Authors: Kelly CM, Kelly CA.
Introduction: Eating Disorders (EDs) are increasingly recognised as a common comorbid condition in autistic spectrum condition (ASC). The diagnosis of ASC may be delayed in those who present with EDs, especially in females who account for 90% of such presentations. They often mask autistic symptoms by copying their neurotypical peers. This can have adverse consequences, as standard therapeutic approaches to the management of EDs are often ineffective at achieving complete recovery in those with ASC, even among those whose body weight is restored.
Methods: We reviewed the recent literature to explore the common factors defining ED’s in ASC and illustrated this with examples from those with lived experience to define potential for therapeutic strategies.
Results: Anorexia Nervosa (AN) is the commonest subtype of ED in ASC and is contributed to by a high prevalence of associated gastrointestinal disorders. Anxiety over sensory issues with taste and smell are often a significant factor. Biosocial factors such as cognitive rigidity, obsession, compulsion and rigidity are also important. The role of specific issues such as alexithymia, hyperactivity, rejection sensitive dysphoria, personality disorder and gender dysphoria has been previously understated. EDs are likely to be less to do with body image and more to be a consequence of rigid or ritualistic behaviour patterns driven by ASC.
Conclusions: Treatment approaches must account for the unique challenges faced by this group. Art and drama therapy may be of help. Cognitive Remediation Therapy, dietitian-led interventions and clinician/carer/patient education have been proposed but have not yet been trialled extensively. We recommend that involvement of those with lived experience of these conditions is an essential part of treatment planning
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