The unique underpinnings of anorexia in autistic people

New research findings could point to new avenues for interventions, and schools have a key role to play

As awareness of neurodiversity grows, researchers are beginning to explore how autism interacts with eating disorders in ways that differ from non‑autistic experiences. This shift matters: autistic people with eating disorders often present differently, respond differently to treatment, and may be overlooked or misunderstood in mainstream systems. Understanding these differences not only deepens our knowledge of eating disorders but also opens the door to more effective support for neurodiverse learners.

A new study from the University of Edinburgh and the University of the West of Scotland, published in the Journal of Eating Disorders, suggests that autistic individuals experience anorexia through distinct psychological and sensory pathways. The research team, led by Emy Nimbley, used Interpretative Phenomenological Analysis (IPA), a method focused on how people make sense of their own experiences, to explore these differences.

Fourteen adult–parent pairs took part: seven autistic and seven non‑autistic individuals, all of whom had received a clinical diagnosis of anorexia at some point. Semi‑structured interviews explored their diagnostic journeys, the factors they believed contributed to their eating disorder, and the role of sensory and emotional experiences. Importantly, both neurotypical researchers and an autistic researcher with lived experience of anorexia analysed the data, adding depth and authenticity to the interpretations.

Key differences in how autistic and non‑autistic participants experienced anorexia

1. The “social self”

 Both groups described a socially driven sense of self that influenced their anorexia, but the nature of this influence differed. 

• Autistic participants described a defensive social self,  a sense of being “at fault” or out of sync socially, leading to withdrawal or self‑protection.
• Non‑autistic participants described a social self shaped by comparison,  feeling inadequate next to others, or overly attuned to others’ needs at the expense of their own.

 2. Emotional expression: Both groups struggled with expressing emotions, but for different reasons.

• Autistic participants linked this to difficulty identifying emotions (alexithymia).
• Non‑autistic participants linked it to prioritising others’ feelings over their own.

 3. Interoception: sensing hunger and fullness

Confusion around bodily cues was common across the sample, but again, the roots differed.

• Autistic participants described lifelong, multi‑dimensional difficulties identifying internal signals.
• Non‑autistic participants felt this confusion emerged because of their anorexia.

These distinctions matter. They suggest that autistic people may require different therapeutic approaches, ones that address lifelong sensory and emotional processing differences rather than assuming the same mechanisms that drive anorexia in non‑autistic individuals.

Why this matters for schools

Schools are often the first place where early signs of eating difficulties appear and where autistic learners may either be supported effectively or unintentionally harmed by misunderstanding.

This research highlights that autistic young people may not show the “classic” signs of anorexia. Their eating difficulties may be rooted in sensory overwhelm, interoceptive confusion, or social defensiveness rather than body image concerns.

Understanding these differences allows schools to intervene earlier, more compassionately, and more effectively.

What schools can do: practical interventions grounded in the research

1. Support interoception and body awareness

Because autistic learners may struggle to recognise hunger, fullness, or discomfort:

• Teach interoceptive awareness through PSHE, wellbeing sessions, or OT‑informed activities.
• Offer predictable eating schedules rather than relying on self‑initiated eating.
• Allow snacks or flexible eating times for students who cannot reliably sense hunger.

2. Reduce sensory barriers around food

For some autistic learners, eating difficulties stem from sensory overload, not body image.

Schools can:

• Provide quiet, low‑stimulus eating spaces.
• Allow preferred foods without judgment.
• Avoid forcing exposure to disliked textures or smells.
• Work with families to understand sensory profiles.

This aligns with the study’s suggestion that accommodating sensory needs, rather than trying to “fix” them,  may be more effective.

3. Rethink social pressures around food

The study shows autistic individuals may experience social environments as threatening or overwhelming.

Schools can:

• Avoid punitive or public monitoring of eating.
• Offer alternatives to crowded dining halls.
• Train staff to recognise that withdrawal or avoidance may be anxiety‑driven, not oppositional.

 4. Teach emotional literacy explicitly

Because autistic learners may struggle to identify emotions:

• Integrate emotion‑identification tools (visual scales, check‑ins, colour‑coded systems).
• Provide 1:1 mentoring or pastoral support focused on emotional awareness.
• Use concrete language rather than abstract emotional vocabulary.

5. Train staff to recognise non‑typical presentations of anorexia

Autistic students may not express:

• fear of weight gain
• desire to be thin
• body dissatisfaction

Instead, they may express:

• sensory aversion
• rigid routines
• anxiety around change
• difficulty interpreting hunger

Staff training should reflect this.

 6. Collaborate with families and external professionals

Parents in the study provided crucial developmental context. Schools should:

• Maintain open communication with families.
• Share observations early.
• Work with CAMHS, dietitians, and autism specialists to create joined‑up plans.

7. Avoid behaviour‑based assumptions

A student who “won’t eat” may actually:

• be overwhelmed by noise
• be unable to identify hunger
• be distressed by textures
• be masking anxiety

Assuming defiance can cause harm. Assuming complexity opens doors.

How Invicta Strategic Consultants Ltd can help

Schools rarely receive training on the intersection of autism and eating disorders, yet they are often the first to notice early warning signs. Invicta Strategic Consultants Ltd specialises in helping schools understand and respond to the complex needs of neurodiverse learners.

We support schools through:

• Whole‑staff training on autism, interoception, sensory needs, and non‑typical presentations of eating difficulties
• Strategic reviews of pastoral, safeguarding, and SEND systems
• Case‑based consultation for complex learners
• Policy development that reflects current research and best practice
• Parent engagement strategies to build trust and shared understanding

If your school wants to strengthen its approach to neurodiversity, early intervention, and student wellbeing, Invicta Strategic Consultants Ltd can help you build a safer, more informed, and more inclusive environment.

To discuss training or consultancy, get in touch with Invicta Strategic Consultants Ltd