Eating disorders

Eating Disorders seem to be more common among Aspies and Highly Sensitive People than in the general population. According to Tony Attwood, 18-23% of teenage girls with Anorexia Nervosa also has AS. And based on a study by Surman et al. (described here) there is high correlation between Bulimia Nervosa and ADHD.

The study noted that people with eating disorders had difficulty in changing self-set rules and learnt behaviour once fixed in the brain. They also saw the world in close-up detail, as if they were looking at life through a zoom lens, but this could be at the cost of having an ability to see and think about self-identity and connections with others without getting lost in the details.

This distorted pattern of processing information has a strong similarity to autistic spectrums. It has even been described as the female form of Asperger’s, a milder version of the disorder. Traits that may appear in childhood, such as obsessive-compulsive disorder or overperfectionism, can often indicate a vulnerability to developing an eating disorder later in adolescence.

“One study, reported by psychiatry professor Janet Treasure (2007), head of the South London and Maudsley NHS Trust Eating Disorders Unit, found that more than 1 in 5 anorexics met the criteria for an autistic spectrum disorder. Asperger’s syndrome expert Tony Attwood (2007) reports a similar rate, with between 18% and 23% of teenage girls who suffer from anorexia also meeting some or all of the diagnostic criteria for Asperger’s syndrome. By contrast, the prevalence rate for all autistic spectrum disorders in the general population is approximately 1%.

A systematic review of 32 individual studies in various countries conducted by Berkman, Lohr, and Bulik (2007) also found that those with anorexia nervosa are more likely to have autistic spectrum disorders, as well as various anxiety disorders (such as obsessive-compulsive disorder), than those in the general population.”

Asperger’s Syndrome and anorexia

“Is anorexia the female Asperger’s?”

Association between attention-deficit/hyperactivity disorder and bulimia nervosa: analysis of 4 case-control studies

Some possible reasons for developing an eating disorder:

– Low self-esteem

Trying to fit in by means of weight control. Probably the strongest motivting factor for many, whether they are on the neurodiversity spectrum or not.

“I have struggled with my appearance…had anorexia and stuff…because I thought if I could be really skinny and all that people would like me for that reason and forget about the AS/HFA and my other differences. For a bit it worked and that is how I sort of got stuck on focusing on my weight and appearance…plus it fit rather nicely into controlling [my] Aspie symptoms bc it allowed a focus upon numbers…my favourite thing in the world!!” – female adolescent Aspie from UK

“Another [reason besides always having wanted to be thin] was that I later heard that others would feel sorry for anorexics, treated them kindly, and looked up to them for being able to abstain from food (I overheard that exact type of discussion). I didn’t know how to make friends, so I thought that starving myself might be one way. A way of getting attention for a person who don’t know how to socialise? Sort of like some Aspies and/or ADHD-ers become the ‘class clown’?”

Emma, Aspie from Sweden

– Low stress-threshold

Many sensitive people have such delicate nervous systems that they experience PTSD-like stress symptoms over what to others are just everyday things, e.g. overwhelming sensory impressions, social confusion, time pressure, demands at school, work, from family members and peers.

I recently saw a BBC documentary about an Anorexia clinic (unfortunately I don’t remember the name of it) where they had found that some anorexics were indeed extra stress-sensitive and lived every day as if under acute threat – which will increase stress hormones and turn off appetite temporarily as a natural fight-or-flight-mechanism. Since their nervous systems kept being in ‘red alert’ on a continuous basis, their appetite kept being suppressed. Whereas bulimics were said to have normal to excessive appetite and having to force themselves to purge.

– Abuse

In some cases, ED may be a symtom of bullying, sexual- or other abuse.

– Control

Like in OCD, controlling one’s body and food intake may be a substitute for perceived or real lack of control in other areas and an anxiety management strategy. Often the need for control is seen as something negative that should be eliminated altogether. But for an Aspie, it can both be a real personality trait and a genuine need to have some measure of control if one is to feel motivated to live at all. It’s just a matter of finding a healthy balance. Allowing an Aspie or OCD family member more control (veto) over other things, especially those that are painful and stressful, may be a way to compensate enough for the calorie-control to subside.

