Autistic behaviours in eating disorder care need interpretation by function, commentary argues

A commentary published in the Journal of Eating Disorders argues that autistic behaviours seen in eating disorder care should be interpreted through their context and function rather than their outward appearance. The piece, authored by Laurence Cobbaert and published on 28 October 2026 as a Matters Arising contribution, responds to a review by Passarini and colleagues on restricted and repetitive behaviours in autism and eating disorders, which proposed possible roles for such behaviours in the onset and persistence of an eating disorder.

The commentary raises several concerns about how the reviewed findings are interpreted. It argues that describing autistic routines as “rigid” without establishing their function may conflate behaviours that sustain dietary restriction with those that actually make eating possible. According to the author, this distinction matters clinically, because the same visible behaviour could support very different assessments depending on what it does for the individual person.

The commentary also points to research on stimming and masking, which it says complicates inferences drawn from changes in visible behaviour. If outward presentation can be masked or modified, observers may misread what is happening internally, and apparent changes in behaviour may not straightforwardly reflect changes in underlying states or symptoms.

A further point concerns causal reasoning. The commentary notes that predominantly cross-sectional findings cannot determine whether such behaviours predispose people to eating disorders or maintain them once established. It acknowledges that the original review recognises this limitation and calls for longitudinal research to address the question.

On clinical practice, the commentary questions the review’s recommendation to assess autism only after the acute eating disorder phase, arguing that this risks delaying recognition of support needs and appropriate accommodations. The author draws on research in eating disorder care illustrating the potential consequences of unmet needs, including situations where concerns about treatment may be dismissed rather than investigated.

Overall, the commentary argues for interpretations grounded in behavioural function and context, cautious causal reasoning, attention to treatment-related harm, and meaningful involvement of autistic people and people with lived experience of eating disorders in developing clinical recommendations. As a Matters Arising commentary, the piece presents the author’s argument about the interpretation of the reviewed evidence rather than new empirical data, and its conclusions rest on the existing literature it discusses.

Subject of Research: A commentary on interpreting autistic behaviours in eating disorder care through context, function and lived experience

Article Title: Beyond appearances: understanding autistic behaviours through context, function and lived experience in eating disorder care

Article References: Cobbaert, L. (2026). Beyond appearances: understanding autistic behaviours through context, function and lived experience in eating disorder care. Journal of Eating Disorders, 14(1), Article 253. https://doi.org/10.1186/s40337-026-01810-8

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01810-8

Keywords: autism, eating disorders, restricted and repetitive behaviours, stimming, masking, cross-sectional studies, longitudinal research, clinical assessment, accommodations, lived experience, Matters Arising, Journal of Eating Disorders