Tag Archives: emotions

Lady eating grapes

Eating disorders and autism–what’s the link?

From the outside looking in, perhaps eating disorders and autism couldn’t look more different. Supposedly, people with autism aren’t attuned to their emotions, whereas people with eating disorders are highly sensitive and turn to food/eating behaviours to cope. But an eminent psychiatrist says:

Strip off the misconceptions, and the two conditions are far more similar than anyone believed.

Janet Treasure, director, eating disorders, Maudsley Hospital, London

It is therefore unsurprising that research has found that in groups of people with long standing eating disorders more than 20% had undiagnosed autism spectrum disorder.

Similarities include fixating on small details, with difficulty seeing the bigger picture and the need for rules, routines and rituals.

On a personal note, well before I was making sense of my life through the lens of autism, it was clear my eating disordered behaviours began as I struggled with changes at puberty. I couldn’t cope with hormones causing bodily and emotional changes that I didn’t understand. I remember specifically thinking I wanted to try and keep everything the same.

An autistic person may develop an eating disorder due to the following:

  • Not being able to sense hunger, this is due to impaired interception.
  • Sensory problems with food e.g. texture, smell, taste, leading to limitations in food tolerances.
  • An intense/restricted interest of counting calories or other specific food related activities – these routine and rules become very difficult to change.
  • High levels of anxiety.
  • Unintentional lying related to food intake or exercise activities.

This could be the perfect storm for developing a restrictive eating disorder (anorexia) but some autistic people could turn towards food and binging/purging behaviours in order to manage their emotions.

When compared to neurotypical counterparts research shows that weight and body shape are less important for autistic people.

Clinicians have managed patients of this kind (girls and women on the spectrum with/without a diagnosis) by increasing therapy that wasn’t working, but they’re now seeing that they have different recovery needs due to their autism:

“We always had this subset of patients who didn’t do very well in group therapy, and our response was, ‘Well, let’s put them in more groups,’ It just alienated them even more; now we know better. Providing a small range of food choices, as well as clarifying rules and expectations, also tends to help people with autism and eating disorders recover successfully.

Craig Johnson, Clinical Director, Eating Recovery Centre, Denver

I, too, have often heard clinicians make similar comments. I can understand the thought process, if patients struggle with group therapy, it can be an incredibly helpful process; noticing and understanding one’s impact on others is important and powerful in society as a whole.

However, an autistic person, struggling with an eating disorder, isn’t struggling with their relationships with others, they’re struggling with understanding internal processes, emotions and, the need for routine and the resistance to change isn’t just a preference it’s a neurotype.

It’s all too common for women to get struck in the mental health system, to be diagnosed with depression, bi-polar affective disorder, borderline personality disorder or eating disorders and only in their 20s, 30s or 40s find out that they actually have autism.

For some, when they receive a diagnosis of autism and appropriate support, their eating disorder disappears, read about Savannah’s experience here. For others, understanding that their “autistic brain [is] obsessing about numbers, patterns and sensations” helps them have a better relationship with themselves, read about Carrie’s experience here.

Therapy

For me, autism has helped me make sense of so much! My anorexia was a desperate attempt to keep things the same, it was a way to (try and) escape a very confusing world where I don’t understand how to fit in and it’s now making sense as to why it was so hard for me to recovery (every time I did, my mental wellbeing would deteriorate) and why I needed so much personal therapy from someone who threw the rule book out the window.

The sad fact is that anorexia has the highest mortality rate, 1/5 people with anorexia will die early, from suicide or malnutrition. However, there is hope, by raising awareness of autism, management of the eating disorder is possible and could set someone free. Combination of specialist therapy and medication to aid with the high levels of anxiety will most likely be required.

Please don’t judge how I eat my bread

How often are we reminded “not all disabilities are visible”? Yet I’ve heard too many stories of people who need to use the accessible toilet being tutted at as they exit. You can’t see a stoma, you can’t see urinary urgency, you can’t see menorrhagia – it’s none of your business why someone needs to use the accessible toilet.

