There are many areas of psychological study which overlap. Occasionally, areas connect in previously unseen ways which can initially seem surprising. With further exploration however, we can find they run in a kind of parallel, with mechanisms that are in fact quite alike. An interesting case of this phenomenon is the relationship between autism and eating disorders.
For many years it was assumed that boys are simply more likely than girls to develop autism. This has been reinforced by historic statistical evidence, with much larger numbers of males each year diagnosed as falling somewhere along the autistic spectrum. Research indicates the ratio of male to female diagnoses range from 2:1 to 16:1, dependent on the specific type of Autistic Spectrum Condition (ASC) investigated (Autism.org.uk, 2017).
Autism is a complex spectrum of conditions which typically affect an individual across three specific areas. They are defined by the diagnostic and statistical manual (DSM) as the following categories:
- Social communication
- Social interaction
- Restricted and repetitive behaviour (DSM-IV, 2000)
When children exhibit difficulties in these areas, they may be assessed for ASC as they could require specialist support, for example, ASC individuals can have special educational needs. If so, simple adaptions can allow them to feel more comfortable in their school environment.
Framing autism as 'male'
Historically, girls outperform boys in early education, especially in regard to language and communication skills (Richardson, 2016). Typically more socially minded at a younger age, teachers often report that girls appear to find social interactions and linguistic communications much more achievable early on than their male counterparts in a class (Wing, 1981).
This tendency has, in part, been blamed for the vast gender differences in numbers of diagnosed ASCs. Many girls on the spectrum seem to manage in primary school, where social situations are simplified. They may ‘camouflage their differences… practise and copy mannerisms and gestures of other girls…to navigate the tricky social interactions’ (Arnold, 2016). Girls can go through their day observing others and mimicking seen behaviour to avoid exhibiting their ASC (Attwood and Grandin, 2006).
Although these young girls may appear to ‘camouflage their differences’, MRI scanning has allowed us to look deep within the brain’s structure, and shown that there are distinct variances in the neurobiology of individuals with autism, highlighting this behavioural coping mechanism (Just et al., 2014).
Framing eating disorders as 'female'
Another social and clinical misunderstanding is the historic comprehension of eating disorders. Conditions such as anorexia nervosa have been considered female afflictions, with a lack of attention and research into males who struggle with eating (Darcy, 2014). Much is written on the pressures girls are exposed to in regards to appearance, with far fewer exploring the same stresses on males.
Gender biases in diagnostic assessment of eating disorders have led to elusive figures on the numbers of males with these problems within clinical literature (Darcy, 2014). As some of these males are missed, so is the fundamental motivation for disordered eating often overlooked; it is not so much specifically about the body, weight or food, as the sense of control and the strict management of feelings via food which drive the behaviour.
Managing anxieties through rituals
A characteristic feature linking eating disorders and ASCs, is the tendency towards repetitive and restricted behaviour. The individual seeks to limit anxiety through rehearsing entrenched behaviours. This similarity alongside issues around gender biases mean that there have been significant problems in accurately detecting females with ASCs and conversely, males with disordered eating.
Recent higher rates of diagnoses of ASCs in females in later life points to the fact that many younger girls fall through the diagnostic net which frames the condition in a male light (Ehlers and Gillberg, 1993). This can be due to the misinterpretation of behaviours; in regards to food, they may be considered as fussy eaters, perhaps being very limited in what they consider palatable. This can equally manifest in an oppositional manner with individuals turning to food as a way to cope with intense feelings that unsettle them (Arnold, 2016).
Motivation for these extreme patterns with food, both in eating disorders and ASCs seems to be the overwhelming urge to fixate on detail and use familiar, repetitive behaviour to satisfy the need for routine, a method developed to ease extreme anxiety. Many women who are diagnosed with ASCs in later life come to the attention of services through issues they have with food, rather than their autism. Similarly, many eating problems in individuals with autism can go undiagnosed as these behaviours are seen as part of the condition’s well known rigid thinking.
Linking these difficulties
Considering these links means that there is much work to be done in re-examining young people with either of these issues in our care. It is hard to untangle these two diagnoses from one another but we must seek to assist each individual and the dynamics which they present. There is an increased chance that vulnerable individuals with blends of these conditions may be potentially overlooked, a fact that deserves professional attention and review.
In order to do this, we need to familiarise ourselves with the subtle nuances of both of these challenging states and with the routes we can take to learn more about their similarities as well as differences. Both involve finding unique ways of making sure that young people feel psychologically nourished, respected and heard (Zucker, 2014). Becoming equipped with knowledge about both ASCs and eating disorders, means we are well positioned to assist young people who are struggling.
Whilst they are still of school age, there is a great deal that can still be done for these young people, struggling with chaotic relationships with food and eating. By giving them access to sensitive emotional support, guided by the knowledge of the overlapping dynamics, we can offer a way of working with their anxieties constructively, so that they can develop greater resilience and better self-esteem to move forward with their lives.
One Education are holding an event entitled ‘Beating Body Battles’ on 5 June 2017 - an interactive training collaboration between arts psychotherapists and educational psychologists offering expert knowledge on eating disorders and body image issues.
AMERICAN PSYCHIATRIC ASSOCIATION. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR, Washington, American Psychiatric Association.
Attwood, T. and Grandin, T. (2006). Asperger's and girls. 1st ed. Arlington, TX: Future Horizons.
Darcy, A. & Lin, I.H. (2012). “Are we asking the right questions? A review of assessment in males with eating disorders”. Eating Disorders: The Journal of Treatment and Prevention, 20-5, 416-426.
Ehlers, S. and Gillberg, C. (1993). The Epidemiology of Asperger Syndrome. Journal of Child Psychology and Psychiatry, 34(8), pp.1327-1350.
Just, M. Cherkassky, V., Buchweitz, A. Keller, T. & Mitchell, T. (2014). Identifying Autism from Neural Representations of Social Interactions: Neurocognitive Markers of Autism. Published: December 2, 2014.
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Wing, L. (1981). Sex ratios in early childhood autism and related conditions. [online] Psychiatry Research Volume 5, Issue 2, Pages 129–137. [Accessed 3 Apr. 2017].
Zucker, N. (2015). Girls with autism may stop eating to blunt social pain | Spectrum. [online] Spectrum. [Accessed 4 Apr. 2017].