A systematic review of qualitative research of eating disorders in autistic adults: convergent and divergent experiences

Introduction: Autism and eating disorders frequently co-occur, yet relatively little is known about how autistic adults experience eating disorders.

Methods: This systematic review synthesised qualitative evidence to explore the lived experiences of autistic adults with an eating disorder and inform autism-informed clinical practice. A systematic search identified 13 eligible studies, which were appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist and synthesised using thematic synthesis.

Results: Findings were organised into three themes: eating disorder experiences cannot be understood independently of autistic ways of processing the world; recovery is enabled through developing self-understanding and integrating autism into personal identity; and recovery is facilitated when support aligns with autistic needs rather than neurotypical assumptions. Autistic characteristics, particularly sensory sensitivities, interoceptive differences, and a preference for predictability, fundamentally shaped the development, maintenance, and recovery of eating disorders. Sensory-driven food restriction was frequently experienced independently of body image concerns, highlighting potential conceptual overlap with Avoidant/Restrictive Food Intake Disorder (ARFID).

Discussion: Autistic adults described eating disorders as inseparable from their autistic experience, indicating the need for a paradigm shift from conceptualising autism and eating disorders as co-occurring conditions towards a model rooted in lived phenomenological experience. Clinical assessment, formulation, and intervention should adopt autism-informed, individualised approaches that recognise sensory processing and interoceptive differences, while future research should examine these mechanisms across a broader range of eating disorder diagnoses.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261375735.