Escalating Distress and Sensory Seeking: Autism in Binge-Type Eating Disorders From a Clinical Perspective

Autism is over-represented in eating disorder (ED) populations, including binge-type presentations. However, research has focused predominantly on Autism in restrictive EDs, particularly anorexia nervosa. Furthermore, studies examining Autism in binge-type presentations have largely centred on patient perspectives, while clinician accounts remain underexplored. Clinician perspectives shape recognition, formulation and treatment adaptation in routine care. This study therefore explored clinicians’ perspectives on working with Autistic patients with binge-type EDs. Individual semi-structured interviews were conducted with 16 multidisciplinary ED clinicians and analysed using reflexive thematic analysis through a neuro-affirming lens. Five themes were developed: (a) Recognition shaped by expectation ; (b) Entrenchment to engagement ; (c) Escalating, unseen distress ; (d) Sensory needs without support ; and (e) Precarious adaptation . Autism appeared under-recognised in binge-type EDs and frequently co-occurred with Attention-Deficit/Hyperactivity Disorder (ADHD), complicating identification and formulation. Emotional overwhelm and sensory seeking may represent particularly salient maintaining mechanisms in this group. Findings highlight the need for improved clinician training, integrated Autism-ADHD assessment, and Autism-informed adaptations to ED treatment models. Lay Abstract Autism is more common in people with eating disorders than in the general population, yet most research has focused on anorexia nervosa. Less is known about autism in binge-type eating disorders, like bulimia nervosa or binge eating disorder, and existing studies have mainly explored patient perspectives. This study explored clinicians’ experiences of working with Autistic patients with binge-type eating disorders. Sixteen clinicians were interviewed. Data were analysed using reflexive thematic analysis to identify common patterns and themes. Clinicians described that Autism is often unrecognised in binge-type disorders, partly because services have traditionally focused on restrictive presentations. Autism also frequently co-occurred with ADHD, complicating identification. Clinicians reported high emotional distress, which could be difficult to interpret, and highlighted sensory needs, such as sensory seeking, as influencing eating behaviours. Finally, clinicians described challenges in adapting standard treatments to better support Autistic patients. These findings suggest that Autism may be under-recognised in binge-type eating disorders, with emotional and sensory factors playing important maintaining roles. Improved clinician training, routine screening for Autism and ADHD, and clearer guidance on treatment adaptation could help enhance care for Autistic individuals with eating disorders.