A factor of starvation

Years ago I spent time in an airport waiting area with a mom and her young son with autism. The silent young man, she said with both chagrin and bravado, lives on a diet of fresh MacDonald's french fries, milk shakes, and megavitamins. At the time I appreciated both her honesty and her predicament, though I think I probably had some smug disapproval going at the same time. These were his boundaries, and this mom was not catering to whims, she was loving him and taking care of him from where he was. I did not know that some day I would understand this mom's nurturing in a very personal way, and that I would continue to wish that I could go back and really hear her and make sure she felt supported and understood, if only from a stranger.

When you spend time in the ED world you cannot help but notice how often you see certain traits in patients, many former patients, and often in family members. Things like difficulty with 'set shifting,' a blinding focus on detail, and difficulties with correctly interpreting the emotions of others. There is a lot of talk now about a connection between autism and anorexia. My first question, of course, was whether these autistic traits were present before anorexia struck, and whether these traits offered new directions for psychological interventions, and whether these traits were affected by malnourishment.

So if these results, Emotional Theory of Mind and Emotional Awareness, stand the test of further research and many of the autistic traits that predispose and maintain the disorder turn out to be "a factor of starvation" this begs the question: will this open a new avenue to understanding autism itself? Could autism - often associated with food aversions and sensory issues - be better treated nutritionally? That is certainly something many parents believe, and they are the ones living both alongside and observing their children.

The paper mentioned above also adds to what should be by now sufficient evidence that "food is medicine" and needs to be the first-line, non-optional, and urgent first step in eating disorder treatment. It pains me to know that it is still 'controversial' to say that ED symptoms are driven by malnourishment, and that most parents are not told this at first diagnosis.

Again, I think we will learn a great deal about eating disorders by looking at other fields, and the reverse.


  1. I didn't fully understand the abstract, but my d doesn't have Autism or similar according to our ped. She said my d is too empathetic to be Autistic, etc. etc.

    SHe did say that she sees very similar lab test results, the food allergies, the tics/stimming similarities with my d and her ASD patients though. My ped believes that what my d and her ASD patients share in common is gut issues, and I think there is a correlation, So perhaps the ASD kids have problems with malabsorption issues to begin with like my d did. My ped sees quite a few patients with ASD and food allergy and I think she is correct in her observations.

  2. I am in recovery from anorexia (weight restored now!) and I find this area of research fascinating. I'm not autistic, but I do have OCD, a tic disorder, food allergies, sensory problems and many aversions not related to the eating disorder. I've always felt that my 'issues' were partly neurological. I also really, really wish somebody had told me when I was younger that so many of the distressing symptoms of eating disorders, like the obsession with food, urges to overeat and poor body image, clear up with proper nutrition. I don't know if I would have believed them but it's terrible that people have to get a hint of the biological nature of the illness through trial and error rather than through treatment. Thank you for continuing to care so much and to help other people for so long after your own daughter's illness Laura :)

  3. It's plausible to me that starvation effects could explain much or all of the emotional issues discussed in this article. But also I think it's possible that having to face the horrible fear of food, etc. that anorexics feel day after day could also contribute to the emotional distress. I often think that if I had to face my most terrible fear (which happens to be of snakes) three times every day I would be an emotional wreck after awhile. The combination of the semi-starvation and the unrelenting fear must be emotionally debilitating.

  4. Fascinating--I hadn't heard the possibility of a connection between anorexia and autism before. My first thought is that each tends to be heavily gendered--obviously there are male anorexics, and autistic women, but overwhelmingly each "belongs" to one sex. One theory for the male autism imbalance is that girls on the spectrum are better able to mask their verbal and speech symptoms because girls develop their speech more quickly than boys; boys develop motor skills earlier. I'm wondering if there's a connection between the verbal and kinesthetic responses (i.e. the typical speech patterns of autistics; the bodily preoccupation of anorexics) being gendered, and their diagnoses. Hmm.

    I didn't believe that my ED symptoms could be a result of malnutrition, especially as I'm of a healthy BMI. It was only after the malnutrition ceased because of treatment that I saw how impaired I'd been.

  5. I have spent years trying to get people to talk about this: that lack of nutrition drives the THOUGHTS and BEHAVIORS of eating disorders. Yet it is still a controversial topic despite the trail of evidence.

    I wish all patients and parents were told this early and often.

  6. I am in recovery from a very long history of anorexia nervosa (AN) of 32 years - and I have an autism spectrum disorder (ASD). My AN has always been 'atypical' in that my eating and exercise behaviours were not focused on correcting a distorted body image, but rather, on controlling disabling anxiety. This anxiety was present from being a very young child and was triggered by changes in routine, social fears/misunderstanding, sensory sensitivity etc. I have always had rituals and routines that are either anxiety related (OCD) or 'special interests'.

    I only started to recover from AN when I was referred to a psychiatrist for one-to-one treatment for my ED four years ago. I gradually re-fed, with a nutritious diet, from a BMI of 13.5, and I agree that re-feeding + weight gain are essential to the recovery process. However, it is important that when a patient has both ASD and AN that the therapist doesn't attribute every 'abnormality' to poor nutrition.

    Girls with ASDs may exhibit quite a different profile to boys with ASDs - and they are often far more socially aware (refer to Tony Attwood's work). My AN was directly related to my ASD because I was 'retarded' socially and emotionally as a child and struggled to cope with puberty and adolescence when the social rules change radically and revolve around the development of deeper relationships, separation (etc.). I was also abused pre-puberty (by someone outside of my family) because I failed to recognise danger signs and social norms that would have been evident to other children of my age. This abuse triggered PTSD and heightened my anxiety.

    In summary: does better nutrition assist autism? I think in some aspects - yes, but the basis of autism is different neurological 'wiring' in the brain, which is likely inherent. Autism is a lifelong condition that may be aided, but not cured by good nutrition and a healthy body weight.


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