Many autistic people experience differences in how they eat. Someone may have strong preferences and dislikes around food but that does not necessarily mean they have an eating disorder.

Evidence suggests autistic people are at higher risk of developing eating disorders, such as anorexia or Avoidant Restrictive Food Intake Disorder (ARFID), compared to non-autistic people. 

Key messages

• Many autistic people experience differences in eating, but this doesn’t mean they have an eating disorder. However, it is important to seek professional support if someone is lacking sufficient nutrients to sustain themselves or is unable to maintain a healthy weight.
• Autistic people are diagnosed with anorexia at higher rates than non-autistic people and often have worse outcomes when seeking treatment.
• Some autistic people are misdiagnosed with anorexia when they have ARFID, although it is possible to have both.
• If you are autistic and struggling with an eating disorder, recovery is possible. Peace Pathway has developed research-backed tools, guides and resources that could help you communicate your needs.

Jump to: Autism and eating behaviours Interoception Autism and anorexia Autism and ARFID Autism and eating disorder services

Autism and eating behaviours

Some autistic people can be very particular about what they eat. 1 in 3 autistic people have gastrointestinal issues⁴, which may affect which foods they can eat. Some autistic people have strong preferences for certain types of food or ritualistic eating patterns. For example, some autistic people prefer eating predictable food, like specific brands that taste the same every time, while others might have sensory-seeking behaviour and seek novel food or intense flavours. Some autistic people may want to avoid unpredictable food like certain fruits, which are sometimes sweet and juicy and other times sharp or mealy.

Having particular eating behaviours doesn’t mean someone has an eating disorder. For example, someone may prefer to avoid certain types of food due to sensory differences, some foods might make someone feel ill or gastrointestinal issues may be a barrier to eating certain things.

However, if your food choices mean you are struggling to meet your nutritional needs, or are experiencing rapid weight loss, it’s important to seek professional support.

Interoception

Some autistic people have challenges with interoception, which can affect their eating habits. Interoception is your ability to sense what is going on inside your body. This can be things like:

• Feeling your heartbeat
• Knowing when you need to go to the toilet
• Noticing your emotions
• Feeling pain
• Being aware of hunger or satiety cues

Sometimes, autistic people may not notice that they are hungry or may not notice their body's signals that they are full. 

Autism and anorexia

Anorexia nervosa is an eating disorder where individuals affected severely restrict their food intake and may rapidly lose weight. Some people may also exercise excessively. Eating disorders can affect people of all genders. 

Although typically associated with low weight, having a low BMI is no longer part of the diagnostic criteria for anorexia, as this is not the case for many people. Often, when diagnosing anorexia, someone’s thought processes are more important than someone’s body weight.

Autistic people are diagnosed with anorexia at higher rates than non-autistic people, and research suggests that 20-35% of people with anorexia are either autistic or have elevated autistic traits.³

If an autistic person has anorexia, it is more likely that this has stemmed from sensory issues around food, rather than motivated by body image.

Some people with anorexia may display pseudo-autistic behaviours as their body responds to starvation.⁵ However, if the person is not autistic, these behaviours will stop when someone begins to eat more.

It's important to know that recovery from anorexia is possible. If you are autistic, using tools and resources from PEACE Pathway may help you communicate your needs to your doctor.

Autism and ARFID

Research from Autistica-funded researcher Dr Will Mandy suggests many autistic women diagnosed with anorexia are more likely to have Avoidant-Restrictive Food Intake Disorder (ARFID).

Someone is likely to have ARFID if they eat a highly restricted selection of food and:

• Are not eating enough calories to sustain themselves
• Being unable to meet their nutritional needs, and require a feeding tube or rely on supplements for nutrition
• Their eating habits affect their day-to-day life

Possible causes of ARFID include:

• Sensory issues around food
  
• Difficulty coping with distress
  

Someone struggling with ARFID is likely to lose weight, but often, this won’t be motivated by body image.

Although ARFID is rare, it is much more common in autistic people. One study found about 44% of ARFID cases in children and young people were among people who had an autism diagnosis.²

We need more research to know more about the relationship between ARFID and anorexia nervosa, as many autistic people may meet the criteria for both.

Autism and eating disorder services

Without tailored support, autistic people experience worse eating disorder outcomes when compared with non-autistic people.⁶

Currently, eating disorders services can often fail to meet the needs of autistic patients. Key problems include:

• Lack of timely autism diagnosis
• Low levels of knowledge about autism among staff
• Some psychological treatments are unsuitable for autistic people
• Lack of understanding about the relationship between autistic traits and features of eating disorders.

However, if you are autistic and struggling with an eating disorder, it is still important to seek support.

The team at PEACE Pathways, who specialise in autism and eating disorders, have developed evidence-based tools that can help you communicate your needs and preferences with healthcare professionals, as well as resources for clinicians and carers.

References

[1] Dickerson, S. Zickgraph, H. (2019) Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development.

[2] Sanchez-Cerezo, J. et al., (2023) A national surveillance study of ARFID in the UK and Ireland.

[3] Westwood, H. Tchanturia, K. (2017) Autism spectrum disorder in anorexia nervosa: an updated literature review.

[4] Lasheras, I. et al., (2023) Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis

[5] Kinnaird, E. and Tchanturia, K. (2021) Looking beneath the surface: Distinguishing between common features in autism and anorexia nervosa.

[6] Nazar et al., (2018) An examination of the clinical outcomes of adolescents and young adults with broad autism spectrum traits and autism spectrum disorder and anorexia nervosa: A multi-centre study.