The Overlooked Connection: Autism and Anorexia
In recent years, research has increasingly highlighted a significant yet often overlooked link between autism and anorexia. A growing body of evidence suggests that as many as half of individuals with anorexia may also be autistic, challenging conventional understandings of eating disorders and their underlying causes. Fiona Wright’s recent essay, I was unseen, even to myself: As many as half of people with anorexia are autistic – Fiona Wright is one of them, sheds light on this connection and underscores the urgent need for more nuanced, autism-informed approaches to treatment.
Beyond the Traditional View of Anorexia
Historically, anorexia has been understood primarily through psychological and sociocultural lenses, often framed as a disorder driven by body image concerns, perfectionism, or societal pressures. While these factors certainly play a role, research indicates that many autistic individuals with anorexia exhibit different motivations and experiences.
For autistic individuals, restrictive eating behaviors are often linked not to a desire for thinness but to sensory sensitivities, a need for routine and control, or difficulties with interoception—the ability to recognize and respond to internal bodily cues such as hunger. In Wright’s essay, she describes her experience of feeling disconnected from her body’s needs, a common theme among autistic individuals with eating disorders. Many report that eating feels overwhelming, unpredictable, or simply unnecessary due to a lack of hunger awareness.
The Role of Sensory Processing and Routine
Autistic individuals frequently experience heightened sensory sensitivities, which can make eating an overwhelming experience. Certain textures, tastes, or even the act of eating itself can be distressing, leading to highly selective eating patterns. Over time, these restrictive eating habits may develop into full-blown anorexia, not necessarily because of weight concerns but due to the rigid and repetitive behaviors that are characteristic of autism.
Similarly, routine plays a crucial role in how many autistic individuals navigate daily life. Eating disorders, particularly anorexia, often thrive on structure and predictability—elements that align with the autistic need for routine and control. What may begin as a way to manage anxiety or maintain order in a chaotic world can quickly escalate into a life-threatening disorder.
Challenges in Diagnosis and Treatment
One of the greatest barriers autistic individuals face in receiving appropriate eating disorder treatment is the lack of autism-informed care. Many traditional treatments for anorexia focus on cognitive-behavioral approaches that emphasize social and emotional aspects of eating, which may not resonate with autistic individuals. Wright’s essay highlights the deep sense of invisibility many autistic individuals feel within the mental health system—often dismissed or misunderstood by providers who fail to recognize their unique needs.
Moreover, many autistic individuals, particularly women, are diagnosed late or not at all, further complicating their treatment. Because autism has historically been underdiagnosed in women, many go through life masking their autistic traits, making it difficult for clinicians to recognize when their eating disorder is rooted in autism-related challenges rather than typical anorexic thought patterns.
Toward More Inclusive and Effective Support
Recognizing the intersection of autism and anorexia is essential for developing more effective treatment approaches. Clinicians must be trained to identify autism in individuals with eating disorders and adapt their therapeutic strategies accordingly. This includes:
Sensory-Friendly Approaches: Acknowledging and accommodating sensory sensitivities related to food.
Routine-Based Interventions: Helping individuals develop new routines that incorporate balanced nutrition in a structured yet flexible way.
Interoception Awareness: Supporting autistic individuals in recognizing and responding to their body’s hunger and fullness cues.
Reducing Social Pressure: Understanding that group therapy and socially focused treatments may not be effective for autistic individuals.
The link between autism and anorexia challenges long-held assumptions about eating disorders and highlights the need for a more individualized, neurodiversity-affirming approach to care. By recognizing and addressing the unique needs of autistic individuals struggling with anorexia, we can create more inclusive, effective, and ultimately life-saving interventions.
As awareness grows, it is essential for clinicians, caregivers, and policymakers to ensure that autism-informed eating disorder treatments become the standard rather than the exception. Only then can we truly support the many individuals who, like Fiona Wright, have struggled unseen for far too long.