Undiagnosed Autism Spectrum Disorder in Women: Clinical Overlap With Anorexia Nervosa

Women with anorexia nervosa (AN) frequently exhibit autistic traits, and a sizeable subgroup meets diagnostic thresholds for autism spectrum disorder (ASD). Large-scale population and registry studies indicate shared liability, and clinical cohorts report ASD prevalence rates of 20% to 30% in AN. Recognition is complicated by the female autism phenotype, characterized by camouflaging, internally directed interests, sensory sensitivities, and preserved social motivation despite high social-cognitive load. These features contribute to underdiagnosis and diagnostic overshadowing in eating disorder (ED) services. Neurocognitive research highlights overlapping set-shifting difficulties, theory of mind (ToM) challenges, and altered social attention, while neurobiological evidence suggests distinct but partially convergent pathways. Autistic features predict longer illness duration and poorer psychosocial outcomes even when weight restoration is achieved. Female-sensitive screening, autism-informed adaptations such as structured routines and sensory accommodations, and service-level models like the PEACE pathway and Delphi consensus recommendations improve engagement and treatment fit.