Have you ever given the person stepping out of their car in the “blue badge” car parking space a sideways glance? You can’t see COPD, you can’t see autism, you can’t see chronic fatigue. There are plenty of people who need to use the disabled spaces who don’t use a wheelchair, it’s not your place to police of the blue badge scheme.

I felt mortified as I nibbled the inner soft section of my bread roll when in a posh restaurant. I repositioned the crusty portions back together because I felt embarrassed I couldn’t finish the beautiful handmade roll. I don’t know what the chef thought when the waitress took my plate back to the kitchen. They probably thought I was just another fussy customer, I doubt they guessed I had a fractured jaw! Sucking the soft inner portion of the bread caused excruciating pain, there was no way I could chew the crust! (I didn’t know I had a fractured jaw at the time – I wouldn’t have gone to a posh restaurant if I’d known!)

Do you feel frustrated with your grumpy colleague?

Did you think the lady in front of you at the checkout overreacted when the cashier made a mistake?

Do you wonder why that person never joins in at your hobby group?

Perhaps you think your neighbour is a bit odd? You maybe fed up of them not cutting their hedge/parking their car in an awkward position/being loud late at night etc…

Maybe you think there’s no excuse for rudeness but my point is that we can never truly know what’s going on for someone else. All sorts of things can make someone act in a particular way but who are we to judge someone else?

You know what I really hate?! People who tailgate! But you know what? I’ve stopped judging them. I don’t know what’s happened to make them try to push me along the road faster than the speed limit. Maybe they’re trying to get a labouring woman to hospital? Maybe their dog threw-up before they left for work and made them late and their boss will unreasonably fire them for being late once? I could curse and get angry but why waste my energy?

I’m often asked why I’m so quiet. It’s because I’m listening. Everyone has a unique story to tell. I’m fed up of being judged. Listening to each other leads to understand, understanding leads to compassion. How much nicer is to have compassion for one another rather than judgment? All we need to do is listen!

Perhaps you could ask your colleague if there’s anything you could do to lighten their load? They might open up about why they’re feeling grumpy, they might just tell you to ***off but the fact that you tried but be the best thing that happened to them that day!

Instead of tightening you clique at your hobby group, invite the shy attendee in, they might not say much so what’s the harm? Inclusion rather than exclusion is so much kinder.

That awkward neighbour?! I think it’s safe to say, most people have at least one tricky neighbour! Sometimes you need to think outside the box! Perhaps take round a bottle of wine or invite them for a BBQ? At some point, try to talk about the tricky issue but remember, until you hear their story, try not to make assumptions, you don’t know why they’re behaving the way they do!

Self compassion takes self discipline

I say self compassion and many will think, at best it’s airy fairy, at worst it’s self indulgent or even hedonistic. But I just want to spend a few minutes putting this in perspective.

So, what is compassion?

People holding hands with caring and compassion

Firstly, you need to notice some suffering, you then need to feel moved, in some way, by this pain and thirdly, you need to feel some warmth or desire to change the situation. For most people it is fairly easy to feel compassion for someone else. For example, if you hear the plight of families in your local area who cannot afford food (step 1), if you’re moved by this (step 2) you may wish to help the situation, while doing your weekly shop, by donating some canned goods (step 3). Easy, isn’t it?!

Feeling compassion for ourselves can be a lot harder.

Most of us are incredibly quick to judge and criticise ourselves for falling short, for making mistakes and for our various inadequacies. But if we can be compassionate to fellow human beings, why do we raise the bar so high when it comes to judging ourselves? Self esteem is a fragile enough entity, why do we insist on making it so hard for ourselves?

It’s a common technique, when recovering from mental illness, to imagine how you would treat a friend in a similar situation. Some people struggle with this, if your self esteem is low enough, you’ll think you’re not good enough to be treated as a friend; but consider this, is what you’re doing, the way you speak to yourself, the way you treat yourself, at the moment, work? If not, you need to try something different.

