Frontiers in Psychiatry 发表孤独症成人进食障碍质性研究系统综述

(Babb, C., Brede, J., Jones, C. R., Elliott, M., Zanker, C., Tchanturia, K.,… & Fox, J. R. ()). ‘It’s not that they don’t want to access the support … it’s the impact of the autism’: The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals. Autism, 25(5), 1409-1421.Interview Schedule.
Identified via thematic analysisMisunderstanding autism and autistic traits
One treatment does not fit all
Improving accessibility and engagement within
Services

When I was in hospital, I kept getting told off for walking on tip toes and for fidgeting a lot … they thought I was doing these things to burn more calories, except I’d been doing them for as long as I could remember.
I felt … very criticised. I was being very resistant – or labelled as being very resistant. I don’t think they took into account how … difficult I found it seeing lots of different people.
It felt like they didn’t care … I used to like to sit in the same seat, just because I knew where it was, and every day a different staff member would go and sit there. And they wouldn’t understand why I was getting upset.
When I explained about needing the food separate, they were very good about accommodating that. And they would separate out the food, and they didn’t necessarily challenge that … but they also gave me the opportunity to try it differently if I wanted to.
With the CBT, maybe the problem is that they assume you have a lot of these skills already … Therefore, I couldn’t even begin to make changes, because I don’t have any of those foundational skills.
I didn’t realise anybody would need me to. I wasn’t realising that I was being taught a general technique rather than to alleviate a particular problem.
[CBT] helped me to understand why I thought and felt the way I did … that understanding helps you to kind of … restructure your thoughts and made me realise what wasn’t true.
I’m largely silent in any sort of group situation because I don’t know what’s expected of me. I’m worried of saying the wrong thing or I worry about misinterpreting people.
They had other groups as well, one which was just a general talking group, which I found was really unhelpful because they had no structure to it.
DBT was really helpful … we spent a long, long time talking through emotions, identifying them and trying to think about how to regulate, how to manage them … DBT was about [emotion regulation] skills, and that was really important.
Emotion regulation was really important to me … when I was in distress, I would just self-harm, just become very unwell. But after that, I actually started to think what was going on … I think that’s what really helped to improve my eating at the time.
[The occupational therapist] helped me get a volunteer placement at my old primary school … that was the best therapy I ever got, because it was practical and gave me something to do.
She basically didn’t believe me when I said this is not about [body image] … she wanted to do body image therapies with me and I … found it humiliating, and also irritating and condescending that I was being not listened to.
We didn’t really focus on my eating … They made me focus on emotion regulation, and just mindfulness really, and social aspects, and that really helped me.
She understood how best to communicate with me, so she gave me written summaries after my appointments, she gave me written information and we used goal setting to help plan my care.
Although I found the groups more challenging, I knew what I had to do during my day. I found unstructured time difficult, and I used to spend my time making my own structure.
The adjustments they agreed were … agreeing a time and day for key work sessions, giving me plenty of notice of change … and I could bring my soft duvet cover in and that then meant that I was comfortable and I could sleep and it’s just minor things like that that can make a really big difference.

(Brede, J., Babb, C., Jones, C., Elliott, M., Zanker, C., Tchanturia, K.,… & Mandy, W. ()). “For me, the anorexia is just a symptom, and the cause is the autism”: Investigating restrictive eating disorders in autistic women. Journal of autism and developmental disorders, 50(12), 4280-4296.Semi structured interviews
Identified via thematic analysisSensory sensitivities
Social interaction and relationships
Self and identity
Difficulties with emotions
Thinking styles
Need for control and predictability

The fact it’s all mixed up, which in my head it shouldn’t all be mixed up, so for me a salad is actually a terrifying food!”.
“That feeling of putting on weight … that’s what kind of sends me back into restricting food, because it’s not about ‘oh god my stomach looks really big’, it’s more about ‘I don’t like the sensation of how my stomach feels’”.
“I’m not very good at judging my own emotions or physical sensations. I don’t really fully understand my thirst and hunger responses, or my fullness responses, so that really influences my eating because I can binge or miss meals very, very easily”.
“I think I was lonely a lot after [my only friend changed school] and that affected it, and I could just get engrossed in food and exercise and just forget about everything else”.
“The moment when I stopped eating at school, was because there was a big canteen, lots of people, lots of social stuff going on, lots of noise”.
You constantly feel like you’re failing, you constantly feel different, you think it’s all your fault because you don’t know that there is something different about you”.
“I have never had much of a sense of self, and I think possibly [AN] then became a little bit like an identity.
Going into hospital and being aware that everybody has the same condition, you then do become a lot more aware of some of the anorexia traits and you do sort of take them on”.
It was more like behaviours that I engaged with to feel calm, but would lead to catastrophic weight loss”.
“When I was restricting my eating, I would get this feeling of just calmness, and I know that I am safer, I know that I am not going to experience these meltdowns that made me feel embarrassed and frightened.[ … ] So I was no longer just losing it”.
“My OCD [obsessive compulsive disorder] started to get worse as I started to fight my eating disorder. I just seem to have kind of variations on the same theme, with the OCD and with the eating disorder. The problem seemed to be not what the content of my thoughts was, but how I thought”.
“I misinterpret [emotions] as physical symptoms and I get very anxious about it: Am I unwell? Am I going to vomit? And that’s when I stop eating because I know that will dampen things down and calm them,
so my emotions are feeding into my eating disorder behaviours, whereas I think my difficulties in perhaps coping with emotions stem perhaps more from the autism”.
“I sometimes imagine life without [AN], and then think, well actually, I would still have a lot of problems, but I wouldn’t have my coping mechanism”.
“The autism and the routine and rigid thinking maintained the eating disorder. I think that’s why my recovery has taken so long for me to get to what I would call true recovery. For me, the anorexia is just a symptom, and the cause is the autism”.
“Sometimes it’s just habit that I will [engage in ED behaviours], because that’s what I have done for the last 15 years, rather than a driven behaviour,
“I seem to have a strong need for control; I will always try and fill it with something. And if I could get rid of that, if I could learn to think differently … that would probably be the only way I could really recover”.

