 five things that I think you need to know about the interplay between autism and anorexia. Now disclosure this is from my personal point of view really rather than professional point of view, personal point of view as someone who has a diagnosis of autism and somebody with a history of anorexia and whose anorexia only became significantly more manageable following the diagnosis of autism and the five ideas that I'm going to share with you today are based on a talk that I gave at the peace pathway conference yesterday which was an international conference based on the work of the peace project at the Maudsley which is a new care pathway for people with comorbid anorexia and autism and I sit on the expert reference group there. Point number one anorexia is a bully to be beaten autism is a friend to be made so when we've got these two diagnoses anorexia and autism then we need to work together to beat the anorexia so we often use the analogy of anorexia being like a bully on the shoulder and we're thinking together about how can we beat the anorexia we want it to go away we want to beat it to overcome it it is not a positive thing autism on the other hand is a diagnosis a label that we will live with forever and we need to recognize the positives there and to run towards this and to work together to make friends with this diagnosis and learn how we can have it as part of our lives and live successfully and manage with it so anorexia we look together to beat autism we look to be a friend. Point number two is that language matters think about identity first versus person first language so particularly when it comes to anorexia and autism I feel personally that we should address these two issues completely differently so I am autistic but I have or I had anorexia so I identify as an autistic person I find that really important I talk about autism a lot I am autistic I feel proud of it some people might choose to be referred to as a person with autism so it removes the label from them a little bit but for me I am autistic I'm proud and loud and whatever about that and that matters however I don't think it's positive to say I am or I was anorexic but rather I suffered with or I have or I had anorexia to remove me a little bit from that label and the reason why that's important to me is because anorexia can become very all-consuming and when we I over identify with that label that can drive some of our decisions behaviors actions and at its worst anorexia really has you in its grips this bully that really takes over your thinking and your behavior and your actions and if you identify with it really closely if you're using language like I am anorexic then it makes you identify with that first and foremost above anything else and remembering this is a bully we want to beat so I am autistic but I had anorexia for me that difference in language might not sound like a big thing but it really really matters and again for me exploring that and picking it apart and thinking about which of these labels I wanted to own and which one I wanted to destroy really mattered as part of my kind of therapeutic and recovery process point number three is that the interplay between anorexia and autism is really complex and we should always be asking ourselves the question am I seeing autism or am I seeing anorexia and the reason why this really matters is because sometimes we need to make exceptions or allowances or bend ourselves a little bit to accommodate autistic traits behaviors challenges however anorexia is really clever and we'll jump on that and use autism as an excuse and I certainly found that when I was ill and I had a diagnosis of autism anorexia would be there going you could tell them that you can't eat that because of the sensory issues or mm-hmm you could tell them that you can't engage with that therapy because you find it too distressing and it would try to manipulate my thoughts my behavior my action just the same way that anorexia tries to manipulate what you do all the time always the thing here is about building really good honest trusting relationships so that we can calmly explore what is autism what is anorexia what are appropriate and reasonable adjustments to be made for autism and at what point actually are we bending to the anorexia this is really really hard and we need to remember as well that a starved brain is one where autistic traits will kind of be exempt sort of exaggerated so we might see the autism kind of coming out more so it's hard and I don't know that there's like a really obvious answer here but I think building a really good trusting relationship so that at times of calm in those times when a person is holding on to the idea of recovery rather than illness we can explore openly and honestly what are the appropriate accommodations for the autism and perhaps which of the bits where anorexia is trying to game it and being really really clear and consistent in our expectations and the boundaries number four is to use the autistic traits that a person has to help them move towards wellness so some of our autistic traits will drive the illness our rules our rigidity sometimes the obsessive nature that we might have may drive the illness and might mean that we become more ill more quickly than neurotypicals however if we take those traits those behaviors the way in which we see the world and we flip it and we use it to our advantage to try and drive wellness instead then it might mean that we are more able more determined to adhere to a really rigid meal plan for example or an appropriate amount of exercise or engaging with therapeutic pathway than our neurotypical peers might be so taking those traits really understanding what autism looks like for this individual and taking those traits that we're driving illness and flipping them and using them to help to drive wellness and recovery instead and point number five autism is for life so when you are supporting someone who is both autistic and anorexic we're hoping that they will move to a point of recovery with the anorexia and that's a whole other question i always consider myself to be in recovery so this is something that could go wrong at any time and i have to really keep on it and i've been caught short on that in the past however i can be in recovery from that autism not going anywhere so at times it is exacerbated by starvation or other triggers and issues and other times it's more easy to manage however autism is a diagnosis i live with every single day and i have to work really carefully to manage it i also had to reevaluate some of my aims and aspirations for myself based on the fact that i'm autistic and that isn't going away so when i was very ill and i would imagine this future when i could eat again and i could throw parties and i'd have dinner parties with my friends then i realized yep might get a better from anorexia might manage to control some of my anxiety autism not going away so i had to reevaluate what my aims and my goals were and what was realistic for me and to forgive myself for the fact that i might never become the person that i thought or hoped i might and instead to readjust what my hopes and aspirations for myself were and to become okay with that when you're supporting someone who is autistic then we think very carefully in eating disorder recovery about how we'll transition back to life and work and managing in terms of food and diet and exercise but with autism we've got to think about the bigger picture as well what does self-care look like what does day to day managing look like how will we manage the anxiety that is such a key part of autism for many people what does that all look like how can we enable ourselves to better manage and remembering that managing our autism and living well with it will mean that the relapse of an eating disorder is far less likely in my opinion so learning to live well with autism for me has been a really key part in getting and staying relatively well so there you go autism is a friend to be made whilst anorexia is a bully to be beaten two language matters i am autistic i had anorexia three the interplay between autism and anorexia is really complicated always ask ourselves is this a reasonable adjustment am i seeing autism or am i seeing anorexia four we can flip autistic traits and behaviors to drive wellness when previously they had driven illness five autism is for life we need the skills the confidence and the understanding to live well with autism if we are to prevent eating disorder relapse