05 Feb Autism, Avoidant Restrictive Food Intake Disorder and Anorexia – Dr Zoe Williams, Child & Adolescent Psychiatrist at Brighton & Hove Clinic
There is an increasing understanding and recognition of the links between the physical presentation of Anorexia and Autism.
ARFID, Avoidant Restrictive Food Intake Disorder has recently been described in DSM 5 and replaces the category of children feeding disorders in describing an across the lifespan rigidity and restriction around eating only certain foods, often resulting in insufficient calorie intake and therefore weight loss. Avoidance of foods as a result of this condition is often as a result of either beliefs about certain food groups (e.g. sugars are addictive therefore should be avoided), sensory issues e.g. taste, smell, texture or as a result of traumatic experiences with food e.g. choking.
Anorexia Nervosa is a separate condition resulting in severe weight loss as a result of proactive restriction with morbid fear of weight gain. The key difference therefore between the two is the cognitive fear of fatness, body image distortion and drive to lose weight that is part of the diagnosis of anorexia; but absent in ARFID. ARFID presents with cognitive distortions/beliefs around foods that may not necessarily be true, fear and anxiety around eating certain foods and therefore avoidance behaviours.
Autism is a well recognised neurodevelopmental disorder (now labelled the Autistic Spectrum Condition) that results in differences in communication with others, expressing emotions and recognising them, rigid and repetitive behaviours, stereotypical interests and unusual use of language and other aspects of communication.
There is an increased understanding that ARFID, Anorexia Nervosa and autism have clear overlapping characteristics, especially in thinking profiles. Indeed those suffering with anorexia when severely malnourished present with clear struggles around recognising social cues and interpreting emotions very similar to those on the autistic spectrum. In fact, it is thought that up to 20% of those with a diagnosable eating disorder would also meet the criteria for Autistic Spectrum Conditions. As the female gender dominate in presentation with eating disorders (10:1 female to male) and are also under diagnosed with ASC; it is often the eating issues that present to services as most pressing and life-threatening.
There is good evidence for CBT as an approach to treating ARFID, with work on anxiety management, systematic desensitisation and Psychoeducation around the importance of different food groups and a balanced diet, as well as some “myth busting” of the common misconceptions around particular foods e.g. “all fats are bad”. This approach is somewhat different to the treatment needed for AN where there is less evidence for CBT more for relational work, specialist case management (e.g. MANTRA) and dietician input, as well as more psychotherapy focused on body image and self-esteem.
In summary, it is an important message to recognise that Autistic Spectrum Condition may well be a feature and therefore enduring in those suffering from eating disorders, especially of the ARFID type. Knowledge and recognition of this will help target and direct therapy to help support and achieve recovery.
– Dr Zoe Williams, Child & Adolescent Psychiatrist at Brighton & Hove Clinic
Brighton & Hove Clinic provides specialist inpatient care and treatment for children and young people aged 12 -18 years old with an eating disorder.
Our expert multi-disciplinary team provide person centred care that is tailored to meet the physical and medical/mental health needs of each individual. We work actively with Tier 3 community teams to facilitate shorter periods of admission and a streamlined return back to normal life.
Lyons, L 2017: “Effective Treatments for Co-occurring ARFID and ASC” Eating Disorders Hope
Arnold, C (2016) : Spectrum news “The invisible link between autism and anorexia”
Ekern, J: (2017) : “Does Anorexia impair One’s ability to relate socially?” From International Journal of Eating Disorders 2013