To feel compassion and to care for ourselves may be at odds with our inner beliefs but it can have such wide ranging benefits it’s worth taking time to think about this.

Self compassion can be put as simply as feeling compassion for others: step 1 – be aware of your pain, step 2 – feel moved by the pain, step 3 – have a desire to change it. But it’s not that simple is it?!

Instead of judging ourselves we need to practice self-kindness. If you’re constantly beating yourself up for making mistakes, this only leads to a negative spiral of stress. If you’re doing your best and you fall short, it’s ok, being kind to ourselves take practice and discipline to replace habitual thought patterns.

We are all human, mortal, vulnerable and imperfect – we can find solace in sharing our humanness rather than feeling isolated in our suffering. Instead of believing we are failing and experiencing suffering as an individual, consider these experiences part of a shared human experience.

2 people looking at a figure on the ground. One person sees a 6, the other person sees a 9.

Remember, sometimes perspective is everything – if you’re a new mum or dad waist deep up nappies, you’ve not had a adult conversation for days, your baby’s got colic and you’re exhausted, it’s likely, you will feel you’re doing something wrong and you’re totally alone. If you pick up the phone and speak to a friend, how will they view the situation? They will think you’re doing an amazing job, your baby is alive aren’t they?!

In all seriousness, sharing experience puts it in perspective and helps us realise we’re all human, stumbling through life, what we perceive as our failings and imperfections are all part of the human condition.

Being mindful of our emotions allows us to experience our emotions in their fullness without suppression or exaggeration. We are able to do this when we’re able to view our emotions within our situation as a larger picture. Mindfulness allows us to view all emotions, (whether perceived as “positive” or “negative”) simply as they are, without judging them or trying to change them.

I do not believe there are negative emotions – all emotions simply serve the purpose of telling us more about a given situation (the negativity is only the judgment we place on the existence of the given emotion).

While identifying and being aware of our emotions, we will enable ourselves to avoid over-identifying and getting caught up in our emotions, thus avoiding negative reactivity.

Element of self compassion by Kristin Neff. Self kindness, recognising our common humanity, mindfulness.

This self-compassion sounds quite complicated, doesn’t it?! It’s certainly not some passive pleasure seeking, it’s an active choice that takes discipline, you decide if the benefits are worth it:

  • Improved self esteem
  • Increased sense of self worth
  • Reduce stress
  • Improved resilience

To start trying self kindness, catch your thoughts and turn them around, you don’t have to become your own cheerleader (unless you want to!) but be more gentle than harsh with yourself:

  • Replace “I’m useless” with “I’m doing my best”
  • Replace “I always mess up” with “it’s ok to make mistakes”
  • Replace “I can’t” with “I’ll try”
  • Instead of always saying “yes” to requests, consider what’s best for you and say “no” or “I’ll think about it” or “I could find time next week”

It’s going to take practice. Some people will find it helpful to write down their common harsh thoughts so that they can think of concrete replacement thoughts and seeing them in black and white can be eye opening.

“You got this” written in flouncy text

If you’re feeling overwhelmed with a situation and feeling isolated. Remember you are human, stumbling and being vulnerable is part of the human condition – talk to a friend, a problem shared really is a problem halved! But this, again, takes discipline, it’s so much easier to dwell in our self pity or not want to both anyone else but you deserve to feel better and you never know, the friend you phone may need you just as much as you need them!

Are you someone who tends to ignore your emotions or do you get carried away with them? Being mindful of emotions as they happen will aid a more balanced approach and will help prevent maladaptive coping mechanisms from kicking in. Emotions do not come with a health warning so being mindful of them, to catch them as your feeling them, to notice them, non-judgementally and allow them to just be, will take discipline and practice!

Self compassion isn’t airy-fairy-self-indulgence. You’re probably someone who finds it easier to feel compassion and care for other people. There are no simple answers but practice makes perfect and as you start to have compassion for yourself, you’ll have even more to give others!