Research suggests that 20% to 35% of people with anorexia nervosa (AN) also have autism spectrum disorder (ASD) or show signs of the condition. In fact, ASD and eating disorders can complement each other, according to Princeton Center for Eating Disorders psychiatrist Kristyn Pecsi, MD.“In addition to having sensory processing issues, many people with autism are wired for restrictive behavior and embrace heightened rigidity – all traits that can predispose someone to the development of an eating disorder,” says Dr. Pecsi, who recently presented Princeton Medical Center Grand Rounds on autism and eating disorders.
While ASD can be easily overlooked in patients with eating disorders, identification is important because it impacts the treatment process and trajectory. Those with both conditions are more likely to have a chronic eating disorder and terminate treatment prematurely. They may have more difficulty engaging in treatment, or be seen as disruptive, uncooperative, or overly compliant.
Dr. Pecsi notes that a slower approach is critical to treating patients who have both ASD and AN – and the fewer changes at once, the better. She offers the following tips for navigating treatment.
IDENTIFY family members who can provide historical context to help differentiate ASD vs. AN behaviors.
FOCUS on targeting AN behaviors and make fewer and less frequent changes, because those with ASD can quickly become overwhelmed. Try to first meet overall meal plan needs before starting to challenge new foods.
INCLUDE an occupational therapist on the care team when possible to provide additional insight on texture/sensory issues and decipher what steps are likely to be most productive.
MINIMIZE environmental triggers. This could include supplying earplugs to reduce noise, a hat to decrease light glare, and a smaller space to eat meals.
UTILIZE meal coaching to take a closer look at what patients are struggling with the most.
EMPLOY sensory items that promote a calming effect, like fidget toys or refrigerated utensils.
UNDERSTAND that patients .may need a safe sensory space – such as a quiet, cold corner of a room – and allow them to use that space. Provide comfort items like pillows or a yoga mat, if desired.
CREATE opportunities for patients to write down their thoughts at the end of the day or on their own time .to help establish a foundation to .share and build on, especially since treatment time can often seem like every moment is spent navigating a crisis due to overstimulation.
“The most important treatment modifications are for providers to loosen expectations and go a little farther to meet patients where they are,” Dr. Pecsi adds. “Small wins along the way can give patients the feeling of achievement they need to continue with treatment.”