In recent years, the field of behavioral health has started to gain a better understanding of the relationship autism spectrum disorder (ASD) and eating disorders. A thorough understanding of these conditions and how they intersect is important for offering meaningful support.   

Autism and Sensory Sensitivities: The Roots of Food Aversions 

Autistic people with sensory sensitivities may face unique challenges when it comes to food. They may respond differently to sensory stimuli from food, such as the texture, smell, or taste of certain foods. For instance, an individual might find the texture of a specific food item overwhelming or off-putting and avoid eating it. 

What a person eats and how much they eat may also have to do with interoception—the ability to understand and interpret physical sensations within the body. Some people have difficulty recognizing feelings of hunger or satiety, which can influence eating patterns. 

Two young children having difficulties eating their food.

Autism and Eating Disorders: Some Overlapping Traits 

Research has unveiled surprising connections between autism and eating disorders, such as anorexia nervosa. Traits like reduced flexibility in behaviors and routines, fixed interests, and challenges in social communication are common to these conditions and may help to explain why individuals with ASD are more likely to develop eating disorders. 

Autism and ARFID: More Than Picky Eating  

Avoidant/restrictive food intake disorder (ARFID) is another eating disorder that may occur among those with autism. Unlike anorexia nervosa or bulimia nervosa, ARFID is not driven by concerns about weight or body shape but rather by fear of eating, aversion to certain food attributes, or lack of interest in eating. For autistic people, food aversions related to sensory sensitivities can contribute significantly to the development of ARFID. 

The Risk of Undernourishment or Malnourishment 

Given the complexities around food intake, autistic people may risk undernourishment or malnourishment. Food selectivity and restrictive eating behaviors can result in limited nutritional intake, making it challenging to maintain a balanced diet. This can lead to impaired physical development, weakened immune systems, and a range of other health complications.  

Spotting the Signs: Identifying an Eating Disorder in Autistic People 

Being aware of potential eating disorder signs and symptoms is vital for early intervention and treatment. Eating disorders can manifest in many ways, and they can look different in people with autism. Signs that an autistic individual may be struggling with an eating disorder include: 

1. Changes in Eating Patterns 

One of the most noticeable signs of an eating disorder is a significant change in eating patterns. This can include restricting food intake, consuming large amounts of food in a short time, avoiding meals, or adhering rigidly to a particular diet, even when it leads to nutritional deficiencies.  

2. Preoccupation with Weight, Size, or Food 

While it's not unusual for people with autism to have specific interests, a sudden or intense focus on weight, body size, or diet could indicate a problem. This preoccupation might present itself as frequent dieting, obsessive calorie counting, or a persistent fear of gaining weight.  

3. Unusual Behaviors Around Food 

Certain behaviors around food can also indicate an eating disorder. These could include cutting food into tiny pieces, eating in secret, disposing of food covertly, or having an intense focus on preparing or cooking food for others without eating themselves.  

4. Physical Signs and Symptoms 

Physical signs are often more evident as the eating disorder progresses. They can include significant weight loss or gain, fatigue, dizziness, menstrual irregularities, gastrointestinal problems, or signs of self-induced vomiting like swollen cheeks or discolored teeth.  

5. Emotional and Behavioral Changes 

Eating disorders often come with emotional and behavioral changes. Look for signs such as withdrawal from social activities, mood swings, heightened anxiety around mealtimes, or an increase in rigid behaviors or routines. 

If you observe these signs, it's important to seek professional help. Remember, these symptoms don't necessarily confirm the presence of an eating disorder, but they do indicate a need for further investigation. Eating disorders are serious but treatable conditions, and early intervention significantly improves the chances of recovery.

A caregiver and a young child are eating together.

Navigating Eating Disorders in Autistic Children and Teens 

Supporting an autistic child or teen with an eating disorder calls for a tailored, compassionate approach. Some strategies to consider include:  

  1. Understanding and Patience: Recognize that food issues in autism are not willful or stubborn behaviors. They often stem from genuine distress and discomfort related to sensory or interoception issues. Understanding and patience are critical in navigating these challenges. 

  2. Professional Support: Therapists, dietitians, and other healthcare professionals skilled in both autism and eating disorders can provide invaluable guidance and treatment strategies. They can assist with interventions like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), or feeding and nutrition therapy tailored to an individual's needs. 

  3. Sensory-Friendly Options: Work towards expanding the variety of foods in the individual's diet gradually. Introducing new foods with similar textures or flavors to their preferred items can be a less stressful starting point. 

  4. Consistent Mealtime Routines: Regular mealtimes can offer a sense of security and predictability, reducing anxiety around eating.   

  5. Education: Teach children and teens about nutrition and the importance of a balanced diet in a way they can understand. Use visuals or interactive activities to make learning more engaging. 

While understanding the intersection of autism and eating disorders can be daunting, remember that you're not alone. There's a wealth of resources and professional help available to guide you. With patience, compassion, and professional guidance, you can navigate this complex landscape and provide the support your child needs.  


Meaghan O'Dea Johnson
Author: Meaghan O'Dea Johnson, MS, CPNP-PC