According to a leading expert, severe cases of anorexia may be the result of undetected autism in women.
Professor Christopher Gillberg, of the University of Strathclyde, says that autism, characterised by defects in communication and social interaction, also makes many anorexic patients unresponsive to traditional treatments and may be responsible for anorexia's low recovery rates.
Professor Gillberg believes that although autism is thought to be predominately a male problem, affecting up to four times more boys than girls, the disorder has been overlooked in women because their autistic traits present themselves differently.
For example an obsession with counting calories may be an outward sign of autism.
He says their research has shown that a small but important minority of all teenage girls, with anorexia nervosa in the general population, meet the diagnostic criteria for autistic disorder, Asperger syndrome or atypical autism.
He has apparently seen quite a number of cases where the anorexia has become completely entrenched because people have not understood that underlying the eating disorder is autism.
Professor Gillberg says anorexic patients with autism tend to be severe cases because traditional treatment for eating disorders proved ineffective.
A good example is family therapy, a popular psychotherapy in which family members discuss eating with the sufferer which is all but useless for autistic patients.
People with an autism spectrum disorder have great difficulty even understanding basic concepts about other people's thoughts and feelings, which means that anything said in a family-therapy session is likely to be misconstrued by the affected individual who will not grasp what is going on in that particular context.
They need far more concrete, one-to-one interventions.