Eating Disorders & ASD: Reflections on World Autism Awareness Day
Almost a year has passed since I delivered my talk to NEDIC on the link between autism spectrum disorders (ASD) and eating disorders. In that time more research has come out to support this surprising overlap between these seemingly distinct disorders. In August 2013, Simon Baron-Cohen and his team at the Autism Research Centre published a study that examined the cognitive profile of 66 teenage women with anorexia. Compared to their peers, women with anorexia had elevated autistic traits, reduced empathy and high levels of systemizing thinking. Systemizing, typically thought of as a “male” cognitive trait is the drive to analyse or construct a system to help understand and predict how something may behave. People with ASD tend to be extreme systemizers. Some have asked – is Anorexia the female ASD? (Joss, 2013).
Autism is typically thought of as a male disorder. Recent stats from the Centers for Disease Control found that boys are 4.5 times more likely to be diagnosed than girls. Is it possible that this huge variance can be attributed to gender differences in ASD presentation? Advocates argue that girls and women are under identified because the diagnostic criteria is based on a male model that doesn’t take into consideration the difference in how females experience the condition. Often girls with ASD are quiet, high achieving perfectionists who go under the radar because they are compliant and not disruptive. Special interests, a key characteristic of people with ASD, are often missed in girls and women because they tend to be more socially appropriate. For instance, a girl may become obsessed with her peers, animals, music or Anime. Being social does not come naturally to them. They work hard at trying to understand what it is expected of them in social situations. Many of the women that I see in my practice are able to “fake it” in social situations but then spend hours afterwards trying to deconstruct and make sense of what took place. They study and categorize people’s behaviour in an attempt to understand others - they are the ultimate people systemizers.
Women with ASD experience high rates of eating disorders due to sensory processing challenges, inflexible behaviours and thinking styles, distorted body awareness and challenges with emotional regulation. A link has been established between eating disorders and ASD. Many similarities in cognitive profile have been highlighted between the populations. Both display a high level of rigidity in their behaviour and thinking. For someone with an eating disorder this may be rigidity around caloric intake, body image, changes in diet. Both groups tend to be perfectionistic. Mood and anxiety disorders are high for both groups and in first degree relatives as well. One thing that is not clear is which comes first - does starvation create features of ASD or does ASD drive someone to develop an eating disorder? Research needs to be done to evaluate those who have recovered from eating disorders to see if ASD characteristics are reduced once nutrition is restored. Regardless, knowing this link creates the opportunity for dialogue between the people who work with these populations to influence treatment approach.
Baron-Cohen, S., Jaffa, T., Davies, S., Auyeung, B., Allison, C. Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular Autism, 4:24.
Joss, L. (2013). Is Anorexia The “Female Asperger’s”? Autism Daily Newscast. Retrieved from http://www.autismdailynewscast.com/is-anorexia-the-female-aspergers/5518...
Dori Zener, M.S.W., R.S.W., is an Individual, Couple and Family Therapist at The Redpath Centre. She has been working with families affected by Autism Spectrum Disorder (ASD), learning disabilities and intellectual disabilities for over ten years. Contact Dori online at firstname.lastname@example.org or visit her website at www.dorizener.com. Click here to watch Dori's NEDIC webinar on Women on the Autism Spectrum and Eating Disorders.