“I have had eating disorders periodically, and still have. For me it is a mix of ED and AS-problems. I have always had a huge need to control everything I do and that I think is connected to AS. Initially it was just that I didn’t know how much was enough to eat so therefore I started controlling my food intake. I have no natural sense for how much is enough, so I can easily eat too much or too little.”

Anastasia, Aspie from Sweden

“I have also had ED in different forms as far back as I can remember. I also lack a natural sense for how much is enough. To have a good food day I need a template in my head, otherwise there is just kaos. Don’t have any eating disorders nowadays (starvation or binge eating) but the thoughts haunt me and at times torment me.

It’s interesting that about ED and AS. I too find it hard to draw a line between them. It is said that many with ED have special personality traits, and ways of being like perfectionism, compulsions, black-&-white thinking, poor awareness of emotions and one’s body etc. These traits have much in common with the problems some with AS have. I’ve seen them in myself and some others with ED I have met.”

‘TheBoxSaysNo’, female Aspie from Sweden

– Hyper-focus & perseverance. Aspies often love making tables and diagrams, so counting calories can easily become a favourite hobby! Orthorexia (healthy eating- and exercise habits gone to extremes) can also become a special interest for many.

“ED has also been a channel for all my fixations, compulsions and interests at once, not having to think to much because everything that is important (in the mind of the sick person) is the same thing. Very sneaky disease since you can never not eat. If it hadn’t been ED I might instead have hyperfocused intensely on some special interest, or developed some other compulsion.

“The way I understand it, ED and other addictions, fixations, compulsion and even intensity level in delving into special interests, may stem from how stressed out one is, or how difficult life is at the moment. Especially for Aspies. One will shut oneself off with one’s current special interest and hyperfocus on it. If one is psychologically OK I think one’s special interests get less ‘tainted’ by fixations and compulsions, and more sound (from an AS-perspective, NTs seem to always think it’s a bit sick).”

Bror Duktig, female Aspie from Sweden

– Personal taste

Some people really think skinny is more attractive and nothing can change that. People in general and Aspies in particular seem to be very set in their tastes and opinions. Having body dysmorphic disorder on top of this can really compound the problem.

“My ideal since I was around three, was to be as skinny as possible. I thought that looked good (without dieting parents or media impressions). Since it came from within myself, it has been difficult to change my thinking. But now I know how weak you are when you’re that skinny, so I think of natural strength as an ideal. This works, but progress is very slow.”

Dina, Aspie from Sweden

– Lack of mental filter & perspective

Like a person with OCD absorbs information about bacteria without discrimination and exaggerates the danger a hundredfold, people with ED often seem to do the same with information about fat, e.g. believing that one teaspoon of butter or olive oil will make them fat as a walrus, practically overnight. Some might benefit from newer scientific findings about how certain types of fat and regular eating actually helps metabolism. Aspies often respond well to logic and proven facts. Those who don’t, however, can be extremely persistent in holding on to once formed views.

Some also tend to interpret information a bit too literally…

“I read in the paper that Swedes are getting fatter. Since I am Swedish, I thought that must include me.”

Dina, anorexic Aspie who is thin as a stick and spends hours each day running or exercising.

TREATMENT COMMENTS

I am definitely not qualified to give any treatment advice here, I just want to comment on some of the treatment regimes I’ve had described from people who have been at ED clinics.

Some ED clinics seem to have a goal that the patient should be able to eat “just like everyone else” in order to be considered healthy. Good idea in theory, but the problem is that the diet of ‘everyone else’ usually consists of abmormally high levels of high-starch carbs and processed food full of sugar, additives and trans fats which are more like anti-nutrients than food. Might work for the aveage Joe, but such a diet can be positively harmful to a sensitive person, which anorexics often are, and to sugar-sensitive people in particular.

