I am known for being rigid. I'm not incredibly fussy or strict but I have my own little rules and routines which I like to stick to because they make me feel comfortable. Because of this, some of my close friends joke that I am on the autistic spectrum. This got me thinking; what if there was a link between autism and anorexia?
Its quite easy to comprehend this link, firstly anorexia involves rigid attitudes and behaviour, which can be seen as resembling the unusually narrow interests and rigid and repetitive behaviour in autism. Secondly, patients with anorexia are often extremely self-preoccupied, the word ‘autism’ literally means an exclusive focus on the ‘self’. Finally, both autism and anorexia involve rigidity on tests of set-shifting, and excellent performance on tests of attention to detail.
Because of this, some scholars have theorised that autism and anorexia could share common underlying cognitive and neural phenotypes. There have been a series of tests to see whether patients with anorexia have an elevated score on a measure of autistic traits, the Autism Spectrum Quotient (AQ). By using EQ-SQ (empathy-systemizing) scores to calculate ‘cognitive types’, patients with anorexia were more likely to show the Type S profile (systemizing better than empathy), compared with typical females.
Systemizing is described as an impulse to follow a strict system of behaviour in day-to-day living, similar to behaviours common in OCD.
From these studies, researchers concluded that adolescent women with anorexia had higher levels of certain traits of autism compared with a large group of adolescent women without anorexia.
Furthermore, a group of Swedish researchers found that 23% of female patients with severe eating disorders had symptoms of autism, arguing that both autistic and anorexic patients had lower levels of oxytocin.
However, it remains to be said that all of this is still a theory.
But something clicked in me whilst I was reading these studies. Perhaps my anorexia is the result of systemizing behaviour which has latched onto the domain of food, causing me to become obsessed with calorie counting, body size and weight.
Its possible for the reverse to also be true as strict, regimented diets have also been used on autistic children as a "cure", resulting in unhealthy relationships with food to form. Even Greta Thunberg, the environmental activist known for surpassing prejudices around autism, revealed she too struggled with an eating disorder. Because certain foods have been prohibited in childhood, this can result in binge eating behaviours in adulthood, consequently leading to cause feelings of shame and guilt due to feelings of loss of control.
Additionally, autistic people can struggle with certain food textures or other senses can make certain food less appealing. Amongst eating disorders, this is often known as AFRID in which people develop an aversion to certain foods based on texture and taste. There was recently an extreme case of this, as a child lost his eyesight due to a B12 deficiency as a result of his "fussy eating".
Autistic people can also struggle with rapid eating behaviours, most commonly associated with binge eating disorder, which is only exacerbated due to diets being used as a source of treatment.
On the one hand, these findings are reassuring for me as perhaps the root of some of my disordered behaviours could be biological, therefore providing clinicians with a new approach to my therapy based on my cognitive profile and not just my behaviour.
However, from this we should also be mindful about how the diet culture can have damaging affects on autistic individuals, exacerbating certain behaviours so that they too develop eating disorders which will unfortunately go undetected due to the mysticism that still shrouds autism awareness and treatment.
If you are worried about yourself or a loved one please contact Beat: 0808 801 0677 or 0808 801 0711.
Baron-Cohen, S et al. (2013) “Do girls with anorexia nervosa have elevated autistic traits?” Molecular Autism. 4(24) https://link.springer.com/article/10.1186/2040-2392-4-24
Gallagher, S. (2020) "GRETA THUNBERG WAS NEARLY HOSPITALISED DUE TO DISORDERED EATING, SAYS MOTHER" Independent. https://www.independent.co.uk/life-style/health-and-families/greta-thunberg-aspergers-eating-disorder-malena-ernman-interview-a9355201.html
Goldschmit, J. “A broad view: Disordered eating on the autism spectrum” Eating Disorders Review. Vol 29(3) https://eatingdisordersreview.com/a-broad-view-disordered-eating-on-the-autism-spectrum/
Knight, R. (2018) “How Extreme Diets Damage Autistic People.” THINKING PERSON'S GUIDE TO AUTISM http://www.thinkingautismguide.com/2018/01/how-extreme-diets-damage-autistic-people.html
NHS (2013) “Autistic traits may be more common in anorexic girls” NHS UK. https://www.nhs.uk/news/2013/08August/Pages/autistic-traits-may-be-more-common-in-anorexic-girls.aspx
Odent, M. (2010) “Autism and anorexia nervosa: Two facets of the same disease?” Medical hypotheses 2010 Jul7; 75(1) pp.79-81 https://www-sciencedirect-com.oxfordbrookes.idm.oclc.org/science/article/pii/S0306987710000551
Roberts, M. (2019) "Teenager 'blind' from living off crisps and chips." BBC News. https://www.bbc.co.uk/news/health-49551337
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