Our Consultant Psychiatrist, Dr Sara Morando, is trained in autism assessment and is a specialist on how ASD can occur alongside eating disorders.
For World Autism Day, we sat her down to learn more about the overlap.

Can you briefly share a bit of information about ASD?

ASD is a neurodevelopmental disorder with a strong genetic component, characterised by social communication defects and restricted, repetitive and unusual sensory-motor behaviours.

ASD is now seen as a spectrum, that can range from very mild to severe. ASD is diagnosed in 1–2% of the UK population (1 per 100 of children and 2 per 100 adults). ASD is affecting around one in 57 (1.76%) children in the UK according to a study of more than 7 million children carried out by researchers from Newcastle University in collaboration with the University of Cambridge’s Department of Psychiatry and Maastricht University.

Diagnoses of autism have been increased in the UK, probably due to a better recognition by both parents and schools in recent years. The potential impact of a delayed diagnosis can cause very high stress to individuals and families, social isolation and can trigger other mental health conditions, like anxiety, depression, OCD and eating disorders.

What is the overlap with autism and eating disorders? What can an eating disorder ‘look’ like with an ASD diagnosis?

ASD can be present in about 10-16%% of people with anorexia nervosa, while 40% of clients with AN can have several ASD traits, and in 12% of clients with ARFID (Avoidant Restrictive Food Intake Disorder). There can be a high social anxiety in clients with ASD and AN, which in two third of the cases can precede the onset of AN. The challenges with social skills, difficulties in recognising emotions and mental states in others could be associated to problems with peers, including rejection, bullying and social isolation. This could result in social anxiety, low self-esteem and emotional distress; eating restriction and/or compulsive exercise could develop as a coping mechanism, to numb and control strong emotions. 30% of people with ASD have also ADHD and often present with anxiety and depression. They can also self-harm and they can be mistakenly diagnosed with a personality disorder.

ASD can be present in about 10-16%% of people with anorexia nervosa, while 40% of clients with AN can have several ASD traits, and in 12% of clients with ARFID (Avoidant Restrictive Food Intake Disorder)

It can be that individuals with ASD and eating disorders feel more resistant to treatment. All co-existing mental health conditions need to be addressed for recovery, with an integrated, multidisciplinary and personalised approach, which includes the family or carers, the school and work environment and any other services involved.

How does an autism diagnosis impact eating disorder treatment? What adjustments do you have to make?

Having ASD can impact the treatment of an eating disorder, as people with ASD can struggle with changes and with new situations, including transitions (e.g. from home to University or work, or from one treatment setting to another), meeting new people, going to new places, making changes to their diet or meal plan, or changes around their weight and body. They might prefer to eat similar foods and therefore develop nutritional deficiency and weight loss. Individuals usually have sensory difficulties, that can include sensitivity to food texture, to sounds and smells. They might struggle with interpersonal interactions, with social talk and to communicate and understand what is going on in their own and others’ minds. They might also have repetitive behaviours, which might include OCD rituals, physical movements and exercise.

People with ASD can find very difficult to be in noisy, fast paced and crowded environments, like medical and general psychiatry inpatient wards. These difficulties can manifest in further eating restriction, anxiety, depression or even self-harm or suicidal ideation, and lead to poor treatment outcomes, drop out from treatment or prolonged hospital admissions.

Does Orri treat clients with autism alongside an eating disorder? If so, what’s our approach?

Orri offers in person and online full time and part time treatment for eating disorders with kindness and compassion at its core, which is very different from a hospital ward, as Orri is a community-based model. We use a tailored and stepped approach, centred around the recovery needs of the individual person.

We frequently have clients who have ASD alongside an eating disorder, and we are able to identify with them and their loved ones an approach to treatment that accommodates their individual needs. Some people with ASD can particularly struggle with social anxiety, or to adjust to a new environment or be overwhelmed in social groups. In these cases, they can access online treatment with us from their own home, including meals, individual therapy, dietitian, occupational therapy support, and regular appointments with the consultant psychiatrist. Our therapists, occupational therapists and dietitians are also specialised in the treatment of ARFID (Avoidant Restrictive Food Intake Disorder), which is present in about 20% or more of people with ASD and includes restriction of foods based on sensory properties and concern about possible consequences of eating, like fears of choking, vomiting, fear of contamination or disgust.

Some people with ASD can particularly struggle with social anxiety, or to adjust to a new environment or be overwhelmed in social groups. In these cases, they can access online treatment with us from their own home, including meals, individual therapy, dietitian, occupational therapy support, and regular appointments with the consultant psychiatrist.

Our approach provides several different therapeutic modalities, meaning that we can provide each client with the best suited approach for their recovery needs.

More specific and personalised assessments, and work around sensory difficulties or repetitive behaviours, can be done in person, online or with home visits. We help clients and caregivers to anticipate and manage transitions and to develop more functional coping and interpersonal skills through CBT (Cognitive Behavioural Therapy) or DBT (Dialectical Behavioural Therapy), individually and in a group, to improve emotional regulation and distress tolerance. We also provide CBT-ARFID, which is a modified version of CBT for the treatment of ARFID.

A big part of our treatment approach involves the family and caregivers in family therapy. We also offer, integrative therapy, trauma work and MBT (mentalisation based therapy). MBT can help the clients with developing more understanding on what is going on in their minds and in others’ minds, improving eating disorder symptoms, emotional regulation, anxiety, self-harm and social interactions. These therapy models are provided within a multidisciplinary approach, which involves working with the client’s family or carers and liaising with other mental health services, primary care, and other agencies (work, education), according to the person’s needs and stage, to facilitate recovery from the eating disorder while, at the same time, improving integration in the community and learning new skills to live a better life.

Find this information on autism and eating disorders useful? If you’d like to ask Dr Sara further questions, contact us and email ask@orri-uk.com. Alternatively, if you wish to speak to one of our Admissions Team members, you can call us.

Do you have any questions? Get in touch with us!