Knowing the signs: eating disorders and autism

Eating disorders are serious mental illnesses that can significantly impact a person’s health and wellbeing. There isn’t a simple explanation or a single cause: eating disorders are triggered by a range of biological, social, and emotional factors.

Research suggests that children with autistic traits are far more likely to develop an eating disorder compared to their non-autistic peers. However, eating often presents challenges for autistic people. This can make it difficult to identify when behaviours may be a sign of something more serious.

Eating Disorder or Disordered Eating?

It’s first important to know the difference between these terms, especially when considering eating behaviours in autism.

Disordered Eating

Some autistic people can show signs of ‘disordered eating’. For example, they may skip meals because of difficulty recognising hunger. Or they may have a restricted diet due to sensory aversions towards certain textures or tastes. This doesn’t necessarily mean that they have an eating disorder. It may just be that the individual requires extra support to ensure they are able to meet all their nutritional needs, within the parameters of their preferences.

Eating Disorders

In contrast, an eating disorder is typically connected with body image, health and attempts to control weight and food intake. Key signs of an eating disorder include behaving in a way that is harmful to physical and emotional health due to anxiety about weight, appearance, or calorie intake.

For young autistic people, a wide range of aversive sensory experiences may lead to limited dietary choice. For some, this may be accompanied by distress around eating. This can result in low energy, malnutrition, arrested growth or weight loss. At this stage, a person may meet the diagnostic criteria for an eating disorder such as Avoidant/Restrictive Food Intake Disorder (ARFID).

Unlike other eating disorders such as Anorexia Nervosa, the desire for weight loss or fear of weight gain is not present in ARFID. Although weight loss and nutritional deficiency are common. Instead, restriction of foods is motivated by sensory properties and beliefs that eating may have negative consequences such as choking, vomiting or contamination.

Do eating disorders look different in autistic people?

Typically, eating disorders, such as anorexia, involve an intense focus on weight and body image. Emerging evidence suggests autistic people may present signs of eating disorders for other reasons, such as coping with difficult emotions, social isolation or bullying.

For others, eating disorders may originate in restricted and repetitive behaviours that take the form of an intense interest such as calorie-counting, exercise, or an insistence on a limited diet.

Spotting the red flags:

Here are just some of the behavioural and physical signs that suggest an individual may be struggling with their eating.

Behavioural	Physical
Fixation with food and weight. For instance, consuming food related media or talking obsessively about food related topics.	Sudden weight loss, gain, or fluctuation in short time.
Avoiding communal spaces at lunchtimes, working through lunch, or eating alone.	Feeling dizzy, light-headed, or fainting when standing up.
Excessive exercising or physical activity. Distress may be caused if this is curtailed. They may hover over chairs instead of sitting, constantly jiggle legs, get up from desk at every opportunity or offer to run errands often.	Frequent fatigue – they may have dark circles or bloodshot eyes. Individuals may appear distracted, struggle to focus and seem disinterested in activities they would normally enjoy.
Insistence on weighing food, or tearing food into small pieces.	Fine soft hairs all over body.
Repeated or prolonged use of the toilet, especially after meals.	Feeling cold or shivering.
Expresses complaints or concerns about body image, for example feeling fat or ugly. Mood is impacted by negative thoughts about appearance.	Calluses on the knuckles from self-induced vomiting.
Wears very baggy clothes to hide weight loss/gain or because of concerns about body shape/size.

Life events

Research has highlighted how stressful life events have the potential to trigger the onset of an eating disorder.

Be aware of changes in weight and behaviour around these events:

School transition: The move from one primary/secondary school to another can be a stressful time, especially in students who struggle with change
Relationships: The divorce of parents could affect a child as can the breakdown of friendships
Death of a loved one: This could include either a family member or close friend
Moving house: These changes can lead young people feeling vulnerable in their new environments, they may not feel in control

What should I do if I am concerned about a young person?

No single practitioner can have a full picture of a child’s needs and circumstances. If children and families are to receive the right help at the right time, everyone who comes into contact with them has a role to play in identifying concerns and sharing information.

Concerns can be raised with the young persons GP or dietician if they have one. They will be able to make a judgement as to whether a referral to the local children and adolescent mental health services (CAMHS) is necessary.