Autism & Eating Disorders: Understanding the Connection and Support Strategies
While eating disorders have long been associated with perfectionism, body image, and cultural pressure, growing research is shedding light on an often-overlooked population: autistic individuals. Autism spectrum disorder (ASD) and eating disorders may seem unrelated at first glance, but the overlap is more significant than once believed—and uniquely complex.
This blog post explores why individuals with autism may be at increased risk for eating disorders, how these conditions interact, and what support strategies are most effective.
How Common Is the Overlap Between Autism and Eating Disorders?
Studies suggest that 20–35% of individuals with anorexia nervosa may also meet criteria for autism spectrum disorder (Westwood & Tchanturia, 2017).
Autistic individuals of all genders may be at increased risk for restrictive eating behaviors, especially in adolescence.
The link may be underdiagnosed, particularly in girls and gender-diverse individuals, due to camouflaging or misinterpreted symptoms.
“We must look beyond body image. For many autistic individuals, food issues are about sensory, control, and predictability—not weight.”
– Dr. Kate Tchanturia, eating disorder researcher
Why Are Autistic Individuals at Higher Risk for Eating Disorders?
1. Sensory Sensitivities
Many autistic people have heightened sensitivity to:
Food textures
Temperatures
Smells or flavors
Noisy, bright, or crowded eating environments
These sensory issues can lead to:
Extreme food selectivity
Avoidance of entire food groups
Limited dietary variety, sometimes mistaken for intentional restriction
In some cases, this can develop into Avoidant/Restrictive Food Intake Disorder (ARFID) or overlap with anorexia nervosa.
2. Need for Routine and Predictability
Rigid routines can affect:
Meal timing
Food choices
Willingness to try new foods
Disruption to these routines may cause distress or refusal to eat, especially during transitions like puberty, school changes, or family stress.
3. Interoception Differences
Autistic individuals may struggle with interoception—the ability to sense internal body cues like hunger, fullness, or thirst.
This can lead to:
Eating too little or too much without realizing
Skipping meals due to lack of hunger awareness
Misinterpreting anxiety or nausea as hunger
4. Social Pressure and Masking
Especially in autistic girls and nonbinary individuals, masking behaviors—trying to appear “neurotypical”—may include controlling eating, mirroring others’ food habits, or suppressing preferences to fit in.
This can lead to:
Internalized shame
Disconnection from bodily needs
Eating disorders as a coping mechanism or identity anchor
5. Anxiety and Co-occurring Mental Health Conditions
Many autistic people also experience:
Generalized anxiety disorder
Obsessive-compulsive traits
Depression
Eating disorders may emerge as a way to manage or control overwhelming feelings in the absence of adequate emotional support.
Common Misdiagnoses or Missed Diagnoses
Autistic traits in eating disorder patients are often dismissed as anxiety, OCD, or “extreme discipline”
Girls and nonbinary individuals may camouflage autistic traits, delaying diagnosis
Autistic individuals may struggle in traditional ED programs that lack neurodivergent-informed care
“Many treatment environments assume that all eating disorder behaviors are driven by weight and shape concerns. That assumption excludes autistic individuals.”
– Huke et al., 2013
What Does Effective Support Look Like?
1. Sensory-Aware Nutrition
Validate sensory needs (don’t force exposure to aversive foods)
Offer safe foods with similar nutrients in preferred formats
Build in flexibility and choice
Use visual menus or structured plans for predictability
2. Interoceptive Support
Use scheduled eating if hunger cues are unreliable
Teach body awareness through mindfulness or body mapping
Encourage consistent routines without rigid rules
3. Therapy That Honors Neurodivergence
Consider autism-informed CBT or DBT
Avoid over-pathologizing rigidity or food preferences
Focus on function and distress, not compliance or conformity
Explore ARFID or sensory-based eating difficulties, not just anorexia/bulimia criteria
4. Accommodations in Treatment Settings
Quiet, sensory-friendly eating environments
Clear, direct communication (avoid sarcasm or abstract language)
Opportunities for solo processing or special interests as regulation tools
Staff training in neurodiversity-affirming care
5. Collaborative, Non-Coercive Care
Empower autistic individuals to co-create treatment goals
Involve occupational therapists, speech therapists, and sensory specialists when needed
Normalize difference: “Your brain works differently—not wrong.”
Support for Parents and Caregivers
Learn about neurodiversity-affirming language and practices
Respect feeding differences while also prioritizing nourishment
Use visual supports, routines, and co-regulation strategies
Seek out autism-informed providers in both eating disorder and mental health care
Support peer connection with other neurodivergent youth or mentors
Final Thoughts
The intersection of autism and eating disorders is complex, deeply personal, and often misunderstood. But with the right knowledge and support, recovery is possible—and should never require someone to mask or lose their identity in the process.
Healing means more than symptom reduction. It means helping autistic individuals build a relationship with food, body, and self that is rooted in acceptance, autonomy, and dignity.
References
Westwood, H., & Tchanturia, K. (2017). Autism spectrum disorder in anorexia nervosa: An updated literature review. Current Psychiatry Reports, 19(7), 41.
Huke, V., Turk, J., Saeidi, S., Kent, A., & Morgan, J. F. (2013). Autism spectrum disorders in eating disorder populations: A systematic review. European Eating Disorders Review, 21(5), 345–351.
Kinnaird, E., Norton, C., Stewart, C., & Tchanturia, K. (2019). Same behaviours, different reasons: What do patients with anorexia nervosa think about autism traits? Journal of Eating Disorders, 7(1), 20.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
Tanna, S., Fisher, J. O., & Birch, L. L. (2021). Feeding strategies for neurodivergent children: Integrating sensory, emotional, and behavioral support.
