Is there a link between female autism and eating disorders, such as overeating or binge eating?

The Link Between Female Autism and Eating Disorders

There is a significant association between autism in women and problematic eating behaviors, including binge eating and other eating disorders. Research indicates that autistic women exhibit high levels of both autism-specific eating behaviors and disordered eating patterns that make them particularly vulnerable to developing eating disorders 1.

Evidence of Association

• Autistic women report high levels of disordered eating behaviors similar to those seen in women with diagnosed eating disorders 2
• Studies show up to 30% of patients with anorexia nervosa are autistic or display high levels of autistic traits, with autism diagnosis often being secondary to an eating disorder diagnosis 3
• There is a reliable association between autism and Feeding and Eating Disorders, with worse clinical outcomes when these conditions co-occur 4
• Systematic reviews indicate that on average, 4.7% of patients with eating disorder diagnoses (anorexia nervosa, bulimia nervosa, or binge eating disorder) have received an autism spectrum disorder diagnosis 5

Specific Eating Patterns in Autistic Women

• Binge eating behaviors are particularly common among autistic women, characterized by:

  • Eating larger amounts of food within a discrete time period compared to peers 6
  • Experiencing a perceived lack of control during eating episodes 6
  • Eating faster than normal, eating until overly full, or eating large quantities when not hungry 6
  • Eating alone due to embarrassment about food quantities 6
  • Feeling emotionally distressed after eating 6

• Autistic women may struggle with both:

  • Autism-specific eating behaviors (food selectivity, food neophobia) 2
  • Traditional disordered eating patterns (binge eating, restriction) 2

Potential Mechanisms

• Several mechanisms may explain this association:
  • Sensory sensitivities common in autism affecting food preferences and eating behaviors 1
  • Difficulty with interoceptive awareness (recognizing internal bodily signals like hunger) 4
  • Rigid thinking patterns and need for routine that may manifest in eating behaviors 4
  • Social challenges that may contribute to disordered eating as a coping mechanism 1
  • Possible shared genetic or neurobiological factors between autism and eating disorders 4

Clinical Implications

• Standard approaches to eating disorder treatment may be less effective for autistic women 1
• Autistic traits can impede typical eating disorder interventions 3
• Treatment settings and approaches may need modification to better accommodate autistic women 3
• Early identification of autism in women with eating disorders is crucial for appropriate intervention 1

Risk Factors and Warning Signs

• Weight-based teasing predicts the development of binge eating and extreme weight-control behaviors, particularly in girls 6
• Dieting behaviors are associated with increased risk of binge eating at 5-year follow-up 6
• Family weight talk and comments about weight can negatively impact eating behaviors 6
• Autistic women may use eating behaviors as coping mechanisms for emotional regulation 1

This evidence suggests that clinicians should screen for autism spectrum disorder in women presenting with eating disorders, particularly binge eating disorder, and adapt treatment approaches accordingly. The association appears bidirectional, with autism-specific traits potentially contributing to disordered eating patterns and eating disorders potentially masking underlying autism in women 4.