The Overlap We Cannot Ignore: Autism & Eating Disorders
Blog Post by Jenna Stone, LCSW-C, Founder of Side Quest Psychotherapy
Eating disorders are often framed through the lens of body image concerns, diet culture, and pressure to be thin. While these factors are real, they don’t capture the full picture — especially for autistic people.
For many autistic individuals, eating challenges are shaped by sensory sensitivities, nervous system responses, and the need for predictability in a world that often feels overwhelming. When these factors are overlooked, struggles with food are too easily dismissed as “picky eating” or lack of motivation, rather than understood as meaningful responses to real physiological and sensory experiences.
If you’re autistic and struggling with food, you may have spent years wondering why eating feels harder for you than it seems to for others. If you’re in eating disorder recovery, you may have been offered treatments that focused on changing your thoughts while overlooking the sensory realities and nervous system responses shaping how you experience food and your body.
For many autistic people, food struggles are not about motivation or effort — they are about safety, regulation, and survival.
Autism and Eating Disorders: A Connection That’s Often Missed
Autism shapes how people experience the world — including food. Sensory input, routines, and uncertainty all influence eating patterns.
Research shows that autistic individuals experience eating disorders at disproportionately higher rates than allistic individuals (Brede et al., 2020), and autistic traits are overrepresented among people with anorexia nervosa (Westwood & Tchanturia, 2017). Yet these numbers likely underestimate the true prevalence. Yet autism often goes unrecognized in eating disorder treatment.
This gap is driven by:
Outdated stereotypes about what autism “looks like”
Diagnostic bias
Masking that hides autistic traits
Lack of routine autism screening
When autism goes unrecognized in eating disorder treatment, adaptive responses to overwhelm may be misinterpreted as defiance or resistance, leading to interventions that increase distress rather than support regulation.
Learning and behavior change are most possible when we are within our window of tolerance — a state in which the nervous system feels safe enough to process information, reflect, and adapt. When someone is pushed outside this window into overwhelm, shutdown, or panic, the brain shifts into survival mode. In that state, expectations to try new foods, challenge routines, or engage in therapy may feel impossible rather than therapeutic.
Autism-informed care recognizes that regulation is not a prerequisite for support — it is something we build together. By prioritizing safety and nervous system stability, we create the conditions in which learning, flexibility, and recovery can actually occur.
When Food Feels Like Too Much: Sensory Experiences Matter
Autistic people may experience food in ways others do not. Textures, smells, temperatures, and even how foods touch on a plate can trigger sensory overwhelm, making meals stressful rather than comforting.
You might:
Avoid mixed textures
Feel distressed by strong smells
Prefer foods that are predictable and consistent
Rely on “safe foods” that feel manageable
These patterns are often dismissed as picky eating, rather than recognized as attempts to maintain sensory safety and prevent nervous system overload.
Sensory-based food preferences alone do not indicate an eating disorder. However, when restriction becomes severe enough to affect nutrition, growth, health, or participation in daily life, it may meet criteria for Avoidant/Restrictive Food Intake Disorder (ARFID) — a condition characterized by restrictive eating not driven by body image concerns (American Psychiatric Association, 2022).
Research suggests a notable overlap between autism and ARFID. Approximately 16% of individuals with ARFID are autistic, and 8–21% of autistic individuals meet criteria for ARFID (Brede et al., 2020; Sader et al., 2023). At the same time, many autistic people have sensory-based eating patterns that support regulation without constituting a disorder.
For many autistic individuals, these patterns are adaptive responses that support sensory safety and nervous system regulation — even as they may create barriers to meeting nutritional needs or participating in social eating.
Sensory factors are only one part of the picture. Restriction can also be shaped by social pressures, body image experiences, and the need to feel safe or accepted in environments that have not always been supportive.
When Restriction Has More Than One Cause
Autistic people aren’t immune to societal pressure to be thin. Messages about health, wellness, and “clean eating” can reinforce restriction, especially when layered on sensory needs.
Food relationships may also be shaped by:
Body image concerns
Weight-based bullying or stigma
Desire to feel accepted or less visible
Attempts to create safety in unsafe environments
For some individuals, sensory-driven restriction consistent with ARFID may coexist with weight and shape concerns that make them very vulnerable to developing anorexia nervosa, bulimia nervosa, and binge eating disorder. However, under the DSM-5-TR, clinicians must assign one primary eating disorder diagnosis at a time, which means this overlap is not always reflected in diagnostic labels.