(Creese, M., Hampton, S., Brede, J., Babb, C., Elliott, M., Serpell, L.,… & Mandy, W. ()). “From that moment, everything has changed”: The experience of women with anorexia nervosa receiving a diagnosis of autism. European Eating Disorders Review, 33(4), 825-834Reflexive thematic analysis on secondary data of 17 semi structured interviewsThe search for understanding and support
A shifting moment
Taking control

‘I’ve always felt like I’m on the outside looking in’.
…it also made me feel less alone because then I realised that here are other people who also have both [ED and autism], and other people have similar experiences.
I don’t think people reacted in a good way particularly … I think people misbelieve me, they see me as so functional and they see how much I’m able to achieve, but they don’t see how much pedalling is going on beneath the surface….
And I have never had a proper psychiatric assessment outside of an ED setting.
they previously diagnosed me with borderline personality disorder but I didn’t relate to it at all’.
So, I seemed to collect a whole set of mental health diagnoses….
‘They didn’t seem [to be] a very clear definition of the boundaries of the [autism] diagnostic criteria they applied to females’.
If only I’d known different, I could have possibly managed this with some adaptions, I could have possibly done that, I possibly wouldn’t have been so hard on myself on achieving things.
I think I had years of struggling with my mental health and anorexia and I reached a point where I was just, I was completely burned out, and I had, I suppose a breakdown. After that point I had to stop work. …They spent about half a day with me and at the end of the assessment they suggested I had ASD.
…what’s wrong with me because I’m just going mad. I can’t fit in, I can’t get on with people, I can’t hold down a job, so if it’s not what everybody’s saying it is [AN] or what it could be, what on earth is it? I was starting to think I had a brain tumour and all sorts of things because I couldn’t cope.
So you have an Asperger’s service, an autism service around if you’re lucky, an ED service around if you’re lucky. But … There doesn’t seem to be a kind of merging of them.
I go to the autism service, and even going there I find really difficult. I feel like I don’t even fit in.
Because I feel, we work on the autism, but we also work on the ED as well, so it is like a more holistic, I suppose, and that has been really effective.
‘from that moment everything has changed’.
There were a lot of differences that weren’t explained by the anorexia. And we would try constantly “there is something else, there is something else”. And after all these years, I finally found what this something else was.
I now understand that all these things came on the foundation of the autism.
I’ve always felt different and like I didn’t fit in and it was kind of like oh actually that’s because I am different and I don’t particularly fit in and that’s okay. And then I could kind of see ways of working with it as a strength rather than letting it hold me back.
[Autism is] not something you get rid of, while an eating disorder, people gave me the impression that if I recover from an eating disorder, my life would be, you know, the difficulties would all go away.
I think my parents were quite, especially my mom, a bit guilty….just because, maybe because, she didn’t push even more to investigate I guess.
You know, I don’t feel I can objectively say whether or not I am autistic, I really don’t, because I’ve never really understood what it should look like.
I didn’t really feel it was me, but then again I didn’t really feel I had enough information to make an informed judgement….
when it’s been undiagnosed for decades and I’ve had to function, which I have.
With this information I was then able to explore all the difficulties. I had the words to communicate, whereas before my way of communication was very much by not eating.
That was kind of a bit of a turning point in that [therapist] understood like how best to communicate with me so she gave me written summaries after my appointments, she gave me written information, we used kind of goal setting to help plan my care.
So [the inpatient unit] created a different space that was separate, because I think they realised for my stay there, it wasn’t appropriate for me to go through the whole treatment programme.
‘I can be a bit more compassionate to myself because it’s not my fault that I find certain things difficult’.
‘It wasn’t closure, it was almost like that was the start for the next chapter of my life’.

(Downs, J., & Adams, M. ()). Re-imagining connection: the role of late autism diagnosis in eating disorder recovery and social support. Journal of Eating Disorders, 13(1), 120.Narrative and autoethnographic methodsThe social dimensions of illness when undiagnosed
Treatment experiences when undiagnosed
The process of diagnosis
The role of social support in autistic ED recovery

I was overcome by the bright LED lights and the basketball court’s reflection. There were at least 100 students in the gymnasium, most older than me. I was equally overwhelmed by how the laughter and loud voices echoed around me.
I turned my increasing anxiety and feelings of isolation inward, making athletics and exercise my passion, the “special interest” I was focussed on becoming the “best” at.
I began to think of my eating disorder as a friend. Something that was always there, something predictable that gave me a sense of identity.
A big part of my experience of the social world was shaped by a sense of ‘not knowing’. Not knowing why I found it so difficult to do things that other people seemingly were able to join in with.
Not knowing how to cope with constantly feeling overstimulated on a sensory level, whilst at the same time being under-stimulated intellectually. Not having others know how and why I was struggling so much.
This got me into some very difficult situations where I didn’t know what healthy boundaries were, and was at risk of being exploited.
felt like spending my life on the outside looking in at the kind of life that I wanted to have.
I found a very effective way of being able to cope with my distress in social environments was to dial down the intensity with which I was feeling everything. That meant numbing my senses and suppressing the vehicle for feeling - my body. That’s where my eating difficulties really began.
It took days to adjust to the unit schedule, rules, other patients, and the physical structure of the unit. Paradoxically, I later found solace in the schedule and rules.
The predictable way of existing that treatment provided was upended when I was discharged. The drastic change in environment, support, and routine caused severe anxiety and a sense of chaos. I soon returned to my eating disorder ‘friend’ and the predictability it provided.
I can see how my eating difficulties arose within a context where my differences - whether in sensory experiences or communication styles - led to exclusion from social support, a lack of belonging, and marginalisation from understanding, both from others and myself.
Instead of helping me untangle these challenges, treatment only reinforced my sense of invalidity by failing to provide the insights I now have about my experiences and needs as an autistic individual with co-occurring neurodevelopmental, psychiatric, and physical conditions.
In treatment, I went from not knowing why I was struggling so much to being given explanations that didn’t fit - explanations that seemed more like stereotypes than reflections of my reality.
By the time I reached treatment, my ability to mask my differences was so ingrained that even the experts couldn’t perceive them.
It took many years before I received a diagnosis and, with it, a doorway to self understanding and a better ability to meet my needs in recovery.
I pursued an autism assessment because my major depressive disorder and ED did not seem to account for all of the challenges I faced.
it was enlightening to reflect on how connected autism was to my ED.
I think the onset of my AN was, in part, a strategy to deal with the overwhelming transition from childhood to adolescence.
AN became part of me, something I was interested in and had to ‘perfect’.
This period of discovery felt like a puzzle finally coming together, providing clarity about struggles that had long felt inexplicable.
At the same time, it was a destabilising process that challenged my self-concept. It felt almost like grieving – not only for the parts of myself that had been misunderstood or overlooked by others but also for the opportunities I had missed because I hadn’t fully understood or accommodated my needs.
The diagnosis gave me a language to describe and communicate my experiences in ways I hadn’t been able to before. It allowed me to re-story my life, reframing my differences as expressions of neurodivergence rather than failures.
Forming relationships with people I’ve initially met through online platforms has been valuable. I’ve connected with friends and colleagues with similar passions, whereas navigating that for the first time in person can feel impossible or irrelevant.
Another integral part of support has been my close relationships with animals. My dog helped me through the worst of my mental health. At times, I became emotionally exhausted, and I would lie in bed for hours. My dog, who I loved so much, sensed I was hurting and refused to leave my side.
My experience of social support might be different, not disordered.
Understanding I am autistic has enabled me to work with my differences, seeing them not as weaknesses but as variations that could exist alongside meaningful participation in social activities and relationships.
I no longer feel compelled to be the same as everyone else or to mask constantly in an effort to fit in. Instead, I can see how I have performed inauthentically in relationships and social situations in ways which often haven’t been supportive of my recovery.
Being autistic doesn’t mean I should opt-out of social engagement or don’t need to find a sense of community and belonging.
I have been able to learn from peers who also navigate multiple struggles including with their health and social experiences.
Ultimately, being able to find belonging, experience reciprocal caring relationships, and feel valued and understood for who I am has been a profoundly reparative and healing process which has challenged the deep-set ideas about myself that entrapped me in my ED in the first place.

