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Q. I suspect that my autistic patient may have an eating disorder, based on her irregular eating behaviors. Is this unusual? (G.B., Houston, TX)
A. The combination of autism/Asperger’s syndrome (ASD) and eating disorders may be more common than we think. In a recent study, for example, almost a fourth of the participants (23.55%) with ASD scored above the cutoff of the Eating Attitudes Test-26 (EAT-26), which pointed to the need for further assessment by a specialized clinician (Eat Weight Disord. 2024. 29:10).
Research over the past decade has made the connection between autism and eating disorders much clearer. Autism-type disorders are neurodevelopmental conditions characterized by difficulties in social interactions and communication, restrictive and repetitive patterns and behaviors, and altered social sensitivity. Eating disorders involve abnormal eating habits and attitudes toward food and body image. The two conditions share psychopathological features such as cognitive rigidity, atypical social cognition, and difficulty processing emotion (J Autis Dev Disord.2020. 50:4280).
According to a recent study headed by Dr. Veronica Nistico at the University of Milan, Italy, adults with ASD without intellectual disability, compared with neurotypical healthy controls, had a higher prevalence of autistic-type eating disturbances but also of eating disorder symptoms and concerns. The authors devised the study to investigate the prevalence of eating disorders and the potential relationship with autistic traits and sensory sensitivity in a group of patients referred for the first time to a mental health outpatient clinic, before a diagnosis had been made.
The study participants were all teens and young adults referred to a specialized consultive clinic for persons between 18 and 24 years of age. At the end of the recruitment period, 259 patients who were new patients or undergoing follow-up at the clinic were added to the study group.
Because of the COVID-19 pandemic, all data were collected online through three autism and Asperger’s syndrome questionnaires, including the Swedish Assessment for Autism Spectrum Disorders (SWEAA) and the EAT-26. The questionnaires pinpointed perception, and sensitivity or sensory input related to food. Sensitivity to certain flavors, problems chewing, as well as spilling food and difficulties trying new foods, for example, were sought.
The mean age was 20 years, and 60% identified themselves as female, 33% as male, 5% as binary, and 2% preferred not to disclose their gender. The average body mass index (BMI, kg/m2) was 22.62. Nearly half (48%) were underweight (BMI <18.5); 15% were overweight (BMI: 18.5-24.9); and 8% were obese (BM >30.0). Altered sensory sensitivity in vision and touch domains was associated with a higher occurrence of autistic-like eating behaviors (SWEAA) and general eating disorder symptomatology (EAT-26).
The authors pointed out that heightened sensitivity of vision and hyposensitivity of touch appeared to be associated with a higher percentage of autistic-type eating behaviors.
Their results also added to the possibility of an association between sensory sensitivity, autistic traits, and eating disorders. This suggests that a substrate for development of abnormal eating behaviors could be shown by the relationship of some degree of distortion of sensory information and the presence of potentially autistic traits.