CEDO Response to AAP Guidelines

As a member of the Collaborative of Eating Disorders Organizations (CEDO), the Multi-Service Eating Disorders Association Inc (MEDA) strongly opposes the new clinical guidelines introduced by the @Ameracadpeds. We do not support intentional weight loss in children via the methods included in the guidelines, especially the recommendation of bariatric surgery and pharmaceutical products for children.

The AAP’s guidelines for childhood “obesity” are harmful, may increase or exacerbate eating disorders or disordered eating, significantly contribute to medical weight stigma and fat phobia, and are not in the best interest of children. We strongly ask the AAP to please reconsider the guidelines, and engage with the eating disorders community to reduce the potential for harm to children.

Check out the full letter PAGE 1 and PAGE 2

Ethics in Eating Disorder Treatment

Ethics in Eating Disorder Treatment

From Our Friends at Veritas

Eating disorder clinicians are guided by ethics to ensure the best for every patient that comes into their care. In general, ethics help clinicians determine appropriate clinical decisions and behavior. They provide a compass for what is “right” and what is “wrong,” although determining that is not usually so simple. Treatment providers will encounter a variety of moral dilemmas in their careers, and ethics can provide a general framework for navigating these situations.

In this blog, we will cover key ethical principles in the treatment of eating disorders, as well as several dilemmas that the field’s clinicians may face.

Ethical Principles in Eating Disorder Treatment

When a person’s work involves caring for the health and wellbeing of others, ethical principles need to be considered regularly. Just like eating disorders themselves, the ethics in the treatment of these illnesses is complex. Eating disorders treatment requires a multidisciplinary team including registered dietitians, therapists, medical providers, and psychiatrists. Depending on a provider’s specific profession and scope of work, ethical principles and standards can vary.

The following are examples of the ethical principles commonly used in the field of eating disorder treatment:

  • Autonomy: giving the patient the freedom to choose, where that is possible
  • Beneficence: taking actions or giving recommendations that are in the best interest of the patient
  • Confidentiality: protecting a patient’s private information and sharing that information responsibly
  • Informed consent: ensuring that a patient has all the information they need in order to give full consent
  • Duty to protect: protecting patients from harming themselves or others
  • Justice: making decisions for the patient that are fair and equitable
  • Paternalism: choosing a course of action without the patient’s consent but in their best interest
  • Integrity: adhering to a moral code that includes honesty and truthfulness

Potential Ethical Dilemmas in Eating Disorder Treatment

Even with the guidance of ethical principles, the treatment of eating disorders is complex. Clinicians will most likely find themselves dealing with conflicting principles, which can make it challenging to decide the best course of action. Learn about several different kinds of ethical dilemmas that arise in eating disorder treatment below:

Resistance to treatment

A patient’s resistance to treatment is often reinforced by the eating disorder itself. Discussing the patient’s reasons for wanting to change and pursue recovery can be helpful in reminding them why they reached out for help in the first place. Resistance to treatment is normal and understandable. Seeking help often comes with concerns about facing social stigma for their illness, fear of letting go of their eating disorder, anxieties about possible weight changes, and more.

The power of the therapeutic relationship

The relationship between a patient and a therapist is essential to aligning eating disorder treatment goals and recommendations. If the patient values their relationship with their therapist, they are more inclined to heed their advice in eating disorder treatment, particularly when pursuing higher levels of care. Therapists must be careful to not abuse the influence they may have over their patients.

Involuntary treatment

Involuntary treatment involves treating someone against their will for the purpose of their safety. For obvious reasons, this concept comes with various ethical dilemmas. Providers must take into account the patient’s illness history, the severity of their eating disorder symptoms, and their general psychiatric state. There are very rare cases when someone may need to be forced into treatment for their own safety.

Treating at a lower level of care than is clinically recommended

There are instances where the patient or the patient’s family does not want to enter the level of care recommended by their treatment team. They could be concerned about other life responsibilities or simply believe that they can take care of the illness on their own. Ethically, providers must respect patient choices while also ensuring that they have all the information they need to make an informed decision.

Provider bias

Everyone, including eating disorder treatment providers, has biases and different subject areas in which we are not experts. Individuals working in healthcare can ensure that they are held accountable for examining these biases by participating in ongoing supervision and consultation, regardless of their years of experience. Getting this support is not shameful; it demonstrates a person’s dedication to their patients and the quality of their work.

