Exploring the Overlap: What Anorexia Nervosa and Autism Have in Common

Guest Blog by Jessica Aronson, LCSW-R, ACSW, CGP, CEDS-C

Note from Dr. Stephanie Miodus, Next Steps Psychology Founder: In my work as a psychologist, I often see how overlapping traits such as rigidity, perfectionism, and sensory sensitivity can influence emotional well-being and treatment planning. I am pleased to share this guest post by Jessica Aronson, which thoughtfully explores anorexia nervosa and autism through an RO DBT informed lens.

Eating disorders (EDs) can present as complex, multifactorial, and stubborn illnesses. As research and science advance, the treatment of eating disorders continues to evolve. These advancements allow eating disorder professionals, like me, a CEDS-C Psychotherapist, to support and understand clients from a holistic lens.

We now understand that one size and one modality does not fit all and that each client’s treatment must be tailored to the individual.

While standard intakes ask about previous history and diagnosis, clients and their families don’t know what they don’t know. This is taken straight from Radically Open Dialectical Behavior Therapy (RO DBT), an evidence-based protocol to treat disorders of overcontrol (OC; a personality style marked by excessive self-control, rigidity, perfectionism, and emotional inhibition). Developed by Thomas R. Lynch, PhD, RO DBT continues to provide a structured path for treating and supporting OC clients. From the RO DBT perspective, autism involves an overcontrolled coping style. One characteristic of autism is difficulties in social communication, social signaling, and social interaction. As autism is often characterized by “restricted, repetitive patterns of behavior, interests, or activities,” I continue to be curious about how similar the inflexible and rigid qualities of these behaviors can feel to those of the qualities of an eating disorder. 

Clients struggling with Anorexia Nervosa, which includes an intense fear of gaining weight, often describe perfectionistic tendencies that began early on in development.  Many of their experiences (school, studying, homework, sport, music, art, etc.) were met with an internal drive that motivated them to achieve higher than average grades and outcomes, which reinforced excessive self-control.

Society at large supports hard work: straight As, Ivy League schools, fancy career titles, and financial success. Let’s consider a neurodivergent billionaire. However, what if they found themselves intensely obsessed with restriction and a fear of gaining weight? What if instead of problem solving and advancing technology, they became solely focused on caloric intake, compulsive exercise, and their body composition. We might then consider them to be a billionaire with an eating disorder.

The takeaway is that clients with overcontrolled coping styles can exhibit similar characteristics. Whether or not we are treating someone with Anorexia Nervosa or autism, there is value in understanding how these clients process sensory information. This includes how they experience internal and external bodily cues and signals. “An increasing body of research suggests that people with EDs experience atypical sensory processing patterns compared to those without such disorders” (Riva & Dakanalis, 2018; Sim & Peterson, 2021).

You may recall a time when you felt bereft because someone you cared about died or a time you had your heart broken, or the feeling of a deep pit in your stomach. How about the stress of studying for a hard exam, that itchy sweater or annoying tag in your shirt, or smelling something before anyone else realized that something was burning? Consider how you responded in these situations. Did you lose your appetite, or anxiously snack throughout the day? Were you able to concentrate and focus? The more we get to know how individuals process and register emotions, sensations, and experiences, the more we can tailor and target treatment to support their recovery.