(Healy, S., Pacanowski, C., Kennedy, L., & Obrusnikova, I. ()). “This cage that I’m stuck inside”: Autistic adults’ perceptions of weight management, body weight, and body image. Autism, 25(7), 1985-1998.Semi structured interviews (dentified via Interpretive Phenomenological AnalysisMental and physical health: direct and indirect interactions
ASD traits and weight management
Body dissatisfaction: unrealistic ideals and misperceptions
Sources of information

my job is also very stressful so when I get home, I don’t want to do anything. I just want to sit in one spot and not move if I don’t have to”.
And yeah, I just find comfort in food. So, I just eat fairly constantly and not very healthily.
I think have somewhat intentionally dissociated my personal value from how I look just, so I don’t have to feel bad about myself. So, honestly, it [being overweight] means a lot. It means a lot for self-esteem.
“… I wanna look not like I have a beer belly. But it’s not just the looks. It’s more that I wanna be healthy, and actually enjoy life, and be able to go do the things I wanna do”.
“Well, I’m interested in the way I look primarily for how it impacts my mental and physical health”.
And then, a lot of us [autistic adults] struggle with certain things like depression, and depression can really affect eating habits and activity habits.
After I got laid off, the depression I was feeling really started to have an impact on what I was eating, and when I was eating, and how much I was eating, and I gained probably eight or nine pounds in a fairly short period of time.
I look at myself and I’m like, wow, I got fat, and I feel gross, and I don’t feel good about myself. And I guess I go into that whole valley of eating my feelings kind of situation.
“I can easily spend hours playing video games, working on genealogical research, reading, or just daydreaming … My interests can easily become obsessive”.
“I’m obsessive about the numbers. I weigh myself every day.
I was so obsessed with counting calories and eating as little as possible because I was so fascinated by the dwindling numbers on my scale that I ended up losing 40 lbs in 2 months.
“I guess I just get really anxious because I don’t know what I’m doing [when exercising]”.
“We [autistic adults] don’t like being around crowds, or going to the gym is not something that really appeals to us. In fact, it is quite horrifying”.
“At these events, there’s food. So, that’s something I sort of go to … so I can just do something with my body that’s not talking”.
People just stress me out and exhaust me, especially in real life, less so online. So, it’s difficult for me to reach out to other people for support and commiseration, which means I don’t really feel connected to other people when I’m trying to lose weight.
It can be difficult to eat a balanced diet because green leafy vegetables freak you out.
“I’m a creature of habit and I get into patterns with food that are generally bad patterns”.
“I can only eat very specific foods at very specific times”.
The best way to explain it is I just kind of have this clock or schedule of the way that my life works. Food is one of the most important things. A lot of the reason that I don’t travel is because I can’t control the food that I eat. I won’t go on dates if I can’t eat the food. Every Wednesday I have to eat Chinese food.
I think it’s my sedentary lifestyle, and also I eat a lot of junk food. And in general, I guess, it’s those things, but also a lot of other things, like genetics, and certain medications I know can cause you to gain or lose weight. And certain medical problems.
“I’m totally not in love with it [her body]. There’s so much work which has to be done that I just wish that I could zap myself into oblivion and start all over again with a brand-new body”.
“I would like to be less, I don’t know, potato-shaped”.
I hate my skin so much that I want this ink [referring to her tattoos] inside me and I want it to like [inaudible] and I don’t want it to look normal … It [her skin] mostly just feels like a cage to me. And so, it [tattooing her body] is just a way for me to decorate this cage that I’m stuck inside.
I have a hard time remembering what I look like … If I try to conjure up a mental image of what I look like, and then I go and look in the mirror, it always surprises me a little … It’s always I look bigger than I remember.
“If my family or friends think I look healthy. I’m allowed to feel good about myself”: Brad. “But sometimes if I’m trying to look nice, then I worry about if other people think I look nice”.
Everywhere I go, I’m constantly bombarded with messages about how women should be slim and pretty, otherwise they’re just hideous sacks of flesh who have no value or purpose … So obviously that sort of toxic ideology does have an impact on how I feel about my weight.
like, oh, if I looked good, at least I would have that because I don’t have anything going for me socially … I wish I could just be a pretty face because I feel like there’s not much else that people see in me.
As I started to lose weight, I really noticed that people make eye contact with me more. People would like start holding doors for me. People are just in general nicer to you. I don’t really understand why but –I’m kind of used to not fitting in based on other reasons, but once I lost weight, that was one less reason.
I’m finding out information on YouTube and Reddit and also Facebook support groups. I do independent research too”.
“I’d done my research the second I found out I had diabetes. I spent the better part of three days researching information on every aspect of it”.
“Thinking that the doctor, usually you just get the generic, “Oh, well, you know, it’s all you gotta do is exercise, eat less calories than you consume, and drink more water”.
“was telling me about how I would lose weight by going on this diet. I was like, “Well, that’s not actually what I’m here for,”.
I have a medical doctor, a counselor, and a psychiatrist. All three work with me on my diet and my sleep and exercise”.
“… the advice that they give me is very individualized to me”:
“how they [medical professionals] interact with you in the space that you’re in is really important….
I’ll try it, and then I’ll burn myself out, and then I’ll be off it forever”.

