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Eating on the Spectrum

By Kristyn Pecsi, MD

Research suggests that 20% to 35% of people with anorexia nervosa also have autism spectrum disorder or show signs of the condition.

In fact, the behaviors associated with autism and eating disorders often intertwine, presenting unique challenges for diagnosis and treatment.

At the Princeton Center for Eating Disorders at Penn Medicine Princeton Medical Center, a multidisciplinary team of board certified psychiatrists, other specialized physicians, nurses, psychotherapists and dietitians provide inpatient treatment for individuals with eating disorders, including those with autism.

A Predisposal Toward Eating Disorders

While autism and anorexia or restrictive eating are distinct conditions, many of the same behaviors associated with autism predispose individuals to the development of an eating disorder.

Consider that many individuals with autism exhibit atypical eating patterns or preferences due to sensory sensitivities, rigid routines, or hyperfocus on specific foods.

For example, someone with autism may desire only soft foods or may not eat food that is hot. Utensils may always need to be in certain spots and food may always need to be presented on the plate in certain way. The lights may need to be dim and the noise level low.

Additionally, difficulties with social interactions, common in autism, may exacerbate feelings of isolation or anxiety surrounding food and eating situations, creating a pathway toward an eating disorder.

Moreover, someone with autism may feel intense social pressure to fit in or to look a certain way, triggering an obsessive focus on food and weight.

Picky Eating or Something More?

For any parent, recognizing whether a child is just a picky eater or is developing a disorder is challenging, but it can be especially difficult for parents of children with autism. 

The most important sign to look out for is whether your child is staying on the growth curve. Are they getting the nutrition and energy they need to grow and stay healthy? If not, it may be time to seek medical help.

Other signs of a possible eating disorder include:

  • Further narrowing of the types of food your child will eat. For instance, instead of 10 acceptable foods, your child will now only eat five. 
  • Eating smaller and smaller portions.
  • Intense interest in calorie counting or weighing food.
  • Excessive exercise or physical activity.
  • Clothes no longer fitting right, too big or too baggy.

If you are concerned your child may have an eating disorder, talk with your pediatrician as well as an autism specialist.

A Multidisciplinary Treatment Approach

Addressing the complex interplay between autism and eating disorders requires a multidisciplinary approach tailored to individual needs.

At the Princeton Center for Eating Disorders, treatment includes individual and group therapy, as well as nutrition counseling and medical treatment for any related health problems the individual may be experiencing.

For patients with autism, an occupational therapist can provide additional insight on texture and sensory issues.

Family engagement is also key, especially in helping the treatment team differentiate between autism behaviors and eating disorder behaviors. Family members can also be a source of comfort for patients during treatment.

Individuals with autism may have more difficulty engaging in treatment or be seen as disruptive, uncooperative, or overly compliant.  A slower approach is critical to treating patients who have both autism and an eating disorder, and the fewer changes at once the better.

Small Wins

Small wins along the way can provide patients the feeling of achievement they need to continue with treatment. This is also true when the patient returns home and continues their recovery.

Some tips parents can use to help their child in recovering from an eating disorder include the following: 

  • Minimize environmental triggers. This could include supplying earplugs to reduce noise, a hat to decrease light, and a smaller space to eat meals.
  • Offer sensory items that promote a calming effect, such as fidget toys or refrigerated utensils.
  • Understand that your child may need to eat in a safe sensory space, such as a quiet, cold corner of the room.
  • Encourage your child to write down their thoughts at the end of the day to help them process their feelings and to share and communicate those thoughts.
  • Practice self-care. Parenting a child with autism and an eating disorder can be emotionally and physically draining. Take time for self-care activities to recharge and maintain your own well-being, whether through exercise, hobbies or seeking support.

The overlap of autism and eating disorders presents a complex challenge. However, recognizing the signs early along with a specialized, comprehensive treatment approach, can help make recovery possible.

For more information about the Princeton Center for Eating Disorders, call (888) 437-1610, option 3, or visit princetonhcs.org/eatingdisorders. 

Kristyn Pecsi, MD, is a board certified psychiatrist with the Penn Medicine Princeton Health Princeton Center for Eating Disorders.

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