Considering personal experience

It is common for eating disorder treatment providers to feel pulled to the profession because they have experienced the illness themselves and want to help others through it. If a provider is in recovery or recovered from an eating disorder themself, they need to be sure to protect their own recovery while they help others. Ongoing supervision, as well as setting and maintaining boundaries, is essential to protecting a provider’s personal health and boundaries.

Considering ethical principles in the treatment of eating disorders is essential to providing quality care that is built on empathy, competence, and integrity.

If you work with patients with eating disorders, please consider attending “Ethical Considerations in the Treatment of Eating Disorders,” a webinar presentation from Krista Crotty, LMFT, PsyD, on Thursday, May 9th.

Autism and Eating Disorders

Autism and Eating Disorders from our friends at The Emily Program

Note: In this blog, we use identity-first language (e.g., “an autistic individual”) to reflect the preferences of self-advocates who embrace autism as an identity category – a diverse way of perceiving and interacting with the world (Taboas et al., 2022Bury et al., 2020). However, we recognize that preferences for this language vary; whenever possible, please ask an individual what they prefer.

Living with and treating an eating disorder may be complicated by the presence of a co-occurring condition, particularly when the condition shares characteristics with an eating disorder. One such condition that shares some psychopathology with a disordered eating mindset—and is frequently seen alongside an eating disorder diagnosis—is autism spectrum disorder.

There are a number of factors that increase the risk of disordered eating or an eating disorder in an autistic individual. By looking at the nature of both eating disorders and autism spectrum disorders, we can better understand their relationship and improve the detection, care, and treatment of both conditions.

What is Autism?

Autism, or autism spectrum disorder, refers to a broad range of neurodevelopmental conditions characterized by challenges in social skills, interpersonal communication, and restricted or repetitive behaviors or interests. It’s important to note that autism doesn’t have “one” look. Autism is considered a spectrum disorder, meaning that there are many types and variances in how it presents from person to person.

An autism diagnosis can generally be made around 18–24 months of age, when characteristics can be distinguished from those typical in early development. That said, signs of autism may not be noticed or identified until an individual is much older.

There are many limitations in pinpointing the global prevalence of autism, such as a lack of public awareness, an evolving clinical definition of autism, shortcomings in public health responses, and underdiagnosed populations such as adults, marginalized groups, and those who identify as girls or women. Experts estimate that for every three cases of autism spectrum disorder, there are two additional undiagnosed cases (Fusar-Poli et al., 2020). Recent studies suggest the median prevalence of autism is one in every 100 individuals worldwide (Zeidan et al., 2022).

There is no medical test used to diagnose autism. Rather, a diagnosis is given after observing symptoms and assessing the severity of behaviors. Some of the more common symptoms of autism include:

  • Difficulty interpreting others’ body language, facial expressions, and social cues
  • Narrow or intense interest in certain topics
  • Difficulty speaking, making eye contact, and/or appropriately managing tone of voice
  • Repetitive or ritualistic behaviors
  • Trouble managing and regulating emotions
  • Feeling overwhelmed in social situations
  • Difficulty maintaining a conversation and understanding conversational give-and-take
  • Need for routines and resistance to change
  • Sensory issues, involving either heightened or under-sensitivity to sounds, smells, light, touch, pain, and other stimuli

The Overlap of Autism and Eating Disorders

The relationship between autism and eating disorders is not well known, but it is surprisingly common. We see higher rates of autism—and autism characteristics—in people who have eating disorders. There is a crossover in the underlying neurological underpinnings of eating disorders and autism spectrum disorders. Like eating disorders, autism spectrum disorders are biological, brain-based conditions. Autistic individuals and people with eating disorders share a number of traits, most notably:

  • Inflexible thinking
  • Sensory processing issues
  • Repetitive behaviors
  • Insistence on routines

While we don’t know the precise scope of the intersection between eating disorders and autism, we do know that autism is more prevalent in eating disorder populations than in the general population. It is estimated that 20–30% of adults and 3–10% of young people with eating disorders also have an autism diagnosis (Solmi et al., 2020).

Traits That Could Present a Risk Factor

Despite the high rates of autism in eating disorder populations, autism does not definitively predate someone to an eating disorder. That said, there are certain characteristics that may precipitate disordered eating habits or the development of an eating disorder in those already susceptible.

