Treating eating disorders in patients with autism: Should treatment standards be implemented on a spectrum?

Abstract

Autistic women have higher rates of anorexia nervosa (AN) than the general population and poorer treatment outcomes than nonautistic AN patients. Gender roles, stereotypes, and expectations play heavily into diagnoses of both autism and AN. The goal of this project was to identify aspects of current treatment approaches that fail to meet the needs of autistic women and possible clinical modifications to improve outcomes. A scoping review of literature published since 2014 examined the overlap between autistic traits and AN in women, explored the possible factors that influence rates of diagnosis, and investigated clinical approaches to treating AN in autistic women. Current literature has not reached a consensus on the explanation for the overlap between AN and autism. Gender differences, “camouflaging” (hiding) autistic traits, and clinical/diagnostic gender bias impact diagnosis and treatment. Staff education, missed diagnoses of autism, and unfavorable treatment facility conditions are barriers to AN treatment for autistic women. Several articles make clinical suggestions to reduce barriers and improve care. Main areas for practice innovation include identifying differences between AN-related and autism-related eating patterns, educating staff and clinicians regarding the autism-specific challenges patients with AN face in treatment, and modifying treatment goals to target social and emotional difficulties that all patients may face. The clinical modifications suggested have been shown to benefit both autistic and nonautistic AN patients.