(Kinnaird, E., Norton, C., Pimblett, C., Stewart, C., & Tchanturia, K. ()). Eating as an autistic adult: An exploratory qualitative study. PLoS one, 14(8), e0221937.Interviews
Identified via thematic analysisAutism and eating
Impact

“if the texture is off, that food can be just fantastic and I’ll still loathe it”.
“I’d rather not eat in a loud restaurant or dining hall, or just anywhere where I can’t talk to people next to me or just have some peace and quiet.
“I don’t like the smell sometimes that forks and knives have on them. So I will insist on clean cutlery, and if it smells peculiar I will send it back and get clean ones. And in fact sometimes mugs out of the dishwasher have that smell in them as well, and I don’t know what that smell is but it’s pungent. And so if it doesn’t smell just right I won’t eat out of it or on it”.
“it’s the immediate feeling of being full. You know, two bites and you’re full, that’s it. Even if you were a bit hungry, two bites and you’re done”.
“Planning and doing things in the right order can be a big barrier to accessing food. For example, I don’t leave my room unless I have a visual mental plan of exactly what I’m going to get, where it is, and how I’m going to get it (often with a backup plan or two so that I don’t panic if my first plan is disturbed), and if I don’t come up with a satisfactory plan I just don’t go at all.
once I start executing a plan I enter a sort of autopilot mode, and the system gets lost if it’s bumped off course. Oftentimes when that happens I quickly give up and pick something at random to get out as quickly as possible, and that can result in accidentally picking something sensory-bad”.
“literally forgetting to eat because I just get too busy to, I don’t know, recognise the signals”.
“you’re quite rigid, you’re quite kind of control orientated, you’re quite kind of perfectionist”.
“I think I’m in control of everything simply because I’m in control of the facts, and I know exactly why I’m doing what I’m doing”.
“The milk was sour at school once, and I wouldn’t drink milk for a long time after”.
“[It is] easier if I don’t have to think about something new to eat. If I know something is good, and that, you know, I’ll feel ok after eating it, then I’m likely to eat it again”.
But I don’t want to eat like that so you know, I don’t feel inspired. I feel a bit repulsed actually, just sit back and observe in grotesque curiosity I suppose”.
I always prefer to eat alone rather than with people. Eating is not about “hanging out”, it’s about “putting food in my belly so it stops complaining”.
Because I started eating it at a certain time of day and then I kept doing that for a long time and I was gaining weight and I noticed that I was constipated and I had to stop that habit. But it’s very easy for me to get into a habit”.
“If you’re not taught how to eat well, and you know the sort of behaviours you see as a child is emotional comfort eating, I guarantee you that’s what my mum does. Then that’s the sort of thing you’re exposed to, you know, having a bowl of cereal sized for six people before you go to bed sort of thing, or you know, asking for a bowl of ice cream and you get the entire tub before you go to bed, just because somebody’s upset you you eat a candy bar. You know, that sort of thing, if that’s what you’ve been exposed to, which I was, then that, the sort of patterns that you assume”.
“We’re all so literal, and all these messages that are out there and all these skinny girls on Instagram- now it’s the bodybuilders on Instagram, you know, the fitness freaks on Instagram … I think these things are all around us, I think we’ve got to think about them very clearly and carefully. Particularly when we’re thinking about how literal autistic people take these messages”.
“Autistic people often misuse “black and white thinking”, and I know that affects what and when I eat at home, because if I go to get a snack and my mom says it’s too sugary or it’s saved for something/someone else, I don’t get a different snack, I just don’t eat. I think that sort of thing contributed to my eating disorder at the start”.
“I definitely have a tendency towards completion that will cause me to finish a meal that I am not necessarily hungry to finish, and that may be one thing about it. There’s definitely a compulsive element to my eating a lot of times. I also think that, you know, there’s an impulsive element to my eating, and they both sort of come together to, you know, create binge episodes when they do occur”.
“For a long time I would eat only foods I recognized. I worked pretty hard to overcome that … and I have learned to like the experience of trying a new thing, even if it may not be what I know … they’ve improved because I worked at them”.
So I feel like that habit helped me diversify my tastes and it definitely gave me courage to try new things”.
“I think not knowing that my body weight was actually linked to how much I put down my neck- no one ever told me that the two were linked together- was just a big issue as well. So I think this has been a lifelong thing for me. Never knowing that the two were related, never knowing it was something that I had at least some degree of control, responsibility for. As a responsible adult. I think once I discovered that about five or six years ago and once I discovered that it was something that I could change and I did have some power over, then that was empowering in itself and that’s when I started to take some control over it”.
“making meal plans helps, I think, because I then kind of have to—I don’t get into a panic about “oh, what should I eat”. I’ve kind of got it all sorted out before”.
“They also know about my “nope” reflex. Some things just make me go “nope” and they don’t chase me with them or ask me to try them anyway … We all abide by these boundaries and it helps tremendously”.
“My experiences, be they atypical, are still perceived as valid”.
“I think it would be helpful if more professionals were aware of the sensory differences and the frequently-comorbid gastrointestinal issues that can make eating difficult for people with autism, as well as the samefooding phenomenon and other routines. Also, in general, they need to understand that meltdowns and sensory overload aren’t tantrums or bad behaviour and can’t be helped by treating them as such—especially with food, it’s not as simple as being picky, it can range from unpleasant to uncomfortable to painful”.
To know that there is a category of people who have these eating issues and they don’t actually have anything to do with the shape of their body. And to tell them that they need to change is wrong. It’s ethically wrong and it’s going to ethically fail, it’s going to cause these people more damage. It’s not the best way to go about things”.