However, when expressing a wish to avoid junk food, it is often seen as the Anorexia speaking, or Orthorexia, rather than a valid concern and reasonable wish. Many dietists have become indoctrinated by national food agencies into thinking of such foods as normal and healthy, even though they are not (they’re just cheap to produce and make a good profit on, and help keep up employment and GNP).

Also, people with AS or ADHD are not stupid. If they’re interested in food, they will find out everything there is to know and often become more of an expert at it than even the most well-educated dietists, and have gotten to know their bodies extremely well by making it a special interest to observe and notice every little thing. This needs to be respected!

A doctor, dietist or clinic worker, must not assume they know more about food or how the patient’s body works than the patient. Everyone is not the same, some actually function differently than the average person.

They should also consider the very real possibility that the information on diet they received in their education might be either outdated or biased and placed there by food industry lobbyists. If they do not recognise sugar-sensitivity as a real disorder, or trans fats as a real health danger, they need to reeducate themselves so they can modify diet recommendations to suit individual needs and sensitivities.

A new trend in some clinics is to recommend eating sugar every day rather than total abstinence, so as to not let cravings build up until they explode in a binge. Again a good thought in theory, and reportedly works for some.

For others it is like recommending that an alcoholic drink ‘just a little’ alcohol every day so as not to build up a craving. For true sugarholics, having a little sugar is more likely to trigger a binge than to keep it at bay. Continuing eating other starch/fast carbs such as bread, potatoes, white rice, and sweet things like fruit, is also likely to keep triggering sugar-cravings, as such things are turned to sugar in the body. For some a Low GI-diet may work.

Besides sugar-sensitivity, many sensitive people are hypersensitive to additives, salicylic acid, gluten or milk protein, often without even knowing it (see Food allergies). Such things should be tested for, or simply avoided, when treating anorexics that could be on the neurodiversity spectrum, as hidden allergies can trigger addictions, and malabsorption problems such as celiac disease will keep the person from gaining weight.

Update: Recent research suggests that people with Body Dysmorphic Disorder process images differently, and that treatment of anorexia with comorbid BDD is facilitated by first treating the BDD (cannot find the article at this time). Also that those who have both conditions are more severely affected than those who have just one of the conditions without the other:

It is important to recognize BDD in patients with anorexia because, based on the available evidence, women with both disorders are more severely ill than those with anorexia but not BDD.9 In the only study of this question, 16 patients with both disorders were compared to 25 women with anorexia alone. Those who had anorexia plus BDD had significantly poorer functioning, had been psychiatrically hospitalized more often (6.3 vs. 3.8 times), and had three times the rate of suicide attempts (63% vs. 20%).9

Is Anorexia Nervosa a Subtype of Body Dysmorphic Disorder? Probably Not, but Read On…

BOOKS

It’s Not About the Weight: Attacking Eating Disorders from the Inside Out

The Secret Language of Eating Disorders: How You Can Understand and Work to Cure Anorexia and Bulimia

The Eating Disorders Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders (Sourcebooks)

8 Comments »

  1. Diana Stewart said,

    In desperate need of an INPATIENT Acute care facility for our 23yr.old newly diagnosed Aspie-Anorexic daughter whom we have Guardianship over. The problem is, no one will take her unless she’s voluntary and she can’t be voluntary because 1) She has Asperger’s (Hello?!) 2) She is in denial about having Anorexia; of course! she has Aspergers!! 3) Anorexia is inheritly psychotic, so her psychosis prevents her from being voluntary 4) co-morbid conditions of ADHD, Auditory Processing Disorder, Dyslexia, Bipolar and OCD. Where can I send her? She is grossly underweight and getting worse by the day. If anyone can give me the name of a facility/program that can treat Anorexia taking into account our daughter is NOT Neurotypical?? The tiny country of Englad has 4 of them! So far, the US has “O”!!!! PLEASE HELP!!!!

