Eating Disorders and Autistic Traits Camouflaging: Insights from the EAT Study

Abstract

Background: Feeding and eating disorders (FEDs) often present in comorbidity with other psychiatric conditions, with a growing body of evidence underscoring their association with autism spectrum disorder (ASD). Individuals with ASD or significant autistic traits (ATs), especially females, often engage in camouflaging strategies to mask their symptoms. However, empirical research on the role of camouflaging within this association is still emerging. This study aimed to assess the prevalence of ATs in individuals with FEDs and to examine their connection with psychological well-being, along with the role of camouflaging as a potential mediator in this association. Methods: A total of 131 individuals with FEDs were assessed through a medical record review, a socio-demographic form, and self-administered questionnaires evaluating FEDs symptoms (EDI-3) and ASD-related features (RAADS-R, AQ, EQ, CAT-Q). Results: In total, 16% of patients scored above the possible high ATs in clinical settings (whereas 53% exceeded the original cut-off) and 25% showed significant camouflaging, without differences between FED diagnoses. ATs were associated with both FED symptom severity and general maladjustment. Importantly, the latter was not directly explained by ATs themselves, but was mediated separately by camouflaging and FED symptomatology. After statistical adjustments, the parallel mediating pathways contributed similarly (48% and 52%). Conclusions: A considerable subset of individuals with FEDs presents significant ATs, with camouflaging arguably linked to psychological distress through a pathway parallel to that of FED symptomatology. This overlap between FEDs and ASD may be clinically meaningful, highlighting the potential importance of assessing ATs and camouflaging to support personalized diagnostic and therapeutic interventions.