(Kinnaird, E., Norton, C., Stewart, C., & Tchanturia, K. ()). Same behaviours, different reasons: what do patients with co-occurring anorexia and autism want from treatment?. International Review of Psychiatry, 31(4), 308-317.Interviews
Identified via thematic analysisRelationship between autism and anorexia
Problems with treatment
Treatment adaptations

I’ve never really had the thoughts of I want to, kind of, I don’t know, be really thin or lose weight. I’ve never really—like it’s always just kind of happened.
it is a bit about body image that everything like that but … It’s more kind of a way of dealing with sensory things like, yeah, it’s a massive thing of not knowing that I had sensory issues and it as a way of coping with those.
The first facility I went to, before the autism diagnosis was problematic because they thought that I was stubborn and lazy and unwilling to help myself, and they let me know it.
They ended up asking me not to come back, because my case was too “complex”.
I’m very very sensitive to noise. You know, extremely sensitive. Like things like laughter and stuff, I can pick it up so easily and I don’t like loud noises, like when someone’s distressed in the room I get very distressed, it makes me feel distressed….
I feel like they didn’t understand that I needed to walk out, because apparently, they handed it over to the other staff for my notes. I feel like they don’t understand I took myself out of the situation because I can’t cope with the noise.
It was sensory and texture and just, caused me so much anxiety not because of what food it was but because of like the sensory aspect of that food … it was always kind of acted as though I was just not really aware and it was really the food that was causing me distress.
And then that made me more angry because it felt like they were saying I was lying.
Treating the AN as though it exists in a vacuum is incredibly harmful, because it’s demoralizing to the patient, it delays recovery, and it frustrates everyone involved.
Emphasis needs to be placed on figuring out which behaviours are anorexia based, and which are autism based. If someone is refusing to eat their dinner, it could be because their eating disorder is telling them that it will make them fat, or, the food could be touching, is an autistic sensory issue.
The behaviours are exactly the same, but the causes can be so different.
Knowing all of this, if doctors and therapists and dieticians can be flexible regarding autistic patients, they’re going to see much better outcomes.
this is why, this is why I’ve felt like I’ve not fitted into the world for the last 45 years, and actually I’m just different and that’s ok.
I have like sensory issues with touch, for example textures. But that’s something, like last time because I think I was masking I wouldn’t bring it up. And it takes quite a lot of courage to be honest and say “actually, yeah, that’s a sensory thing for me”,
like last time I kind of thought “oh well to recover you have to mix your foods” so, I don’t know, it was almost like masking the recovery.
I know that their model of therapy is not going to deal with that. I, so, it’s not going to address what I think.
I think as somebody who’s on the autistic spectrum and who has an ED, I think AN is kind of like a product of who I am and how I think.
but people getting that like someone is going to still have, probably, a rigidity around their food, like and that not being totally—not just in inpatient, in outpatient as well—that’s not the battle to be fighting.
It should be about how much is that person able to now be like engaging in life.

(Li, Z., Chubinidze, D., Croft, P., Webb, J., Sarpong, A., Zesch, E., & Tchanturia, K. ()). “Don’t talk to me like I am an illness”: exploring patients’ needs using the communication passport in an eating disorder service. neuropsychiatrie, 39(1), 28-35.An explorative qualitative analysis of 38 completed communication passportsCommunication preferences
Sensory sensitivities
Special interests and strengths
Important message to the care team
Dislikes and struggles
Support needed

“calmly, kindly, gently” with a “soft voice”.
“Sensory needs (e.g. my sensitivity to light, sound, touch, texture, taste, or smell and how you can support me)”,
“slamming doors”, “alarms”, “footsteps”, and “loud music on the radio” stressful,
“Low light helps me focus. Bright lights are distracting”.
“need flavour and need sweet”).
My family and friends all mean a lot to me”.
“Treat me like a normal person”; “Don’t talk to me like I am an illness”.
“I want to get better”.
“[Dislike] schedule that is uncertain”; “[Struggle with] processing information”.
“I struggle to ask for help”.
I don’t like being forced”: “[Dislike] being patronised”.
“[Struggle with] giving myself permission for enjoyable activities”.
My dislikes and things that I struggle with, and how you can support me”.
“The reassurance that it is okay to eat my meals”.
“If a plan is going to change, please tell me”.
“Check in with me”; “Asking me what could help in the moment”.
“Help by talking about other things outside of [ED]”.
“I need time on my own”.
“Keep me in the loop”; “Be collaborative with me”.

(Makin, L., Meyer, A., Mondelli, V., & Tchanturia, K. ()). Regulating with food: a qualitative study of Neurodivergent experiences in adults with binge eating disorder. Journal of Eating Disorders, 14(1), 13.Interviews
Identified via reflexive thematic analysisUnderstanding the Neurodivergent self
irregular eating leading to bingeing
binging to self-regulate
personalised and adaptable support

“I don’t know” [026] and “I haven’t thought about it” [022], and wished clinicians had explored this with them, saying “because it’s something that hasn’t really been discussed or looked at, it’s not something that I’ll know what needs to be managed”.
“there’s no way to, like, say, oh, it’s this or that. So, for now, it’s just, like, damn”.
“It didn’t come up in therapy because I hadn’t thought about it. But if they were to [ … ] bring it up, I think it could have made things a lot more clearer for me.
wow, like, there’s a lot of things that could be like, yeah, parallels. And there’s a lot of explanations that were applicable”.
“once you understand the reasons that you do stuff, then it’s much, much easier to change your behaviour”.
I might skip lunch there because I didn’t like what was to offer and there was no alternative that I liked” [009] and “I was a finicky eater and then I’d kind of eat once I discovered what I felt I could eat”.
Gets like a lot of consistency. But I know it takes exactly 3 hours. And so if I don’t have orange juice ready, I will wait until I have that orange juice. I’ll wait for it to slushify before I eat”.
“I think that when I’m hyper-focusing I forget everything else, so I don’t eat or take care of myself. And so, I mess up my eating routine and then I’ll binge to “make up” for what I didn’t eat”.
“I think something that led to bingeing is also not recognising that I’m full. [ … ] I think my whole sense of like interoception is not great”.
“[bingeing] was probably like sensory seeking behaviour” [002], with eating having “become a bit of a sensory thing”.
“wholemeal bread and butter, like slice after slice, because I really liked the contrast of like the texture”.
“swallowing specifically or like just having a feeling in my mouth” [032], or the “sensation of chewing”.
“recognising that I just want the sensory input and I’m not actually hungry, helped me to choose more vegetables”.
Maybe I need a little shot of dopamine before I do the task [ … ] So that might be like crisps or drinks and really icy cold, sparkly water.
and don’t have to worry about the people around me and have my food in peace”.
I just do it, I don’t think, I just do it and then when I’m doing it, that’s when I think ‘Oh, ****’ [ … ] And I’ve been known to travel far and wide to find a specific cake that I want.
“Neurodivergent people have different needs [that] might change over time”.
“I do think CBT can be super helpful for some Neurodivergent people because it’s very structured”.
“I think possibly having a community to turn to of people going through similar struggles would be nice”.

