Beyond appearances: understanding autistic behaviours through context, function and lived experience in eating disorder care

Passarini et al. review restricted and repetitive behaviours in autism and eating disorders (EDs), proposing possible roles in the onset and persistence of an eating disorder (ED) and discussing implications for assessment. This commentary examines specific interpretations of their findings. Describing autistic routines as "rigid" without establishing their function may conflate behaviours that sustain restriction with those that make eating possible. Stimming and masking research complicates inferences from changes in visible behaviour. Predominantly cross-sectional findings cannot determine whether such behaviours predispose to EDs or maintain them. The review acknowledges this limitation and calls for longitudinal research. Its recommendation to assess autism after the acute ED phase also risks delaying recognition of support needs and appropriate accommodations. Research on ED care illustrates the potential consequences of unmet needs and how concerns about treatment may be dismissed rather than investigated. I argue for interpretations grounded in behavioural function and context, cautious causal reasoning, attention to treatment-related harm, and meaningful involvement of autistic people and those with lived experience of EDs in developing clinical recommendations.