Eating Disorders and Autism: The Need for Neurodiversity-Informed Treatment

Eating disorders are complex conditions requiring specialized, individualized care.

When autism is also a factor, traditional treatment approaches can sometimes fall short.

Research indicates that autistic individuals have a higher prevalence of eating disorders, particularly anorexia nervosa and Avoidant/Restrictive Food Intake Disorder (ARFID). Studies estimate that between 20-35% of individuals with eating disorders are also autistic (Huke et al., 2013; Westwood et al., 2016), with more recent research by Tchanturia (2024) finding that approximately 35% of women with anorexia nervosa exhibit comorbid autism traits. These findings highlight the importance of adapting treatment to support neurodivergent needs effectively.

Why Are Autistic Individuals at Higher Risk for Eating Disorders?

Autistic individuals experience the world differently, impacting their relationship with food and therapy. Evidence-based research highlights several key factors contributing to eating disorders in this population:

• • Sensory Sensitivities: Research by Brede et al. (2020) shows that autistic individuals sometimes have heightened sensory sensitivities, making certain textures, smells, and tastes overwhelming, which can lead to food avoidance.
  • Cognitive Rigidity and Repetitive Behaviors: A study by Tchanturia et al. (2019) found that autistic individuals with anorexia display more pronounced cognitive inflexibility, leading to rigid food rules and compulsive eating behaviors.
  • Interoceptive Awareness Difficulties: Research by Brewer et al. (2016) highlights that many autistic individuals struggle with recognizing hunger and fullness cues, leading to disrupted eating patterns.
  • Anxiety and Need for Routine: Autistic individuals sometimes use predictable eating routines to manage anxiety, as found in research by Kinnaird et al. (2020), which can become rigid and restrictive over time.

The Benefits of a Neurodiversity-Informed Approach

A neurodiversity-informed approach acknowledges that autistic individuals experience food, hunger, and recovery differently. Instead of enforcing neurotypical eating patterns, treatment can be adapted to:

• • Accommodate Sensory Needs: Gradual exposure to new foods should be tailored to individual tolerances rather than forcing overwhelming experiences (Zickgraf et al., 2020).
  • Use Clear and Direct Communication: Autistic individuals sometimes struggle with abstract language, so treatment should prioritize clear, structured explanations (Westwood & Tchanturia, 2017).
  • Provide Predictability and Structure: Routine-based eating can be supportive if balanced with gradual flexibility-building strategies (Kinnaird et al., 2020).
  • Address Executive Functioning Challenges: Support with meal planning and preparation can help reduce decision fatigue and improve adherence to nutritional goals (Harris et al., 2019).
  • Recognize Masking and Burnout: Many autistic individuals suppress their struggles in treatment settings, making their challenges harder to detect (Mandy & Tchanturia, 2015).

Adapting Family-Based Treatment (FBT) for Neurodivergent Needs

Family-Based Treatment (FBT) is considered one of the most effective approaches for adolescent eating disorder recovery (Lock & Le Grange, 2019). When adapted for autistic individuals, it can be particularly beneficial in providing structured and predictable support.

A neuroaffirming approach to FBT could include:

• • Sensory-Informed Meal Support: Accepting some safe foods and making gradual adjustments instead of enforcing exposure to distressing foods.
  • Differentiating Autism Traits from Eating Disorder Behaviors: Recognizing when rigidity is an autistic trait rather than a symptom of the eating disorder (Tchanturia et al., 2019).
  • Providing Predictable and Structured Guidance: Using visual schedules and step-by-step instructions to reduce anxiety around meals (Harris et al., 2019).
  • Avoiding High-Pressure Exposures: Gradual, low-stress approaches to food challenges rather than sudden, overwhelming expectations.
  • Understanding introceptive awareness and sensory sensitivities.

By making these adjustments, treatment can better align with neurodivergent needs, creating a supportive environment that fosters recovery in an individualized way.