    • Ing said,

      Sorry, I have no idea where to send her. I’m in Sweden and only have this site for information purposes.

      I wish eating disorder clinics would educate themselves on neuropsychiatric conditions and how these may complicate treatment. Being in denial is part of the eating disorder so I don’t understand how volition can be a requisite for admission.

      I can only wish you luck in trying to convince one of the clinics in your country to take her in anyway.

    • Sue said,

      Hello,
      Wondering if you found help for your daughter. We are in the same boat, unfortunately for our 20 year old aspie son with anorexia. Looking desperately for help….
      Sue

  2. Niki said,

    I’m wondering if it is the same for Bulimia. I have AS and had Bulimia from 1999 until 2009, sometimes with Anorexic features. For me I think it started partly because i was overweight for my age and height and secondly because it was a special interest. I also think it was a way of coping with sensory difficulties as well as social difficulties too. I’ve always hated the way that clothing feels on my skin, particularly around my waist and anything with rough or bulky seams. I thought if I were thinner, these things wouldn’t bother me so much. I’ve also never liked the feeling of being full, it drives me nuts, panic attack nuts. So when I learned that I could make that feeling go away by inducing vomiting it was amazing. I’m also a perfectionist and prone to black and white thinking so it makes sense that I struggled with an ED. I’d be really intersted to know if a study on Asperger’s and Bulimia is ever conducted as I doubt that I’m the only Aspie to ever have Bulimia.

    • wintersraven said,

      I know you wrote this years ago but I am desperately seeking advice and information, I wondered if you ever did find out if there was a correlation between bulimia and Aperger’s? I have mainly had Anorexia but interspersed with significant periods of bulimic behaviours. I completely understand the discomfort about being too full, I also have problems with textures, mainly fabrics and seams of clothing.
      My boyfriend (who has Asperger’s) has often commented how many Aspie traits I have, as has my sister’s boss (whose son had Asperger’s) and they all think I should try to get a diagnosis. I disbelieved them and only now have I begun to truly research I find that there are misdiagnoses in women of all the things I have had in the last decade (Depression, OCD, Social Anxiety and Eating Disorders.) So far the only evidence I can come up with to counter their theory is that there have only been passing references to Anorexia in most books, even those specifically for women, and no mention at all of Bulimia. I worry though, that I may have inadvertently ‘copied’ the BN side from a friend, as I did with almost every other behavioural trait, just to fit in, saw it as something we had in common, and it became habitual because of the sensory relief of having textures I liked, followed by the release of pressure. I am sorry if I am sharing too much personal information, or if you don’t want to be reminded if you have now recovered (I hope so) from your eating disorder through finding a treatment that works with your Aspergers. If so, please can you tell me about it? I felt so often that much of the ED treatment I was in missed the point entirely, trying to teach me to be ‘normal’ when I knew I could not be. Now might have an answer as to why I felt I was different I am willing to try again, I just don’t know where to start.

  3. Bobby Zelechowski said,

    Eating disorders are sometimes hard to cure. It requires a long rehabiliation time…

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  4. Audra Sottile said,

    Aside from being mega-rich and famous, what do David Beckham and Leonardo di Caprio have in common? Both suffer from Obsessive-Compulsive Disorder (OCD), Obsessive-Compulsive Disorder is an anxiety disorder that is characterized by an obsessive or distressing thought. It may also involve compulsions or “rituals.” It is such a serious concern that event the World Health Organization has labeled OCD as among the top 10 most disabling illnesses faced by society today. In the United States alone, it is estimated that 3.3 million people are suffering from OCD.^

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  5. Leanne said,

    This is a really reassuring and informative site- thank you! Just a little feedback though- it would be really encouraging if a number of researched treatment and relief options were documented here. As a highly functioning hyper sensitive person, it is really empowering when I am able to explore treatments independently. s well as having all my suspicions and thoughts about my problems confirmed, which this site does well, it would be positive to observe ways forward! However, thank you for your efforts so far to get this information about “people like us” out into the mainstream. Leanne


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