In a world where many often value clear answers and a straight path forward, eating disorders – and their treatment – can feel difficult to understand. They develop in response to a mix of genetic, environmental, and social factors that may be different for each individual. Understanding the connections between autism and eating disorders sheds a bit of light on some of the risk factors for these conditions. With more knowledge on how eating disorders develop, we can be better equipped to provide holistic treatment to those who need it.

Here, we take a look at some of the connections between eating disorders and autism. While we’ve noted overlap between these two conditions before, recent research shows a correlation between masking behaviors and eating disorder severity. Masking refers to the strategies autistic people use to hide or suppress autistic traits to fit into environments that expect neurotypical behavior. Researchers recognize that masking autism can have mental health consequences, including increased vulnerability to anxiety, depression, and burnout. These trends are echoed in studies that specifically look at eating disorder severity in autistic individuals. Understanding the intersection between autism, masking, and eating disorders can help clinicians develop more inclusive approaches to treatment and recovery.

Background on Autism

Autism Spectrum Disorder (often referred to as autism or ASD) is a neurodevelopmental condition that shows up in a broad range of symptoms and experiences, hence being called a  “spectrum.” Some people with autism may live independently while others may need more support for daily life. Characteristics of autism may include impacts to social skills as well as communication and behavioral patterns. In some cases, autism may affect speech or intellectual ability. 

Autism advocate Stephen Shore put it simply with his famous quote, “If you’ve met one person with autism, you’ve met one person with autism,” referring to the unique ways that ASD shows up in each individual.

The Connection Between Autism and Eating Disorders

Both eating disorders and autism often co-occur with other mental illnesses. People with autism are commonly diagnosed with attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, as well as sleep disorders. Eating disorders are often diagnosed alongside other psychiatric disorders like mood disorders, anxiety disorders, and post-traumatic stress disorder (PTSD). In addition, eating disorders are also commonly diagnosed in autistic people.

In fact, research on feeding and eating patterns in autistic people has shown that eating disorders are more common among autistic individuals than those without. Notably, autistic individuals are diagnosed with eating disorders like Avoidant/Restrictive Food Intake Disorder (ARFID), pica, and rumination disorders far more often than their neurotypical peers. This trend also extends to other eating disorders like anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). However, the majority of current research has focused on overlap between autism and anorexia nervosa.

Anorexia nervosa, in particular, appears to occur disproportionately among autistic adolescents and adult women. Some studies estimate that more than 20% of women with AN meet the diagnostic criteria for autism, suggesting overlap between these conditions.

Shared Traits Between Autism and Eating Disorders 

Researchers are still working to understand why eating disorders, particularly anorexia nervosa, appear more frequently among autistic individuals. While more research is needed to fully understand the underlying mechanisms, many experts believe the connection may be partly explained by overlapping neurocognitive traits. Certain patterns in thinking, sensory processing, and emotional awareness that are common in autism may also shape how individuals experience food, eating, and body-related behaviors. These traits include:

• Preference for routines and predictability
• Cognitive rigidity or difficulty shifting between tasks
• Sensory sensitivities related to food texture, taste, or smell
• Differences in emotional awareness or interoception (the ability to sense internal body signals like hunger and fullness)
• Hyperfixations on food or health
• Social differences that can increase feelings of isolation

These traits do not cause eating disorders on their own. However, they can shape how individuals experience food or eating. For example, sensory sensitivities may make certain foods feel overwhelming; difficulty interpreting hunger cues may disrupt eating patterns; and hyperfixations on health, body weight, or food may turn into an eating disorder.

Another behavior that some autistic people experience is called masking. Notably, a recent study that looked into correlations between various autistic behaviors and eating disorder severity found masking behaviors to be closely tied to eating disorder symptoms. 

What Is Masking and How Does It Connect to Eating Disorders?

Masking, also called camouflaging, is a term used to describe the strategies autistic individuals may adopt to hide behaviors associated with autism. Masking may be conscious or subconscious, and often develops early in life as a result of social pressures and cultural stigmas around autism. Many of our social environments, like school, workplaces, and friend groups, reward behaviors that appear neurotypical and discourage behaviors associated with autism. As a result, autistic individuals may learn to camouflage their natural communication styles in order to avoid misunderstanding or exclusion.

