Teens with autism, particularly girls on the spectrum, may be more likely to develop eating disorders than their neurotypical counterparts. While research into this phenomenon is just beginning, the possibility of these conditions co-existing is worth examining. Do parents of autistic teens know the risks? Do the teens themselves? And where is the connection? This is a topic deserving of a book, but, alas, I am only a columnist and can only share some ideas.
Though the correlation between ASD and eating disorders may seem arbitrary at first glance, there is nothing arbitrary about it. Eating disorders are characterized by obsessive-compulsive behavior surrounding food and the body of the patient, often accompanied by body dysmorphic disorder, or BDD. A large number of girls who go undiagnosed with ASD in fact receive their diagnoses after seeking help for an eating disorder, and some 20% of patients diagnosed with anorexia nervosa are found to be (unknowingly) on the spectrum.
Tony Attwood, an expert in girls on the spectrum, has said that because of the ritualized behavior that leads to disordered eating and eventually a diagnosable eating disorder, girls with ASD can obviously be very prone to sliding down that slippery slope. An eating disorder is an obsession that manifests very similarly to a classically autistic “special interest,” and the lure of nutrition, calorie counting, and the seductively vast world of dieting can be fascinating to an autistic, who may only develop the self-hating dysmorphia of an eating disorder as a result of his or her newfound obsession. Add some Aspergian food allergies and sensory issues (making eating complicated to begin with) and Aspergian perfectionism into the mix and you’ve got a patient who fits the typical profile of one at risk for an ED.
Not only are people on the spectrum more detail-oriented, perfectionist, obsessive-compulsive, and obsession prone than neurotypicals, but the very way that autistic people see the world may be an eating disorder risk. It’s commonly understood that autistic people have problems with what is referred to as “zoom-out” focus, and, especially when dealing with people, see the parts of things instead of the whole. Body dysmorphic disorder is marked, and some would say caused, by the patient seeing their individual body parts instead of their whole body. Where a non-BDD patient would look in the mirror and see a face, a patient with BDD sees an eye, another eye, a nose, a mouth, cheeks, etc., the same way an autistic sees a face. The failure to put the pieces together leads to (or can be a result of) focusing on these individual pieces, instead of seeing how they fit together into a greater context.
Ever met someone with a large nose, who hates their nose, when you think it “suits” them? That’s because you are seeing their whole face, how well their nose matches the angle of their jaw and their heavy brows, when they are only focusing on their nose, criticizing its every bulge and curve. This phenomenon is the essence of BDD, and the fact that people on the autism spectrum in a sense come equipped with a dysmorphic view of the world can leave them incredibly prone to self-loathing and body dysmorphia, especially for girls, who are encouraged to critique their bodies in this way.
Boys on the spectrum may not be subjected to the vast physical pressures put on girls, but that doesn’t mean they are exempt from eating disorders, or body dysmorphia. Societal pressure may fuel the fire, or be the catalyst, for an autistic girl, but simply taking an interest in dieting is enough to suck an autistic boy into the same situation.
Now, I’m not saying that autistic people can’t try to lose weight, or can’t learn about nutritional science or become nutritionists or health experts. This has less to do with keeping autistics away from these triggers and more to do with educating autistic children from an early age about their bodies. Many autistics, and many children in general, don’t give much thought to their bodies until they suddenly start changing when puberty hits.
If you are a parent of a young child, know that the solution isn’t to reassure your daughter that she’s beautiful (in fact, praising little girls for their beauty can be incredibly unhealthy for a myriad of reasons) but to teach her about all her body does. Teach her (or him) about how and why people look different, and about the natural variations in the human form, whether it be fat or thin, big nosed or small. Of course, we’re fighting an uphill battle against our culture here, but a child’s first notice of his or her body shouldn’t be when they start to notice they don’t like it.
And if you are an autistic teen (or preteen, or adult) who has started to notice that your waist isn’t as narrow as a woman’s “should” be, check out Natalie Portman in Star Wars to see a beautiful woman without an hourglass waist. If your legs are too big, check out Beyoncé. Even better, book at the people around you on the street or in school who you consider to be beautiful, and find your “flaws” in them. If you have to, stand back a few feet from the mirror and squint. Know that you are not your appearance, and your appearance is more than your individual features.