- Interpret autistic behaviours by context and function rather than labelling them as rigid, to distinguish behaviours that sustain restriction from those enabling eating.
- Cross sectional evidence cannot establish causality; longitudinal research needed, and stimming and masking complicate inferences from observable behaviour changes.
- Avoid delaying autism assessment after acute ED phase; attend to treatment related harm, unmet needs, and involve autistic people and lived experience in guidance.
J Eat Disord. 2026 Oct 28;14(1):253. doi: 10.1186/s40337-026-01810-8.
ABSTRACT
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.
PMID:42958456 | DOI:10.1186/s40337-026-01810-8
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