Autism, ARFID and my relationship with food

TW: Eating disorder 

Intro 

My relationship with food has always been complicated, and my autism is undoubtedly part of why very few, including professionals, struggle to understand why. This post is a topic I’m particularly cautious about writing publicly as I have faced so much stigma, judgement, and ableism regarding my diet. However, it’s an important topic, so let’s start. 

Why I can only eat some food

One of the key things that people noticed and made judgments on is my ‘limited diet’. In my diagnosis, they put it down to my need for repetition. In reality, it’s primarily sensory processing. I am extremely sensitive to taste (apart from when it comes to salt and vodka, where I’m hyposensitive). Most of the food I eat is bland, and I physically cannot tolerate eating anything that has a strong flavour or is too spicy as it triggers my gagging reflex and makes me want to be sick. It is not a choice. It is my body physically responding to tastes it can’t handle. In recent years sensory sensitivity has formally been recognised as part of autism, and for me, simply tasting some food triggers a strong reaction. 

It isn’t only about taste

It isn’t all about the taste, but texture can just be as important. Different foods mixed in together and too much sauce also causes my gagging reflex. Yes, I’ll be that person in the restaurant ordering my burger with no relish, no mayo and asking for a few toppings. I usually only eat lettuce and onions with my burger, and onion is a food I’ve only tolerated eating for a few years now. 

My experience of food concerning taste and texture I feel as well described by an eating disorder that was formally recognised in 2013 called Avoidant Restrictive Food Intake Disorder (ARFID). Below is a description of AFRID from the DSM. 

(American Psychiatric Association, 2013)

As you can see, it describes a lot of my eating habits. Although I’ve never received an ARFID diagnosis, my autism diagnostic report described my eating during childhood as ‘Avoidant Restrictive Food Intake pattern of eating’. I don’t think I’d be diagnosed with ARFID today as I have managed to expand my diet, but I still eat a ‘limited’ number of foods by most people’s standards. 

Interoception, ADHD and recognising my hunger  

Autism also can impact an individual’s Interoception, which is the sense that signals information about the internal condition of our body (Authentically Emily 2021, DuBois et al., 2016). My Interoception impacts my ability to recognise thirst, when my bladder is starting to get full (it only lets me know when I’m bursting) and hunger. For some reason, my body struggles to communicate with my brain when I’ve had enough food and when I need to drink water. It creates challenges for me in managing my food intake and avoiding dehydration. 

Many people also didn’t understand why I was a ‘chubby’ girl but had a limited diet. It made sense to me. Junk food tends to be bland, meaning I could tolerate it, unlike many healthier foods, and I’ve always struggled to recognise when I’m full. Although some autistic people have the opposite problem where they don’t recognise hunger due to Interoception, it can work both ways, and as we all know by now, no two autistic people are the same! Also, my differences with interoception could be influenced by my ADHD (Kutscheidt et al., 2019), increasing the challenges I have with food and drink. 

What’s my relationship with food like now?

So you may be wondering what my relationship with food is like now? Well, it’s better. About  11 years ago, I was able to start expanding my diet. So although my diet is not what many professionals would consider ‘healthy’, it is certainly more balanced; I can eat my five a day and the food I eat covers all the main food groups. 

You may be wondering how this is possible. Well, I’ll show you my thoughts in a few bullet points.

  • I started to like more food when I wasn’t pressured to try new food. Previously I would be expected, bribed, and threatened into eating new food. This developed into a phobia of eating new food (as most of the food people were forcing me to eat made me physically sick). 
  • When I first tried new food and liked it, I was so surprised and didn’t think it was possible. However, I don’t experience that phobia now. The impact from the adults who handled it disastrously at the time is still felt to this day, and I feel incredibly self-conscious about how others will perceive my food and my diet. 
  • I also noticed that the food I chose to try next and felt comfortable doing so also helped expand my diet rather than an adult telling me what food I should try next.
  • Sometimes I can’t stand to be in the same room as food that is too overwhelming. I already feel ill before the food has touched anywhere near my mouth. It will be too distressing for me to try new food if it smells too much. 
  • I also tried food that wasn’t too dissimilar to the food I already enjoyed; this made it easier for me to gradually expand my diet. 

If you enjoyed this post, like to support my writing or would like to say happy birthday, I would be forever grateful if you could buy me a coffee (or tea in my case).

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 

Authentically Emily (2021) ‘Interoceptive Awareness in Autism and ADHD’ Available at: https://www.authenticallyemily.uk/blog/interoceptive-awareness-in-autism-and-adhd Retrieved 28th May 2021. 

DuBois, D., Ameis, S. H., Lai, M., Casanova, M. F., & Desarkar, P. (2016). Interoception in autism spectrum disorder: A review. International Journal of Developmental Neuroscience, 52, 104–111.

Kutscheidt K, Dresler T, Hudak J, Barth B, Blume F, Ethofer T, Fallgatter AJ, Ehlis A. C. (2019). Interoceptive awareness in patients with attention-deficit/hyperactivity disorder (ADHD). Attention Deficit Hyperactivity Disorder.11(4):395-401. doi: 10.1007/s12402-019-00299-3.

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