When it comes to recognizing an eating disorder, there are some common factors people typically look out for, such as restricted eating, excessive calorie counting, or anxiety around food. However, it’s important to understand that some of these behaviours can also be indicators of autism, and there are times the two conditions might overlap – unpicking them can be a complex and nuanced process.
For example, calorie counting could form part of a repetitive behaviour pattern but look to others like a desire to eat less. Restricted eating might stem from sensory issues around food, rather than a desire to lose weight. Likewise, the desire to control weight could be a sign of an eating disorder, but it could also form part of an individual’s autistic profile.
Sensory issues around food
Many autistic people experience sensory differences around food, which can lead to restricted eating or eating disturbances such as ARFID (Avoidant Restrictive Food Intake Disorder). ARFID has similar characteristics to anorexia nervosa, in that is involves limited or restricted eating, but unlike anorexia, ARFID is not driven by concerns around body image.
It’s common for autistic people to have sensitivities to taste, texture, sight, sound, or smell – all of which play a big part in eating and mealtimes and can lead to eating disturbances.
Some autistic people might be very specific about what colour food they eat, some might dislike wet foods like gravy or sauces, some might dislike certain textures, some might even feel strongly about where food sits on their plate.
Sound sensitivity can also affect behaviour around eating and lead to Misophonia – an inability to tolerate specific sounds or their associated triggers. For example, the sound of cutlery scraping against a plate, family chatter over dinner, the sound of other people chewing – these could all be really invasive for someone with a sound sensitivity and create quite a distressing experience around mealtimes.
Real life example:
I spent time with a young woman who had been continuously put into a hospital eating programme, but it just wasn’t working for her. Eventually, she was assessed for autism and it became clear that she was autistic and also had anorexia nervosa.
She explained to me very clearly that it was the sensory experience of eating (specifically group eating) that was halting her progress. For her, the texture of the food going down her throat was too much to process, and the sensory experience of being watched and seeing and hearing others eat was overloading. She was experiencing this overload regularly while eating at home with her family.
This is something I have heard several times – both family mealtimes and eating out at restaurants can be too much sensory demand with all the noise, smells, and sights. Sensory overload can lead to anxiety and overwhelm, and of course, intense anxiety around food and mealtimes would be a huge blocker to eating for anyone.
How can you tell the difference?
When clinicians try to unpick the difference between autism and an eating disorder, we’re looking for what is actually driving the behaviour, because what we see on the surface might not be an obvious indication of the cause or trigger behind it.
To explore this, we would observe behaviour around food and try to work out whether it arises from a desire to lose weight, or a desire to avoid certain foods or eat in a certain way. While the results might look similar, the cause is different.
To help with this process, we might ask a patient to keep a food diary which includes surrounding eating patterns, such as eating times, what food was eaten and what was avoided, why something was avoided, and any smells/sights/sounds when eating. We would also consider whether eating disturbances were accompanied by other behaviours like challenges with communication, repetitive behaviours, or other areas of restriction or fixation.
It’s really important to start recording evidence as soon possible, to help unpick the complexity around what might be causing an eating issue. It’s essential that we make sure we support the right behaviours, and how we would approach the treatment of eating disturbances resulting from a sensory sensitivity, would be very different to treating an eating disorder.
Real life example:
I worked with a young woman who went running multiple times a day, collecting exercise data on her FitBit. She progressively lost weight to an unhealthy level, and it started to look like anorexia to her family and doctors.
When we delved deeper, we uncovered that the driver for this behaviour was actually about the FitBit data collection, and a love of the numbers and graphs she could produce on her laptop. She enjoyed the running, but it was the data that was at the centre of it for her. Once we realised that, we were able to put the right support in place, like finding healthier ways to collect this kind of data. An eating regime would not have addressed this issue.
Take away tips
Predictability around food and mealtimes can be really helpful – knowing what you will eat, what time you will eat, and who will be there. Planning is key, so if you can, consider the following:
- Plan what you will eat for the week ahead, including a timetable of when and where you will be eating
- Carry snacks with you in case challenges prevent you eating as planned, so you don’t go hungry
- Ask people you are with not to eat trigger foods while you’re together
- Explain your needs and eating issues to people you are eating with.
If you’re going out:
- Where possible, check the menu in advance
- Take earplugs, headphones, or a nose clip if needed
- Have an exit plan, including a way to get home if you need to leave early
- Aim to eat in quieter places or at quieter times of day.
If you have any concerns for yourself or a loved one, start keeping a detailed food diary as soon as possible and seek help as soon as you notice the issue. Proper observation and assessment are vital to understanding what truly lies at the root of any eating disturbance.
