Bridging autism and eating disorders: a scoping review on repetitive and restrictive behavioral patterns

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties in social communication and restricted and repetitive behaviors (RBs). Autistic individuals frequently exhibit co-occurring physical and mental health conditions, worsening long-term outcomes. Among these, feeding and eating disorders (FEDs) are particularly prevalent. Autistic traits may increase vulnerability to FEDs, and people with FEDs often display elevated autistic features. In particular, cognitive rigidity in FEDs seems to reflect RBs patterns typical of ASD. The current scoping review aimed to examine the relationship between autistic features and FEDs with specific reference to RBs, and to assess whether this association differs between pediatric and adult populations.

The review was conducted in accordance with PRISMA guidelines for scoping reviews. A systematic search of PubMed, PsycINFO, and PsycArticles, with no time restrictions, yielded 204 records. Only peer-reviewed articles written in English were considered eligible. Consistent with our hypotheses, the review included research on autistic individuals as well as on individuals with FEDs or meeting established cut-off scores for FEDs. After removing duplicates and screening titles, abstracts, and full texts, 10 studies met the inclusion criteria.

The reviewed studies consistently reported an association between ASD and FEDs with respect to RBs across the lifespan. Of them, four focused on pediatric populations while six on adults. While specific types of RBs associated with FED symptoms, such as repetitive or unusually intense interests, are present in both pediatric and adult age, others seem to manifest differently according to the individual's age. Further, our findings suggest that RBs may play a role in predisposing autistic individuals in developing FED symptoms.

The current scoping review shows that RBs may play a role in predisposing autistic individuals to FEDs but also it could potentially act as a feature of ASD in FED populations. Overall, our results highlight the need for tailored assessment, evaluation, and treatment approaches that can capture the unique presentation of eating disorder symptoms and autistic features.