Interoception and Proprioception: When Body Signals Are Hard to Read
If you’ve ever realized you’re suddenly starving after not eating all day, or felt full after just a few bites without understanding why, you’re not alone. Many autistic individuals experience differences in interoception — sensing internal signals such as hunger, fullness, thirst, or nausea. Some also experience differences in proprioception, or body awareness — sensing where the body is in space and how it moves. When body awareness feels unclear, it can be harder to:
Gauge portion sizes
Pace eating
Notice fullness cues
Feel grounded during meals
These differences reflect how the body is sensed and experienced, not necessarily body image distortion. They cannot be resolved through cognitive strategies alone; support often includes accommodations, pacing, and body-based approaches.
When body signals are difficult to read —and harder to describe— communicating needs around food can become another challenge.
Communication Differences and Being Misunderstood
Autistic people may communicate distress or body needs in ways that differ from neurotypical expectations, leading to needs being overlooked in treatment.
Someone may:
Struggle to identify or describe internal sensations
Use literal language that is misinterpreted
Shut down or become non-speaking when overwhelmed
Express distress through behavior rather than words
Need extra processing time
When quick, emotionally expressive responses are expected, these differences may be mistaken for avoidance or disengagement.
Communication differences can also make it harder to advocate for accommodations — especially in environments that prioritize compliance over collaboration. When misunderstood, many autistic people learn to mask their needs, increasing stress and disconnection from their bodies.
Masking, Social Exclusion, and Body Image
Masking — hiding autistic traits to fit in — can help navigate social spaces but often comes at the cost of chronic stress and disconnection from one’s needs.
Bullying, exclusion, and stigma can shape body image and self-worth. Feeling “too much” or out of place can lead to body dissatisfaction, even when body image was not the original driver of eating challenges. For some, controlling food or body size becomes a way to cope with rejection, reduce visibility, or create a sense of safety. Research suggests that social difficulties, camouflaging, and a desire to fit in may contribute to disordered eating in autistic individuals (Kinnaird et al., 2019).
Medical Complexity as an Additional Layer
For some autistic individuals, eating challenges are further complicated by co-occurring medical conditions that affect digestion, pain, energy, and nervous system regulation. Conditions such as Ehlers-Danlos syndromes (EDS), mast cell activation syndrome (MCAS), dysautonomias, and gastrointestinal disorders can make eating physically uncomfortable, unpredictable, or even painful.
When food is associated with pain, nausea, or fatigue, avoidance may reflect the body’s attempt to prevent harm. Acknowledging medical complexity does not mean giving up on recovery — it means building approaches that are safe, realistic, and responsive to the body’s needs.
What Autism-Informed Care Can Look Like
Autism-informed care recognizes that eating challenges may be rooted in medical complexity, sensory processing, interoception, anxiety, and lived experiences of stigma.
Supportive approaches may include:
Honoring safe foods as a starting point
Offering sensory accommodations
Using collaborative, flexible meal planning
Providing reminders when hunger cues are unreliable
Pacing change to prevent overwhelm
Safety is not avoidance — it is the foundation that makes recovery possible.
Moving Toward Inclusive Recovery
Recovery becomes more accessible when care aligns with your nervous system rather than working against it.
If you’re autistic and struggling with food, please know:
Your sensory needs are valid
Difficulty sensing hunger is not a personal failure
Eating the same foods can be a form of regulation
Medical conditions can shape eating experiences
You do not need to become less autistic to recover
You deserve support that fits who you already are.
Sources
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Brede, J., Remington, A., Kenny, L., Warren, K., & Pellicano, E. (2020). Excluded from the table: Autistic people’s experiences of eating disorders. Journal of Eating Disorders, 8(1), 1–14.
Kinnaird, E., Norton, C., & Tchanturia, K. (2019). Clinicians’ views on working with anorexia nervosa and autism spectrum disorder comorbidity. BMC Psychiatry, 19, 292.
Sader, R., et al. (2023). Autism and avoidant/restrictive food intake disorder: A systematic review of prevalence and clinical presentation. Journal of Eating Disorders.
Westwood, H., & Tchanturia, K. (2017). Autism spectrum disorder in anorexia nervosa: An updated literature review. Current Psychiatry Reports, 19(7), 41. https://doi.org/10.1007/s11920-017-0791-9
Jenna Stone, LCSW-C
Founder, Side Quest Psychothapy
About the Author: Jenna Stone, LCSW-C (she/they) is an AuDHD therapist and the founder of Side Quest Psychotherapy, a neuro-affirming practice based in College Park, Maryland. They specialize in eating disorders, ARFID, OCD, and autism and ADHD evaluations and are licensed to provide services to residents of Maryland, Virginia, and Florida. Their practice also offers nationwide recovery coaching and advocacy through a collaborative team model, using harm reduction and autonomy-centered approaches to support outpatient stability and step-down transitions from higher levels of care.