(McIntosh, A., & Hunter, R. (35)). Exploring recovery from anorexia in autistic adults: a qualitative study. BMJ open, 16(1), e111034.Semi Structured interviews
Identified via reflexive thematic analysisRecovery in progress
Changing to healthy mindsets
Sensory experiences
Engaging with treatment

“not a linear thing” (P5) and they have “had slip- ups for sure”.
I guess that is just part of recovery. I choose to eat and do the right thing even though my mind would still prefer to weigh 80 pounds.
I struggle with that word ‘fully’ because I do think I am recovered … there’s this kind of ‘its definite’ and you’d never be vulnerable to that illness ever again which I think that’s kind of naïve thinking … like any mental health problem or like addiction it’s like an automatic thing to go to.
However, I do still have parts of me that are anorexic and still in anorexic thinking.
It was a lot due to my parents commenting on my weight … it wasn’t just my parents, like there would be relatives stating if I gained weight, or if I lost weight and they made me feel conscious.
[If] I see that they’re eating, I’m always tempted to consciously eat less than them.
looking at content creators who focused more on body neutrality and body positivity, rather than looking at influencers who’s like ‘you can lose this much weight in 2 weeks.
I am extremely privileged, and I have two sisters and several close friends who know I am … bonkers … and still show up.
taking lower stakes work and managing how much work I have and how much I’m juggling is important.
makes you convince yourself that you’re not worthy of anything or not deserving of anything”.
It kind of seeps its way through to different sort of elements of your life.
[It] affected my self- esteem, and I would tell myself how stupid I was or how I did not deserve to live, or how I did not deserve to eat. So, I would not eat.
“it’s very hard to break out of those … thoughts that led to the eating disorder … very hard to break rules”.
I often have nightmares too. Not only about weight, but about not being enough or the consequences of eating or people like dying and things … once I dreamt I died, and everyone was talking about how fat I looked at my funeral.
“don’t have to suffer anymore”.
I’ve essentially had to rewire my thinking … I am not losing control by following a meal plan … I am making the conscious decision to eat … I am in control by saying that I will do these things.
I learnt to not be so hard on myself ….
Weight doesn’t give you the full picture, it doesn’t give you your body fat percentage, it doesn’t give you like the strength that you have from certain physical activity.
I try and actively avoid triggering content on social media, news articles, thinspiration stuff.
Social media and TV shows and movies … blatant fat phobia. And the way society makes it very hard to be okay with being in a larger body … there is no size that is healthier or attractive than another. And people in bigger bodies can be just as healthy, or healthier than people in smaller bodies, and just as beautiful.
I don’t think I’d be able to stay in recovery if I didn’t have my support system.
My parents have been so supportive of me and my struggles with mental health as a whole in the past, I almost feel like I owe it to them to at least try … I missed out on so much when I was anorexic.
… just being with someone while eating, and where eating is something pleasurable, has been very invaluable.
We are very far apart but we video chat with each other sometimes and eat dinner together,
The way that my body works in terms of sensory … at all times I feel every single piece of clothing on my body, no part of it ever goes away.
I didn’t have a normal relationship with food … I don’t communicate very well with my body, so I don’t feel hungry necessarily and I don’t necessarily notice or make the connection that I’m being hypoglycaemic because I haven’t eaten.
I knew I was upset about gaining weight, but I wasn’t upset necessarily, because I wanted to gain weight … It was just very confusing.
Everything just felt wrong and that led to a lot of anxiety around my body and around existing in public spaces and a lot of depression from that disconnect from my brain, from what I was and what I should be.
It’s also not disordered behaviour, it has nothing to do with me choosing to eat or not, it’s just a fact of life. It’s how I react to this experience.
One participant described the distressing experience of smelling a food they avoided as being like an “extremely high- pitched squeal at all times”.
It is frustrating because even when there are times that I want to eat or foods … if my senses can’t handle it, then I just can’t do it.
I feel a lot more comfortable if I can just taste every component, then the whole thing all together.
“gives a sense of control, a sense of ownership, a sense of predictability”.
I really do like is the routine. I do like knowing exactly what I’m going to eat, with who I’m going to eat with.
being autistic definitely made the depths of my obsession worse and the obsession was the main root of the anorexia.
I’m also very rigid and categorical in terms of needing to have earned eating food.
Who knows, without the autism, and by connection the obsessive nature that comes with it, maybe I wouldn’t have developed anorexia at all (.
It scares me very much when I’m not able to access myself, like my brain, like I’m used to doing.
I felt like I was dying … My body was shutting down, and my doctor said I had just a few more weeks to live if I did not get help. My heartbeat was slow, I had zero energy, I could not think.
Nobody really acknowledged my autism for a few months … and they were like ‘nah that’s just your eating disorder’ … I wasn’t given explanations for things which made me really distressed and just having panic attacks when it wasn’t about the food, it was about … nobody giving me clarity.
“you don’t look anorexic”.
“there were parts of it that didn’t really land with me”.
but it didn’t really help me deal with the sensory difficulties of … having my body changing rapidly or, you know, eating a lot of food, or dealing with digestion.
They were very focused on whether or not I thought I was overweight, which I’m not delusional I know that I’m not, and I never had a specific like desire to look a certain way … I also think it’s pretty harmful to have that as such a big criteria.
“containment and the structure of the [treatment] ward was definitely helpful and not being solely responsible for my own care”.
“steps to follow and order”.
a test for me to see like if I could be responsible for myself and it gave me that chance to really like prove it to myself.

(Nimbley, E., Buchan, K., Maloney, E., Kettley, S., Sader, M., Duffy, F., & Gillespie‐Smith, K. (36)). Using Photovoice methods to set research priorities with autistic people with experience of an eating disorder. Journal of Clinical Psychology, 81(8), 677-693.Research questions via photovoice
Identified via thematic analysisImpact of early experiences
Function of the ED
Barriers and facilitators to ED recovery
Understanding and accommodating for complexity
Changing research culture

