Understanding the associations between social and emotional expression, communication, and relationships in individuals with eating pathology

Research suggests that a disproportionate number of female individuals being treated for an eating disorder (ED) also have autism spectrum disorder (ASD). Alexithymia, or difficulty identifying and describing emotions, may mediate the relationship between ED and ASD. In this study, we explored the association of autistic traits with symptoms of alexithymia and eating pathology, as well as the potential mediating role of alexithymia. Two hundred and twenty-eight female participants aged 18 and older were recruited from online ED support platforms to complete an anonymous online survey via Qualtrics. The survey included three questionnaires: the Toronto Alexithymia Scale-20, the Autism-Spectrum Quotient (AQ), and the 13-item Eating Disorder Examination Questionnaire. More than half (54.8%) of participants met the clinical threshold on the AQ. Participants with a positive screen on the AQ scale also reported more symptoms of alexithymia (92.6% of individuals with a positive AQ vs. 79.8% of those without), B = 9.02, p < 0.001. A positive AQ screen was also associated with significantly greater disordered eating symptoms, B = 4.26, p = 0.031. Alexithymia mediated this association, a × b = 1.98, p < 0.05. The results establish a strong positive relationship between autistic traits and alexithymia, supporting previous data and suggesting that autistic female individuals struggle to identify emotions. Additionally, alexithymia served as a mediator between autistic traits and disordered eating. Understanding this relationship may help inform the treatment of autistic female individuals who are also struggling with ED.