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Wednesday, 20 October 2010

Anorexia, Orthorexia And Autism

I was marking an essay today with a man who feels very proud of himself because he tries to stick to a very rigid diet with very little wheat and no fat and a whole range of forbidden foods. He periodically binges when his willpower fails and feels it is a sign of what a weak person he must be.  He isnt underweight and now realises that he has a serious problem in his relationship with food.

That got me thinking about orthorexia and anorexia its cousin. The latest thinking is that anorexia is a form of autistic spectrum disorder. That kind of figures to me, since everyone I see with the illness is driven, perfectionist, pays intense attention to detail and likes things to be predictable and ordered. We don't tolerate mess and uncertainty very well and go round with a high baseline level of anxiety.

Like people with autism, the anorexic can be easily disgusted by the idea of certain things like food contaminated with fat or by certain textures and smells.

Orthorexia is thought to be a  variant or escape from anorexia. The choice of a limited range of foods appears to be motivated by concepts such as "love of animals" or the desire to eat a healthy natural diet. All of these are understandable motives, but personality studies consistently show common features between the anorexic personality and the person who feels compelled to eat a very healthy diet and who feels bad if they cannot follow their strict food rules.

The other clue about this kind of eating is that it is often a proxy for weight loss.

So does a focus on food really handle these problems properly? Experts now think that the core problem is some kind of executive failure in the brain which causes a failure to handle all the information flows correctly. In other words there is some kind of disconnect between the information coming in and the ability to manage and respond to it flexibly.

So what we see in the room with anorexics and orthorexics is poor thinking flexilbility, poor problem solving skills, too much attention to detail, high anxiety, a compulsion to get it right which is paralysing (because you can never get it right) and great rigidity. If it ain't working, just do it more but never change.

 "Cognitive Remediation" is supposed to help with this and one good benefit is that it doesn't focus on eating habits- which in any case are heavily defended in anorexics and orthorexics alike.

This kind of treatment involves exercises like finger tapping and rhythmically clenching and unclenching hands. The client may think you are silly but at least he or she will not make you their enemy.

CR is supposed to be helpful, but we do not have any up to date research about it. The autism connection is interesting however and I think we may need to go further with it. Perhaps more of us are "autistic" than we think.....or perhaps we need to give "autism" a different name.

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