Autism Spectrum Conditions and Eating Disorders

Autism is a neurodevelopmental condition defined by difficulties in social interaction and a tendency toward restricted, inflexible, or stereotypic interests or behavior, manifested early in development. These characteristics may present in rather diverse profiles and are viewed as a spectrum of features, dimensionally distributed between neurotypical presentation and pervasive disorders. They are often accompanied by differences in sensory processing and difficulties with emotion regulation and executive functions. Boys and girls differ in profiles, and this contributes to the challenge of diagnosing autism in the mostly female anorexia nervosa (AN) population. For instance, girls tend to display better expressive communicative skills while still struggle with social understanding, and they tend to be able to mask or camouflage their social difficulties more. It is well documented that autism diagnoses are more frequent in persons with AN. However, there is a large diversity. In addition, several features associated with autism are more frequent in people with AN more broadly, even without a diagnosed autism. Especially cognitive inflexibility, weak central coherence, and social cognitive impairment are documented, and difficulties navigating the social world may render the rule-based life of AN more appealing for some. For people with autism, AN may play a functional role as a stress response and a coping mechanism. This may explain why recovery from AN seems more difficult for persons with autism and autism features. Adaptions to accommodate autism and autism features in eating disorder services are growing in recent years. Examples include cognitive remediation therapy, radically open dialectical behavior therapy, and the PEACE pathway. In addition, standard manualized treatments may be adapted to better meet the needs of individuals with autism features.