Asperger Syndrome (AS) is thought to be the highest functioning form of Autism Spectrum Condition. Females on the Autism Spectrum are underdiagnosed and often come into a clinic with other mental health issues, many labels or diagnoses, some of which include: anxiety disorders, ADHD, sleep disorders, panic disorders, obsessive-compulsive disorder, depression, bi-polar disorder, borderline personality disorder, eating disorders or schizophrenia.
Females on the Spectrum are generally much more social, really good at “faking” it, understanding non-verbal body language, working very hard to “fit in” and “pretending to be normal”.
Women tend to be much more social than men, observe and watch others more in order to learn what to do, learn how to hold their bodies, what to say and when to say it. All of these skills do not come naturally and an enormous amount of energy is put into these skills. Females are generally able to hold it all together during the day and then let it all out at night. At night, the “falling apart” may look like, jumping, screaming, flapping, outbursts or withdrawing into their caves.
Women generally tend to have better empathy and theory of mind skills. However, these theory of mind skills become affected by sensory issues, stressful situations, social situations, processing of verbal information, high levels of anxiety, conflict and/or arguments.
Of those that come into clinics, anorexia nervosa appears to be the most common eating disorder that females (21.7%) on the Spectrum tend to experience (Nichols).
What is the link between eating disorders and Autism Spectrum Conditions (ASC)?
There is a overlap, possibly a genetic link between ASC and AN.
The lifetime prevalence of an eating disorder is 0.9%. ASD is highly over represented in AN (12-32%). Some commonalities between ASC and AN include:
1. Executive function deficits
2. Mood and anxiety disorders
4. Rigidity in behavior and thinking
5. Theory of Mind Deficits
Autism Spectrum Characteristics that increase the risk of developing an eating disorder include:
1. Clumsiness and knowing where one’s body is in space
2. Body awareness issue, distorted image of body in space
3. Limited social insight; difficulty with understanding how others see their body
4. Stomach issues, a feeling of no appetite, bloatedness
5. A lack of sense of being hungry or thirsty
6. Medication side effects (SSRI’s, antipsychotic and associated side effects of weight gain)
7. Sensory processing sensitivities
8. Stress management
10. Picky eating
Where does a percentage of almost 1/3 of the population with AN having ASC come from?
51 women over 18 years were evaluated using formal interviews, developmental histories and 32% of those met criteria for ASC, but only 11% of them knew that they had ASC. Their families had no idea that they had ASC. The highest prevalence of personality disorders (OCD) were also present.
In terms of intervention and treatment, a modified treatment schedule is important due to learning difficulties, mental health issues including ASC, a balanced/different course load.
What is desperately needed is a routine global screening program for all females who come into a clinic with an eating disorder. It is critical to know if a client has an ASC or has symptoms of an ASC because the symptoms of ASC do not go away post-treatment. The eating disorder may be alleviated, however the symptoms of the ASC have not. This will help the client, their families and their treatment professionals.
Goals for treatment of an ASC and AN include:
1. Treating the sensory processing condition
2. Improving the rigidity and inflexible thinking processes
3. Improving the range of foods eaten
4. Rigid repetitive behaviors need to be replaced with more functional behaviors
5. Increasing and widening the range of foods eaten
6. Decreasing anxiety levels and improving depression levels
7. Work with the preference for sameness and routine
8. Improving sensory processing issues and desensitizing to aversive foods
S Baron-Cohen, A Jaffa, S Davies, B Auyeung, C Allison, S Wheelwright (2013)
Do girls with anorexia nervosa have elevated autistic traits?
Gillberg C, Cederlund M, Lamberg K, Zeijlon L: Brief report: “the autism epidemic”.
The registered prevalence of autism in a Swedish urban area. J Autism Dev Disord 2006,
Eating Problems and Overlap with ADHD and Autism Spectrum Disorders in a Nationwide Twin Study of 9- and 12-Year-Old Children
CAVEAT: My research is focused on females, due to the lack of research and information on the female profile
Tania Marshall 2013. All rights reserved.
Tania Marshall©. 2013. All rights reserved. Duplication in
whole or part is explicitly forbidden. Thank you.