This is in-depth content. To fully follow the arch of thought here (and how it relates to creative businesses), check out Part 1 and Part 2. However, you can still garner a lot from this specific information if needed.
Sadly, as gifted girls grow up, it is common to see their self-confidence progressively decline as their perfectionist habits increase. By the time they reach their teenage years, girls caught in this trap are vulnerable to mental health issues. An under the radar twice-exceptionality (such as autism) only compounds their struggles.
Giftedness and Autism (The Odd Couple)
The researcher Christopher Gillberg first suggested a relationship between autism, giftedness, and anorexia more than 30 years ago. Research on the subject has only recently taken off.
Multiple studies constructing the cognitive profiles of both anorexics and autistics suggest they share common struggles.
Trouble Set-Shifting: A Friend or Foe?
Set shifting is a domain of executive functioning skills allowing people to adapt to situations. Some people believe issues with set-shifting aren't always negative because the context of the hyper-focusing matters.
For example, switching attention from one task to another matters in a school environment where people are shuffled around. It matters in a world where most people value changing activities frequently.
However, someone who has issues with set-shifting, when left to their own devices to focus on a task they enjoy, may have the stamina to stick with the task for hours longer than the average person.
Is this executive functioning issue a strength or a weakness?
Are we negatively labeling what doesn’t fit smoothly into our schools or into society?
Theory of Mind: You Think I Think We Think
Impaired theory of mind is part of the core diagnostic criteria for autism spectrum disorders. Theory of mind involves being able to see the desires, intentions, beliefs, and perspectives of others and experience them as separate. It involves empathy, which may compete with systemizing, as discussed earlier.
Is This Research Implying I’m Not Empathetic? I Feel Everything!
To answer this question, we need to consider how the anorexic profile exhibits superior verbal fluency and memory. For example, studies show these individuals recall specific word choice and specific events at a rate far above the normal population. Higher verbal memory helps them navigate social spheres and pick up on the rules of a game they didn’t initially understand (or were overwhelmed by as they studied the details and not the larger picture).
Many of these people actually become masters of cultural social rules because their memory compensates for their social weaknesses. They become class presidents, many become sweet and likable, they excel at writing papers, and many even study psychology thrilled to learn more about the "mysterious" rules of human behavior.
In treatment, many of these anorexic girls have superimposed rote-memorized social skills, but this doesn’t mean they don’t feel strongly or deeply (that’s a separate conversation involving hyper-sensitivity inherent in giftedness). In short, they systemize their empathy and have the ability to think their way to their feelings. Also, they may have extremely debilitating empathy for broader issues in the world but struggle with the norms of everyday interaction.
To explain, let's turn to Tony Attwood, an expert on Asperger's and comorbid anorexia. He says the higher their intelligence, the higher their verbal memory, and the more they are able to study others and hide their autistic traits. They are therefore eternally able to evade an autism spectrum diagnosis. Their difficulties may not manifest in a severe enough fashion to warrant an exploration of a diagnosis, but they are still vulnerable and left to navigate on their own as social chameleons.
Loneliness and the Delima of Attention
Another study on the special social struggles of those who are gifted reveals more. Although above average in many domains, including behavioral self-concept and academic self-concept, gifted students are found to have lower self-disclosure scores. Being lower in self-disclosure is a hypothesized reason for these students’ loneliness because self-disclosure is imperative in order for close relationships to develop.
If a gifted anorexic patient finds self-disclosure to be a moral dilemma - because they think being a listener is the wise thing to do, seeing another person’s point of view is the wise thing to do, or being emotionally controlled (thus pretending nothing is wrong) is the wise thing to do - they have essentially created an interpretation of spirituality that is so morally strict it actually messes them up. They then develop the habit of communicating their strong reactions and strong opinions through their disorder.
All Behavior is Communication
If a person has a strict moral code, struggles communicating issues of conflict, and doesn’t believe in drawing unnecessary attention to themselves, anorexia becomes a good middle man for communicating to the outside world.
Here are some possible things anorexia might be saying:
"I refuse to conform. My individuality and my beliefs are more important to me than pleasing others.”
"Something really terrible happened. I’m disgusted by attention-seeking verbal behavior, and I want to show you my pain on my body.”
"My natural energy and intensity probably annoys people. I’ve found a way to deaden it.”
"I am not a threat.”
"I want to leave or change this relationship, family, or work environment.”
"I am bored. I want to talk with you about interesting things like philosophy, the meaning of life, and psychology. The drama I am creating through my disorder brings that into our lives.”
"I didn’t succeed at something important to me. I will enter a challenge I can control and go into competition with myself.”
"I don’t understand society’s expectations. The adult world looks fake. I quit.”
Of course, these are only some possibilities. Many anorexics have existential angst towards society because society subtly dismisses those who are introverted, feel deeply, analyze, or are gifted. Family, friends, and treatment teams are at the mercy of an anorexic patient’s ineffective attempt to speak in code about their existential angst.
If we imagine the anorexic as a brutally honest individual trying to hide their brutal honesty, they are caught in the middle in a way that suddenly makes more sense.
Attention to Language = Different Outcomes
As a whole, individuals with anorexia and those recovered from the disease display impaired social functioning and are often (but not always) gifted individuals who for a time slipped into the twice-exceptional category due to starvation (or are permanently in the twice-exceptional category with autism).
In a study that included 43 young females with anorexia, 28 individuals recovered from it, and 41 control individuals, those higher in verbal memory exhibited lower social impairment in the long run. What is significant here, is those who had anorexia but had high verbal memory were able to recover, presumably because they had less long-term struggles with social functioning.
On the opposite end of that positive news is a study confirming the long-term negative outcomes for those diagnosed with both autism and anorexia. All of the participants in this study suffered from anorexia in their teens and were tracked down 18 years later. At the mean age of 32, one in four patients had no paid employment due to a psychiatric disability. The outcome for life expectancy and quality of life regarding adjustment to adult living was considerably worse if autism was present.
Helpful Resources to Consider
You don't have to have had chronic anorexia to see yourself in some of the above information. As an educator, I have used this interesting resource while trying to understand my students better and when assessing their giftedness and/or AS.
If you work with gifted girls or are the parent of a gifted girl, I’d like to bring your attention to the book Counseling and Teaching Gifted Girls. Below is one of many great quotes from this book.
“The inner world created by gifted children is often more intense and more vivid, often having been created to make up for what they lack in their own childhood. As gifted children grow into adolescence and adulthood, they often experience the need to create a different type of make-believe self to inhabit in the everyday world in order to hide their individuality and uniqueness.”
The above book is a go-to book of mine because it also mentions the practice of bibliotherapy. Gifted individuals often show an interest in the biographies of others.
Books can help with exploring the lives of women and men in history who have balanced their multipotentiality and giftedness, thus offering an example for individuals in the process of self-development. I look forward to talking more about the specific process of bibliotherapy in upcoming posts.
To conclude this series on financial anorexia, I will provide a Part 4 discussing my personal reaction to this information on systemizing along with several questions I was left pondering after researching.
Disclaimer: As always, if you need psychological or financial advice please seek a professional for your specific situation.
Below is the main source for the studies discussed in this article. More sources are available upon request.
Bentz, M., Jepsen, J. M., Kjaersdam Tellnus, G., Moslet, U., Pedersen, T., Bulik, C. M., & Plessen, K. J. (2017). Neurocognitive functions and social functioning in young females with recent-onset anorexia nervosa and recovered individuals. Journal Of Eating Disorders, (1), doi:10.1186/s40337-017-0137-3