Sensory processing challenges

One eating-related issue common in autism are sensory processing challenges. This is a characteristic that is often present but not required for an autism diagnosis. Sensory processing challenges include both over-reactivity (a heightened sensitivity to sensory inputs from the environment, such as sounds feeling extremely loud or lights seeming too bright), or under-reactivity (an inadequate reaction to sensory input, such as not noticing that a fire alarm has gone off).

For individuals on the spectrum who have this heightened sensitivity, the texture of foods can be especially significant. A person with heightened sensitivity to the texture of foods might complain that the food they’re consuming is too mushy or too wet, too crunchy or too dry. This sensitivity can have a profound impact on an individual’s food choices, leading them to be very selective about what they will consume on a regular basis. They might be highly attuned to differences among brands of the same food or the cooking style and day-to-day preparation of the food.

This sensitivity to food can lead to a very narrow nutrition profile—one limited to “safe” foods with repetitive flavors and textures. In reducing the range of what is okay to eat, an individual with heightened sensitivity may become undernourished, making it harder for the brain to work effectively and clearly. People who struggle to meet their nutritional needs from food as a result of sensory qualities typically meet the criteria for Avoidant/Restrictive Food Intake Disorder (ARFID).

On the flip side, other autistic individuals may struggle with eating because they don’t have a good sense of when they’re hungry or full; they lack interoception, or awareness of what’s happening in their body. People who struggle to be aware of what their body needs may go through spurts of overeating, undereating, or a mixture of both.

Intense interest

Another characteristic common in many autistic individuals is the tendency to dive intensely into an interest. Rather than being interested in a wide variety of things on a surface level, many individuals tend to have one or two areas of all-consuming interest. Autistic individuals who exhibit this pattern may find themselves narrowing in on an obsessive interest in food or weight. Some will be intensely interested in nutrition or physical activity.

Sometimes this focus will turn inwards to a fixation on a particular body type. In pursuit of this interest, an individual may begin tracking their measurements or calorie counting, which are warning signs of anorexia nervosa. It is very likely that an individual with this intense interest and approach may have a limited range of nutrition or very strict, inflexible rules around eating. This puts them at a heightened risk of developing a full-blown eating disorder.

When this narrowed interest in nutrition and the body intersects with a strong desire for things to stay the same (another hallmark trait present in autism spectrum disorders), an individual may struggle deeply with natural fluctuations in weight or shape, particularly during puberty or pregnancy. This may contribute to an all-consuming focus on nutrition intake and body size or shape to ensure their weight is consistent. This inflexible thinking puts an individual at risk of disordered eating or exercise behaviors that do not support their wellbeing.

Ritualism and avoidance to change

It is common for autistic people to have a ritualistic approach to eating. The term “food jag” is frequently used in the autism community, and refers to a tendency to eat the same foods, prepared the same way, every day, and sometimes every meal. These restrictive eating patterns are often displayed in children and may continue into adulthood.

Autistic people may struggle with cognitive flexibility, which can lead to dichotomous thinking about food. Autistic individuals might display a rigid desire for control that manifests in the form of a very limited nutritional palette composed entirely of “safe” foods. This predetermined inflexible eating path could trigger or intensify an eating disorder.

Treating Eating Disorders in Autistic People

The presence of autism spectrum disorder has the potential to complicate a client’s illness, as well as their eating disorder recovery. Research shows that autistic adults tend to experience longer-lasting and more severe eating disorders (Tchanturia et al., 2019). The good news is that autism does not make eating disorder recovery impossible—or even less likely (Nielsen et al., 2015).

The key to achieving full recovery—which is, and has been proven to be, completely possible for autistic people—is comprehensive, individualized treatment that prioritizes the needs of the autistic individual with an eating disorder. Providers must keep the potential presence of sensory issues, intense interests, cognitive inflexibility, and interoception at the forefront of assessment, diagnosis, and treatment. It is essential that eating disorder treatment for an autistic individual is inclusive, enabling, and affirming. Because autism is a spectrum disorder, a treatment plan should ultimately honor and reflect the unique needs of the client.

The Emily Program takes a personalized approach to eating disorder treatment and recovery. Please give us a call at 888-364-5977 or click here to learn more about the individualized care we offer.