Masking behaviors can include:

• Forcing eye contact
• Mimicking others’ speech patterns or body language
• Rehearsing conversations in advance
• Suppressing stimming behaviors such as fidgeting or rocking
• Carefully monitoring facial expressions and tone of voice

Masking isn’t a phenomenon exclusive to autism – it’s a behavior that most people use to “feel normal” or hide a part of themselves that they perceive to be different or stigmatized. However, some masking behaviors, like suppressing stimming, are specifically associated with autism.

The Impact of Masking on Mental Health

In a society that holds a strict view on what a “successful” or “normal” person looks and acts like, masking is a means of fitting in. But fitting into a system that doesn’t support the diverse needs of all humans often takes a toll.

Studies on masking behaviors in autistic women have found that camouflaging is associated with increased rates of:

• Anxiety
• Depression
• Suicidality
• Identity confusion

Masking requires constant self-monitoring and social awareness. Over time, this effort can become mentally and emotionally exhausting.

The Connection Between Masking and Eating Disorders

The added stress of masking behaviors can increase risk to mental health, in general. And we see this trend reflected when we specifically look at rates of eating disorders. Recent research has identified that higher levels of camouflaging behaviors in autistic individuals were associated with more intense eating disorder symptoms.

However, though researchers see this correlation, they have not identified the cause behind this connection. The pattern does highlight how the social pressures autistic individuals face create additional layers of stress that intersect with eating disorder risk. As research in this area grows, it is helping clinicians better understand how autism-related experiences, including masking, may shape the development of eating disorders.

Notably, some of the participants in the aforementioned study were masking autistic behaviors but did not have an autism diagnosis. This brings up an important trend: a historical underdiagnosis of autism in people who are assigned female at birth.

The Potential Impact of Undiagnosed Autism

When autism was first identified as a diagnosis in the 20th century, it was thought of as a condition that primarily affected males. For decades, autism research focused on male study subjects and neglected symptomatic differences in how autism shows up for females.

To put this in perspective, the ratio of males to females with autism has often been stated as 4:1. However, recent research has proposed that as many as 80% of autistic females are undiagnosed, and that this ratio may be more like 3:4. This inconsistency likely stems from the trend that autism often shows up differently in males versus females. Women often have more subtle symptoms that are more likely to go unrecognized.

Because of this, many individuals grow up without the language or support to understand their experiences. Instead, they may learn to cope by masking their autistic traits in order to navigate social environments that reward conformity. Research confirms this theory. A study on autistic camouflaging found that females were more likely to mask autistic behaviors than males. 

Intersecting Influences on Eating Disorder Risk

This brings up the concern that the eating disorder risk factors associated with autistic masking may compound with those that stem from social pressures around physical appearance. Many women already face intense cultural messaging about body size, dieting, and appearance. When these pressures intersect with the effort to mask autistic traits and navigate social expectations, the result can be an additional layer of vulnerability to disordered eating behaviors.

Recognizing these overlapping influences is an important step toward improving early detection, expanding appropriate support, and ensuring that autistic individuals, including those who have gone undiagnosed, receive the quality treatment they deserve.

What This Means for Eating Disorder Treatment

Another piece to this relationship that we are learning more about is the importance of access to autism-informed ED treatment. Autism does not affect the likelihood of someone’s ability to recover from an eating disorder. But if treatment doesn’t take an autism diagnosis into account, it can present more challenges to healing. A qualitative study found that many caregivers of autistic individuals with eating disorders found that the current treatments available didn’t meet their loved ones’ needs in recovery.

Moving forward, there are measures that clinicians and healthcare professionals can take to start creating a more inclusive environment. For example, including autism screening in eating disorder assessments can help identify neurodivergent individuals early. With those needs identified, more care should be taken around supporting diverse sensory experiences, providing clear structure, and creating treatment environments where individuals can feel less pressure to mask.

If you or someone you care about is navigating autism and eating disorders, it is important to know that support is available. At The Alliance for Eating Disorders, our team can help individuals and loved ones find the care and support they need to live a life beyond eating disorders. Learn more about our mission or call our helpline at +1 (866) 662-1235.