I sat in the dark observing my son through a two way mirror, watching the teachers and the children intently. The director, Dr. Mudita Bahadur, stepped inside the darkened room as I furiously scribbled notes on a yellow pad, and gently asked how I was doing. It was Noah’s first week at St John’s Therapeutic Preschool school and my husband and I were both relieved and overwhelmed. We had much to learn.
After a few words, I asked her why there were so many more boys than girls in the class. She immediately replied that the boys are all diagnosed for behavior issues, but most everyone misses the girls because they don’t cause problems. “The girls grow up and develop eating disorders.”
AUTISM AND EATING DISORDERS
When Dr. Bahadur casually mentioned the link between autism and anorexia, I remember my head whipping in her direction to meet a steady gaze. I knew exactly what she was talking about.
My work specializes in weight management and metabolic health. Over the years I’ve worked with hundreds of clients struggling with some measure of disordered eating, including anorexia and bulemia. However, many of the individuals also present with behaviors and experiences that resemble what are commonly considered “on the spectrum”.
Resistance and opposition top the list, but I also observe more anxiety and rigidity, greater adherence to routine, more black and white thinking, and more perseveration (a preoccupation with specific behaviors and/or speech). Classically the individual gets stuck, and then struggles to get unstuck in activities that alarm (think self-injury) but also those that self soothe.
Individuals expressing disordering eating as well as individuals “on the spectrum” also tend to experience more food aversions and more food sensitivities. I notice greater challenges with sensory integration overall. I’m taken with how many people avoid food–or consume excessive food–to muffle the noise from an increasingly chaotic and overwhelming environment.
MORE TO EATING DISORDERS THAN BODY IMAGE AND THE SCALE
With the recent spotlight on National Eating Disorder Awareness Week, renewed attention highlighting the link between eating disorders and autism peppered the media.
I’ve thought about the similarities for years. In 2001 I authored an article titled, Behind the Food: Novel Factors Influencing Behavior and Food Choices in Disordered Eating for the SCAN dietetic practice group’s newsletter, Pulse. There I hinted at the connection by exploring mind set and sensory integration.
Little to my knowledge, Christopher Gillberg first questioned a link between autism and anorexia in the 1980’s. Additional researchers continue to weigh in on the subject with a flurry of attention recently including this paper in Spectrum News. Clearly, we are learning there is more to an eating disorder than preoccupation with weight and body image.
CURIOSITY ABOUT THE LINK BETWEEN ANOREXIA AND AUTISM
A rather unique mix of circumstances drive my curiosity, starting with a colorful and personal history of anorexia and bulemia throughout my youth and young adult years. My son’s diagnosis with autism opened up another chapter of the journey. I continue to weave these lessons with techniques used in motivational interviewing in working with my clients and at home.
Most recently emerging research linking the gut microbiome with both physical and mental health opens a whole other realm of possibilities. Food matters, how we grow our food matters, and exposure to antibiotics and other antimicrobial agents matter, too.
MORE THOUGHTFUL ASSESSMENTS, MORE INTEGRATED TREATMENT
With additional insight, I hope that clients can look forward to more thoughtful assessments and integrated treatment. However, all clinicians–psychiatrists, therapists, and dietitians alike– will need to familiarize themselves with both spectrum and eating disorder challenges, sharpen their observation skills, and truly listen to their clients.
This past fall I saw a new patient diagnosed with anorexia and the MD intended to treat her in an eating disorder unit. Despite classic demographics (20 yr old college student, 85 pounds, restrictive eating patterns), both the therapist and I presented a strong case to continue outpatient treatment.
Yes, our patient struggled with many food related issues, but none of them related to an out-sized fear of fat, body weight, or distorted body image. Mostly she needed someone to listen and help her figure out an approach to food that works, as well as address a myriad of other challenges regarding anxiety and sensory integration.
I wonder how many other patients receive treatment for an eating disorder that isn’t.