“what happens when we are younger fixes so much as we [get] older”.
I was taught that it was important … you know those messages would affect anybody. But it’s like as an Autistic person who is learning to navigate the world through figuring out the rules.
A really powerful image and it sounds like it resonates with a lot of us.
The rules we tend to make or create in our minds and they become so like powerful, they’re so important to us. It’s like hard to justify like why I should have this type of food or this amount of food or this kind of brand of food. And then, I don’t know, I just feel like the rules cannot be broken … it’s that kind of black and white thinking, like, no, you cannot break it. Whereas I’ve heard experiences from those who have eating disorders not coming from that autistic kind of lived experiences. It’s not as, as much, if that makes sense.
How do we break the generational cycle of eating disorders? How do we sort of make that support so that the younger people that are coming up through life now are able to kind of realise, like, how can they have sort of a healthy relationship with food, what can we do to kind of stop that continual thing?
I guess for me that picture is about trying to break that cycle. It’s about trying to create something for my children that is different. So, I guess that picture is one moment where I feel like I managed to do that. You know, one moment where I managed to put my own shit behind me.
I was trying to get across that food fuels my brain, [and] sometimes I don’t want to think so fast, so I’ll reduce the amount I’m eating to slow down my brain a bit.
Interesting for future research that three people with autism find that they reduce [for] their brain activity. That was what my psychiatrist think is the whole cause of my ARFID, reducing food to cope.
It was something that I sought comfort in … I was definitely seeking comfort and escapism from those kind of overwhelming feelings. I think that’s probably the best way to put it.
“to a point where my body wasn’t doing anything that wasn’t absolutely necessary to keep me alive and emotions were something that I almost stopped experiencing”.
“problems with processing and expressing emotions, or alexithymia.
I really idolized her in a way … And it was like, yeah, I think that added to it in itself of almost like, you know, trying to almost mimic that. Being like, if I was like her, I would fit in. If I was like this other popular person who also looks like this, I would fit in. [Being thin] just felt like it was taught everywhere, and it was a way of fitting in and being accepted.
And at the same time are trying to fit in and, and trying to sort of meet an ideal of what they think that, you know, you’re trying to act like you think other people think should act, in the same time, you think ‘I should look like a normal person’, you know, especially when there’s, you know, you feel the societal expectations on how you should look as well.
[Sensory experience of clothes] makes being happy about all the things I can do difficult because I can’t go out the house because I feel so uncomfortable in what I’m wearing. So then that freedom I’m supposed to have now isn’t really there. And I think, you know, finding a way to help with that side of things and making that process easier would, would be really beneficial.
“is a whole other variable to a situation that I did not have to think about before (and it turns out I get very overwhelmed very fast when I’m too hot)”.
It feels like textures on the inside and I can’t get away from that. And like that’s, that’s the problem.
I’m Autistic, I’m going to approach my recovery like I’m Autistic. I feel like being Autistic [can] sometimes be a blessing and a curse in terms of recovery and relapse and both whatever.
But, like, that actually being routine really almost helped? I felt like if I’d had that support and continue with, to maintain that routine and that recovery … that like genuinely I would probably mostly nearly be recovered from my eating disorder.
I found routine and reminders extremely helpful to avoid eating too much throughout the day.
Becoming more flexible in my thinking this was not something I was going to be able to do as I naturally have a preference for routine and familiarity. Attempting to change this or challenge it in some way would have created even more distress to me and wouldn’t be something I would be able to maintain. It was important for me to understand the difference between what anorexia was controlling and what was just my way of being.
“personally for me, it has actually been useful to try and separate those aspects of my life and impact that they have on my eating”.
Just to kind of reflect on the kind of figuring out thing like … I sometimes get really frustrated with people like now when people are kind of like ‘oh is that your autism or?’ and I’m like ‘I don’t freaking know’ like I’ve only been me … I don’t know how there was something that I can separate out and there’s some things not and it’s sometimes really frustrating.
you can’t really separate the two…100% we have to stop trying to separate and just have everything together and look at it as the whole person. I don’t know why but it makes me so angry”.
if it’s useful for you to pick it apart, if it’s useful for us to pick it apart, then having professional support to do that is really, really useful. But if someone else is trying to pick it apart to minimize something or diminish something or challenge us in a way that we don’t find supportive or helpful, then maybe that’s not a helpful route to go down.
To treat someone, you do need to look at cause and I think if you took me and someone else with ARFID, then our treatments will be so incredibly different because of the different routes and you know, there are so many different reasons for I think like categorising people, not just by their symptoms but by, how this has come about it’s going to be a lot more effective to treat them.
consistently missed both by GPs, by eating professionals by every other professional … and that is simply because they weren’t aware.
It’s really common [in Autistic people] to have like digestive related problems … and then also if you have an eating disorder and then you try and eat in like quote un‐quote ‘typical ways’. you quite often have like all sorts of digestive chaos as well … It’s like, so I said in hospital, like, ‘I feel better when I don’t eat.’ And they thought I meant like somehow like mentally or something, I feel better. And they were just told me that I didn’t. And that was just completely dismissed.
think that a definite research priority that needs looked into is why are those co occurrences more likely in Autistic people and how does that link in with treating the whole person? I think that’s often overlooked.
I think if they have the right education and understanding of what [co‐occurrences mean] and why they might be, it can just hopefully start those conversations and improve that awareness, which is really important.
Especially in my culture with within the‐ Indians and South Asians, there is that kind of culture of when you go to families and parents that love eating or overfeeding someone. And it’s I guess their kind of hospitality or they just they want to kind of welcome and have, have people around and I suppose [they] use that food as a social aspect of gathering.
I just want to agree with that as well. I think that like, like you say, the sort of like different cultures aren’t really like spoken about or acknowledged in like treatment and like teams.
I don’t think anyone told the nutritionist that I wasn’t a girl. And they basically saw me and went I don’t really know anything about male biology and then this is kind of specialised for girls, sorry.
I think we over gender it sometimes. We talk about male eating disorders, and I’ve never seen someone talk about male eating disorders that isn’t to do with gyms or body image of muscle dysphoria … and it’s just not true.
We try to categorise things so much we lose sight of the person, and I think it’s just the person we need to be looking at.
I’m hoping that, like, the training and priorities of treating people with autism and eating disorders is welcoming everyone’s point of view and it’s not like discriminating against anyone … I guess what I’m saying is that I think that it’s really important to not judge anyone and not discriminate against anyone and welcome everyone with more open arms because from my experience sometimes that’s not happened.
I think if practitioners in this area are more informed and or more individuals are upskilled to work with people with autism and associated eating disorders that this could potentially be life changing for some. I also think that as part of developing any education for professionals, it would be important for them to engage with those who’ve got lived experience.
I think for me, real recovery happens in the real world, and I think a way to prevent that is really where the research should be, or at least making community support robust and looking at ways for it to be adapted for people with ASD. I think a research priority is just trying to get the right support in the community for people and how to make that better, how to keep people at home, not let is escalate.

