The Association Between Cognitive Flexibility and Eating Behaviors in Autistic Women With Eating Disorders

Reduced cognitive flexibility is a trait associated with autism and has also been implicated in eating disorders (EDs). However, most studies have not distinguished between autistic and non-autistic individuals in ED samples, potentially obscuring group-specific patterns. This study investigated self-reported cognitive flexibility and its association with eating behaviors (traditional ED pathology and ARFID symptomatology) across four groups: autistic women with EDs (ASD + ED), non-autistic women with EDs (ED), autistic women without EDs (ASD), and non-autistic controls.

Participants included 30 ASD + ED, 30 ED, 29 ASD, and 60 control women (N = 149). All completed the Detail and Flexibility Questionnaire (DFlex), the Eating Disorder Examination Questionnaire (EDE-Q), and the Nine Item ARFID Screen (NIAS). Group comparisons were conducted on self-reported cognitive flexibility (cognitive rigidity, attention to detail), ED pathology, and ARFID symptoms. Associations between cognitive flexibility and eating behaviors were examined across and within groups.

ASD + ED and ASD groups showed significantly greater difficulties in self-reported cognitive flexibility than ED and control groups, which did not differ from each other. Associations between self-reported cognitive flexibility and eating behaviors varied across groups, with attention to detail showing the clearest pattern. Attention to detail was associated with ED pathology in the ASD + ED group and with ARFID symptomatology in the ASD + ED, ASD, and control groups, but not in the ED group.

These exploratory findings suggest that self-reported cognitive inflexibility may be more strongly associated with autism than with EDs alone and highlight the importance of considering co-occurring autism when examining cognitive characteristics in ED populations.

This study explored how cognitive traits - like attention to detail - relate to eating behaviors in autistic and non-autistic women with and without eating disorders. Findings suggest that certain thinking patterns may be more closely linked to autism than to eating disorders alone, underscoring the need for greater clinical awareness of autism-specific features when assessing and supporting individuals with disordered eating.