number of recommendations for support options for this population, including peer-based support and psychoeducation. With the current paper replicating similar ndings in prior studies evaluating needs associated with co-occurring ASC and ED, this study adds strong support to arguments that associated populations, including patients, carers and clinicians, do require specialised adaptations [21,22,28,32].…”

“…Gold-standard observational diagnostic measures combined with developmental assessments suggest that autism prevalence in AN may be around 10%, compared to a general population prevalence of ~ 1% [19,20]. Individuals with both an ED and a diagnosis of ASC may experience additional issues compared to their neurotypical peers, including sensory problems motivating food restriction, di culties engaging in treatment due to communication differences, and high levels of cognitive rigidity making it di cult to change ED-related behaviours and cognitions [21,22].…”

“…Consequently, parents caring for a child with ASC are likely to experience additional challenges that may not be typically experienced by a parent caring for a child with an ED only, and so may not be addressed by existing caregiver interventions or support for ED caregivers. To date, two qualitative studies have explored the experiences of carers of children with a diagnosis of both ASC and AN [21,28]. Brede et al (2020) explored the relationship between restrictive eating di culties and ASC with carers, patients and clinicians.…”

“…To date, two qualitative studies have explored the experiences of carers of children with a diagnosis of both ASC and AN [21,28]. Brede et al (2020) explored the relationship between restrictive eating di culties and ASC with carers, patients and clinicians. They found that ASC and AN are closely intertwined, and that women with both conditions have different needs compared to people with AN only.…”

Family History of Eating Disorder and the Broad Autism Phenotype in Autism

“…ASD can manifest as rigidity in eating and exercising or fixations on body image and calorie counting which may obscure underlying autism spectrum disorders. [Brede et al 2020] investigated the relationship between AN and ASD through qualitative assessments and found that both these conditions shared overlapping features including difficulties with emotions and social interactions, a desire for routine and control, and similar sensory sensitivities. The study also proposes a model of autism-specific mechanisms that may underlie restrictive eating difficulties which further highlights the complex relationship between these disorders.…”