(Nimbley, E., Gillespie-Smith, K., Duffy, F., Maloney, E., Ballantyne, C., & Sharpe, H. (37)). “It’s not about wanting to be thin or look small, it’s about the way it feels”: an IPA analysis of social and sensory differences in autistic and non-autistic individuals with anorexia and their parents. Journal of Eating Disorders, 11(1), 89.Interviews
Identified via Interpretive Phenomenological AnalysisThe Social Self
Feeling the unknown
Sensory foundations

I can only realize now but how much I struggled with social interaction and kind of things like that. I’ve always felt really really different, and I didn’t really know why….
just the way that I feel about myself, I think that’s a big part in feeling … um … I guess not feeling like I deserve or need to eat.
There’s some distortion there like is occurring on my side. It’s not my ability to perceive those emotion but it’s just that distortion about myself and the way people feel about me that kind of interrupts the processing of that.
I think when my diagnosis it was kind of a weight off my shoulders. Like okay with the socializing example, like I knew blaming myself … like I was doing something wrong and I was finding this more difficult than a normal person so clearly there is something wrong with me.
And when I got the diagnosis it was like okay, I’ve not done anything wrong it’s just my brain works differently and I can now put things in place, try and like help myself in a way.
Actually, the first time I think since starting school I felt that I could relate to my peers was when there was a particular group of us in inpatient care … who I think were all wired the same way.
Very uncomfortable. Not just like, I think with a lot of the sensory things it’s not just a case of a like or a dislike. I used to explain it as a full body response to it as opposed to oh I like that smell, I don’t like that smell.
It’s because social interaction is an extra thing to have like to try and process that I’m already putting a lot of my effort into that that other things will slip through easier. Like the lights will affect me more or people talking in the background will affect me more and that kind of stuff.
What I struggle with, and I struggle with it in my own life as much as anybody else’s, is actually knowing what to call this feeling and therefore what the solution to this feeling might be….
But I’m not very good at knowing how other, verbally, how other people are feeling. I just sort of feel like I absorb it like a sponge. And I sometimes feel in my own life,I often don’t know how to describe how I’m feeling,
expressing my emotions is very very difficult. Um, and that makes … that usually means that I kind of end up bottling them up. And I guess I know when I’m feeling bad, or I’m struggling or a lot, but kind of really pinpointing what I’m feeling, I just don’t really seem to be able to do that very well….trying to express how I feel or my emotions, that is very very hard for me.
If someone asked how are you feeling, I would know exactly how I’m feeling, but I’m not going to tell them how I’m feeling.
I can tell you that I feel dizzy, that my stomach hurts, that I feel tired, that my mouth feels dry, but will not connect that to I feel hungry, or I feel thirsty. And I used, even when I was younger didn’t I, my eating would be on a routine so I knew that I had lunch so I would eat. It wasn’t like, oh I’m hungry.
And if I’ve eaten something, it was usually for the sensory seeking side of it? So, I’ve had time when I’ve wanted something crunchy so I’ve had something crunchy, it’s not like oh I’m hungry I’ll have a snack. I’ve never really done hungry.
I’m not very good at knowing when I’m hungry. It’s not necessarily that I don’t know when I’m hungry … it’s a bit hard sometimes to tell the difference? I know there’s a problem but I can’t tell you….I can’t tell you what the actual sensation is. Sometimes I can’t tell whether I’m really full or really hungry.

(Sedgewick, F., Leppanen, J., Austin, A., & Tchanturia, K. (38)). Different pathways, same goals: A large‐scale qualitative study of autistic and non‐autistic patient‐generated definitions of recovery from an eating disorder. European Eating Disorders Review, 30(5), 580-591.Online study with free response answers
Identified via thematic analysisWeight
Restoration
Lack of ED behaviours
Thoughts and behaviours
Cognitions
Emotional responses
Getting on with life
Ongoing challenges.

“weight restored” “reaching a healthy weight”.
“‘not binging/purging any more’, ‘not starving myself to match my mental im-age’ and ‘not restricting calories’. ‘not weighing myself.
obsessively’ and ‘not tracking calories’”.
‘obsessive or ‘disordered ideas about food’,
not interrupted with thoughts of calories and food’.
no longer ‘constantly thinking about food and/or my weight’ and that ‘thoughts about food are no longer constant for me’.
“‘no longer looking at “thinspo” ‘,’no longer trying to be underweight’ and ‘I no longer constantly want to be thinner’”.
‘recovery is healthy thinking patterns as well as healthy weight’.
not occupied by ED thoughts and consequently not engaging in disordered behaviours’.
no longer having a destructive relationship with food, exercise or my body. To no longer live a life preoccupied with my weight or my body and altering either through unhealthy means’.
‘[I’m] focussed on being happy [now]’, ‘feeling safe and comfortable’ and ‘I feel worthy of food’. Similarly, the concept of ‘learning to love yourself’ and being ‘relax[ed] around food and my body shape’.
‘I can eat without enormous amounts of anxiety and shame’, ‘I can eat without guilt’ and ‘[I] can eat on a regular basis without fear’.
now ‘get scared about losing weight’,
‘food does not control me anymore’ and of ‘no longer being controlled by an ED’.
being able to deal with symptoms’ or ‘my symptoms are now less intense … I know how to manage it’. And ‘to be able to binge once without causing a chain of negative behaviour’,
I eat food now’ – ‘having a fully healthy eating schedule’, ‘I can enjoy unhealthy foods’, ‘eating whatever I want when I want to’ – ‘I do my best to eat 3x a day minimum’, ‘actively trying to keep a standard eating schedule’.
healthy relationship with food’, ‘no longer choos[ing] food based exclusively on nutritional value’, and being a ‘healthy weight [and] able to eat freely’.
‘more like a remission in a chronic issue with the ever-possible potential of a flare up’. ‘I don’t believe I can be recovered anymore than a sober alcoholic can be not an alcoholic’. ‘still struggl[ing] sometimes’, ‘one is never ‘recovered’, but rather ‘in recovery’’.
I still can’t eat many kinds of food’) and (‘binging less but not fully recovered’) retained ‘some disordered habits’ or ‘an unhealthy relationship with food’.
‘cravings and self-loathing’, (continuation of).
‘there are times that I can still feel it’s grip on me’.
‘actively living with disordered thoughts while being able to overcome those urges’.
‘probably substituted food for smoking’ instead of learning to ‘deal with emotions in more productive ways’.
hyper-fixate on the healthiness of something’, and one gave a long list of her new rules for ‘acceptable’ eating: ‘following guidelines from fitness magazines, and now online blogs on vitamin sufficiency,
if your body feels worse after eating than when you were hungry then don’t eat it.

Frontiers in Psychiatry 发表孤独症成人进食障碍质性研究系统综述

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