Correlation: noun. A mutual relationship or connection between two or more things.
Correlation is a term often used in the science world. I think they like it because, especially in psychology, it can be very hard to prove anything. Medical doctors can do lab tests and MRI’s. Biologists can watch bacteria grow and mutate. Even in neuroscience, which is probably the closest you can get to psychology, they can stain and observe brain matter. Psychologists don’t have anything like that. A lot of the time, all they can really do is observe. Try something, observe. Have their colleagues try it, observe. Ask their patients to report back, hope the reports are accurate, observe. Getting valid statistical information can be a real challenge. So when they have two variables, it’s rare they can say that they have causation- the action of causing something. Unable to say with confidence that one thing caused another, they instead rely on correlation. Saying well, we observed that when A went up, B went down. In very layperson terms, this is basically how they write the DSM.
There are a lot of conditions that have correlations with Autism. From mental things like ADHD and anxiety, to Sensory and Auditory processing issues; even medical disorders like Autoimmune Disorders and Gastrointestinal problems. There are even more documented than this. But enough with the medical mumbo jumbo. Clearly I’m writing about this because one of these correlations is important to me. Which is true. It’s important to me because the professionals in my life not being informed about this connection severely impacted my treatment, prolonging it by close to a year. A year. Of my life. You see, I have an eating disorder. Anorexia Nervosa, if we want to be really specific. And I like being really specific. You’ll get used to it. When I went into treatment, I hadn’t been diagnosed with Autism yet. I only had a vague idea of what autism was. And what I definitely didn’t know was that Anorexia and Autism Spectrum Disorders are highly correlated. Some experts say that up to 20% of patients diagnosed with Anorexia also fall somewhere on the Autism Spectrum. And when both conditions combine in a perfect storm, it takes a lot of knowledge and patience to treat them together.
Autism and Anorexia overlap on multiple fronts. In fact, fMRI scans tell us that a malnourished brain looks surprisingly similar to an autistic brain. From rigidity and inflexibility and to trouble with theory of mind and empathy, for autistic people, these two are uniquely intertwined. One way this shows up is with rules. One of the major challenges in treating people with anorexia, on its own, is that their lives are governed by strict rules. Throw autism in on top of that, and dissecting the unhealthy and unproductive eating disorder rules from the more functional autism rules is frustrating at best, and incredibly harmful at worst. Want to try your hand at it? Here are some examples of both eating disorder rules and autism rules. Can you tell the difference?
- There are foods that are only for lunch, or only for dinner
- I cannot drink more than 4 oz of water at a time
- Meals have specific times: I cannot eat before or after them
- My plate must have grains, protein, and vegetables represented
- I must know the nutrition content of what I’m eating
- I must know what I’m eating at least a few hours before I eat it
- I can’t continue to eat once I stop feeling hungry
- How much I eat depends on how my day was
I’ll include the answer at the end. Are you back? How did you do? It doesn’t really matter, just guessing gave you better idea of the challenge that autistic people with anorexia face during treatment.
Speaking of eating disorder treatment- that is something I’m very experienced in. I spent two years in treatment, at various levels of care. The first year was very hard. No one knew I was autistic (not even me!) and me and my team were baffled over why conventional treatment wasn’t working. I was having daily panic attacks, my rules were becoming more rigid, and the more therapy I did, the more confused and frustrated we all became. Then someone suggested autism, and eventually it was recommended that I find a program that dealt with more complex cases. Hearing that did not feel good. But it was good. I met with a doctor before I went to my new program, and she said while I’d need formal testing, she could safely say that I was somewhere on the Autism Spectrum Disorder. And I wanted to shout it from the rooftops. I’m not stubborn, I’m autistic! I also wanted to shove it in the face of every professional who said I wasn’t trying hard enough. But I didn’t. Because I have social skills. This doctor. Another doctor also told me something that changed everything that I knew about anorexia treatment: that with anorexia and autism, you can’t treat either alone. You can’t have one of them stable without the other. They’re a bonded pair. Turns out, my panic attacks? They were meltdowns. And all the therapies we tried? Needed to be modified for autistic patients. When my team started taking the autism into account, all of a sudden, I started getting better. I started feeling better! When we figured out what food rules were harmless, helped me develop schedules and routines, and put emphasis on my sensory needs, my progress was spectacular.
This is what autistic people need. Not just in anorexia, but with any comorbidity that exists. You can never treat one without acknowledging the other. And it’s so hard to find therapists and doctors that specialize in more than one thing. So I think we need a change. I’m not saying that every professional needs to be an expert in everything. And I’m definitely not saying that it’s the job of patients to be educators. But if we’re willing to work together, for both sides to educate themselves and cooperate to find out what works, then everything will be better. Not a quick fix. And not perfect. But better. In this case, correlation can improve lives, and I’m all for it.
Answer Key: Autism, Eating Disorder, Autism, Autism, Eating Disorder, Autism, Eating Disorder, Eating Disorder.