Compensatory Strategies in Adolescent Females with a Restrictive Eating Disorder and Later Diagnosed Autism: A Qualitative Study of Patient Records

Purpose: This qualitative study explored descriptions of social development and compensatory strategies concerning young females (YPs) diagnosed with autism during treatment for a restrictive eating disorder (R-ED), as they may represent a subgroup whose difficulties have gone unnoticed earlier in life, potentially contributing to the development of R-ED. Methods: Thematic analysis was conducted on excerpts from patient records of 41 YPs with R-ED and later diagnosed autism. Results: Four main themes emerged: (1) YPs attempted to adapt to social interactions by mimicking behaviours and relying on friends, and they strove to adhere to social norms despite the costs; (2) Parents helped YPs navigate social relations and adapted family life to meet the YPs’ needs for structure, routine, and sensory issues; (3) Throughout YPs’ childhood, parents interpreted YPs challenges as character traits or mental health issues such as anxiety; (4) There were no early childhood concerns. Conclusion: The compensatory strategies such as mimicking peers, adhering to societal expectations despite costs, and parents meeting YPs’ atypical needs may contribute to a late autism diagnosis. Assessing autism characteristics and compensatory strategies in YPs with R-ED may guide interventions and improve treatment effectiveness for this subgroup.