“It’s not about wanting to be thin or look small, it’s about the way it feels”: an IPA analysis of social and sensory differences in autistic and non-autistic individuals with anorexia and their parents

Abstract

Background Despite increasing evidence to support an overlap between autism and anorexia nervosa (AN), underlying mechanisms remain poorly understood. Social and sensory factors have emerged as promising targets in both autism and AN, however there remains scope to compare these differences across autistic and non-autistic experiences of AN. Drawing on dyadic multi-perspectives, this study explored experiences of social and sensory differences in autistic and non-autistic adults and their parents and/or carers. Methods Using interpretative phenomenological analysis (IPA), dyadic interviews were conducted with 14 dyads, with seven autistic dyads and seven non-autistic dyads. Data analysis was subjected to a triangulation of interpretations: (1) the participants themselves; (2) a neurotypical researcher; (3) and an Autistic researcher with lived/living experience of AN. Results IPA identified three themes in each group, with similarities and differences between autistic and non-autistic dyads. Similar themes were identified regarding the importance of social connectedness and socio-emotional difficulties, as well a common lack of trust in the social and sensory self and body. Autism-specific themes centred on feelings of social ‘defectiveness’, disparities between sensing and expressing certain cues, and lifelong, multi-sensory processing differences. Non-autistic themes reflected social comparisons and inadequacy, and sensitivities to the learning of ideals and behaviour through early experiences. Conclusions While similarities were observed across both groups, there appeared to be notable differences in the perceived role and influence of social and sensory differences. These findings may have important implications on the delivery and modification of eating disorder interventions. Specifically, they suggest that while treatment targets may look similar, subtle differences in underlying mechanisms and approaches may be required for Autistic individuals with AN across sensory, emotion and communication-based interventions.

Autistic traits, sensory sensitivity and eating disturbances in a sample of young adults referring to a generalized mental health clinic

“…The two conditions also share common psychopathological features, such as cognitive rigidity, atypical social cognition, and difficulties in emotion processing [ 6 ]. Moreover, the existence of alterations in sensory sensitivity, a typical feature observed both in patients with ASD and in patients with ED [ 7 ], has been linked with higher ED severity, difficulties in regulating emotions, and distorted perception of body image; notably, it often remains present despite treatment and weight restoration [ 8 , 9 ]. Though both full-blown ASD forms and subthreshold autistic traits have been identified in ED beyond Anorexia Nervosa (AN) [ 5 ], most research has concentrated on the latter.…”