Disclaimer:
The material in this blog is not to be used by any commercial or personal entity without expressed written consent of the blog author. The statements in this blog are not intended to provide individual strategies or interventions. The author does not in any way guarantee or warrant the accuracy, completeness, or usefulness of any message and will not be held responsible for the content of any message. Always consult your personal Occupational Therapist for specific sensory processing advice.
The intention of this blog is to help autistic individuals that have eating disorders explain their experience and the factors that might influence their challenges with avoiding or restricting foods. It is also the intention to support parents, carers and professionals to consider the different variables that may be contributing to or reinforcing an eating disorder. I am not a doctor or eating disorders expert, if you think that you or someone you care for has an eating disorder you should seek medical advice.
Consideration number 1.
Difficulties with identifying when full or hungry because of interoceptive processing differences.
Many individuals with autism have difficulties with interoceptive awareness, this means that they can find it difficult to identify when they are full or when they are hungry. This can increase their vulnerability to eating disorders as they may be able to go for long periods of time without eating and only perceive hunger when it becomes very intense. If an individual has difficulties with identifying and processing the sensation of hunger it becomes very difficult to respond to our bodies needs for nutrition.
Consideration number 2.
Challenges with mind body connection.
Difficulties with perceiving the sensory information from our bodies can mean that individuals rely on thinking rather than feeling this can create a lack of sense of the body and mind being connected. As such objectification of the body becomes easier. This increases vulnerability to eating disorders as it becomes easier for our minds to control and override information from our bodies. In this way it is easier to impose strict diets and exercise routines on ourselves and not attend to the signals from our bodies even when we are able to perceive these.
Consideration number 3.
Interoception and Anxiety
As autistic individuals our cognitive processing systems can be easily overwhelmed because of the level of analysis and information processing we need to perform just to complete everyday activities. For many autistic individuals having to navigate a predominantly non-autistic social and cultural environment can also be very challenging.
Because of the difficulties we may have with perceiving and identifying physiological sensations (difficulties with interoception), we may not realise that we are becoming anxious or dysregulated until we are at a high level of anxiety or dysregulation which means that it is only when we are very anxious or dysregulated that we become conscious of this.
Not identifying early sensations associated with anxiety or dysregulation means that we may not identify when we need to use pro-active strategies to manage anxiety or dysregulation. When we experience high levels of anxiety or dysregulation the management strategies, we have available to us is significantly reduced. This may lead to the use of maladaptive strategies such as an eating disorder or actions that present a risk to our physical health such as self-harm.
For example, when we do feel bodily sensations, this can help divert our attention from our thoughts and be calming. This can be achieved by engaging our bodies in activities such as yoga or sports that give us a lot of feedback from our bodies however this can also be done by getting very hungry. In this situation hunger can be a maladaptive coping mechanism for managing our anxiety. If an individual has high anxiety and interoceptive processing differences, then this also means that when we do identify the hunger, we would possibly already be at the point of damaging our bodies.
Consideration number 4.
Sensory Sensitivities
Many autistic individuals experience tactile sensitivity and some individuals in addition experience olfactory and gustatory sensitivity. This can mean that it is difficult to tolerate certain textures, tastes and smells of food. Many autistic individuals may already have a limited number of foods that they are able to tolerate. When our anxiety increases our sensitivities can increase too this means we are at risk of further restricting the foods that we are able to eat.
Consideration number 5.
Preference for rules and routines
Because of our sensitivity to external sensory stimuli the world is often experienced as intense and unpredictable. In order to manage this unpredictability many autistic individuals have a preference for rules and routines. Our cognitive strengths in following rules and routines can reinforce disordered patterns of eating by the ability to set rules and routines about what and when we can eat, gradually further restricting and cutting out foods as an eating disorder develops.
Consideration number 6.
A desire to fit in and/ or not stand out.
Like other people autistic individuals may have a strong desire to fit in with their peers. The lengths and efforts that autistic individuals go to in order to mask any differences can extend to wanting to look and behave in exactly the same way as their peers. Dieting and the desire to be thin are unfortunately still dominant aspects of our culture. Autistic individuals can be just as vulnerable to this culture as their peers and with the vulnerabilities outlined in considerations number 1 to 5 this can make autistic individuals more vulnerable to eating disorders.
I would suggest that in order to inform appropriate support for individuals with eating disorders it is really important to have a thorough understanding of an individuals sensory processing differences and the underlying factors that have led to the presentation of an eating disorder and the mechanisms that are maintaining it.
Further reading
Adamson, J., Kinnaird, E., Glennon, D., Oakley, M. and Tchanturia, K. (2020). Carers’ views on autism and eating disorders comorbidity: qualitative study. BJPsych Open, 6(3).
Galiana-Simal, A., Muñoz-Martinez, V. and Beato-Fernandez, L., 2017. Connecting eating disorders and sensory processing disorder: A sensory eating disorder hypothesis. psychopathology, 37(8), pp.1077-1087.
Herbert, B.M. and Pollatos, O., 2018. The relevance of interoception for eating behavior and eating disorders. The interoceptive mind: From homeostasis to awareness, 4(4), p.165.
Jenkinson, P.M., Taylor, L. and Laws, K.R., 2018. Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory. Journal of psychosomatic research, 110, pp.38-45.
Merwin, R.M., Zucker, N.L., Lacy, J.L. and Elliott, C.A., 2010. Interoceptive awareness in eating disorders: Distinguishing lack of clarity from non-acceptance of internal experience. Cognition and Emotion, 24(5), pp.892-902.
Riva, G. and Gaudio, S., 2018. Locked to a wrong body: Eating disorders as the outcome of a primary disturbance in multisensory body integration. Consciousness and cognition, 59, pp.57-59.
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