Clinician perspectives on barriers and enablers to autism‐affirming eating disorder care

Nimbley, Emy, Austin, Amelia, Tchanturia, Kate, Thomas, Kai ORCID: https://orcid.org/0000-0002-7584-2881, Jones, Catherine R. G. ORCID: https://orcid.org/0000-0003-0541-0431, Gillespie‐Smith, Karri and Duffy, Fiona 2026. Clinician perspectives on barriers and enablers to autism‐affirming eating disorder care. European Eating Disorders Review 10.1002/erv.70157

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Abstract

Objective Autistic people with an eating disorder (ED) report more negative experiences of ED treatment and are at greater risk of requiring higher intensity services. Current ED treatment options do not fully meet underpinning drivers of autistic people's experiences of EDs. There remains little guidance or understanding on how autism-informed adaptations are implemented. This paper aims to explore clinician-perceived barriers and enablers to implementing autism-affirming adaptations in UK ED services. Method Semi-structured interviews were conducted with 12 clinicians in multidisciplinary roles across UK ED services who were beginning to implement autism-affirming care. Data were analysed using critical realist thematic analysis. Results Clinicians described many barriers associated with implementing autism-affirming care underpinned by longstanding beliefs about the risks of accommodating ED behaviours. This contributed to anxiety about making adaptations to care and the potential to over- or under-accommodate autistic needs. An underlying assumption that evidence-based practice solely equates to manualised treatment for EDs constrained adaptation. A commitment to individualised formulation and care, regardless of diagnosis, and valuing a diverse multidisciplinary team were key enablers. System-level barriers included siloed autism and ED resources and training. Conclusions Autism-affirming adaptations challenge some core underpinning messages historically embedded in siloed ED services.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Psychology
Publisher:	Wiley
ISSN:	1072-4133
Date of First Compliant Deposit:	27 July 2026
Date of Acceptance:	16 July 2026
Last Modified:	27 Jul 2026 09:00
URI:	https://orca.cardiff.ac.uk/id/eprint/188457

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