The Intersection of Eating Disorders and Neurodivergence
The Intersection of EDs and Neurodivergence
The intersection of neurodivergence and eating disorders has become more a topic of conversation in the field as of late, and rightfully so. This topic is an important one, and not just because of the statistics- nearly 35% of people with ADHD have Bulimia Nervosa and nearly 20% have Binge Eating Disorder. Studies also show that 37% of autistic people have Anorexia Nervosa and nearly 55% have Avoidant/Restrictive Food Intake Disorder (ARFID).
While this occurrence is not new by any means, it has been vastly understudied, meaning neurodivergent folks have been misdiagnosed, misunderstood, or even flat out missed altogether. This blog aims to discuss traits that can overlap with eating disorders, treatment considerations, and practical support strategies for loved ones. It also aims to provide resources for those struggling with an eating disorder and for their loved ones.
What Is Neurodivergence? (Autism, ADHD, and More)
Neurodivergence is a naturally-occurring difference in how one’s brain functions or processes information. Examples of neurodivergence include, but are not limited to, autism, ADHD, OCD, dyslexia, dyscalculia, and Tourette Syndrome. When discussing neurodivergence in this blog, the writer will focus on autism and ADHD.
The medical model has long pathologized neurodivergence, conceptualizing and treating brain differences as diagnoses, “shortcomings”, or “areas to be fixed” to be “more like neurotypical” brains. This blog will focus on the neurodiversity paradigm, which emphasizes the value and beauty of neurodivergent brains, highlights that there is no “typical” brain, and that the problematic areas to solve include changing our social environment to be more inclusive and accommodating versus trying to change or “normalize” neurodivergence.
Overlapping Traits: Neurodivergence and Eating Disorders
As previously mentioned, the intersection of eating disorders and neurodivergence is under-researched, but there are certain neurodivergent traits that can overlap with an eating disorder.
1. Sensory Sensitivity and ARFID
A trait often seen in autistic people or people with ADHD is sensory sensitivity. This can include sensitivity to light, sounds, tastes, smells, and textures. All of these instances can play a role in eating (as loud sounds and bright lights can be overstimulating and distracting), but the most prominent focus in research is sensitivity to taste and smell.
While not everyone who has sensory sensitivities to these two senses has an eating disorder, those with Avoidant/Restrictive Food Intake Disorder (ARFID) may greatly struggle with food intake because of this. If someone has the Avoidant subtype of ARFID, their food preferences/choices will be severely limited due to aversion, disgust, or extreme distress with one or more of their senses related to food.
2. Interoceptive Differences and Eating Patterns
Interoception relates to internal signals the body gives us. It communicates our body’s needs with our brain, like the need to use the restroom, to sleep, or to eat. Neurodivergent folks may have a hyper-awareness or hypo-awareness to these cues.
If there is a hyper-awareness, the sensation of hunger or fullness will feel even more intense and can lead to overwhelm of the nervous system or an avoidance of food to avoid the overwhelm. A hypo-awareness to interoceptive cues can lead to forgetting to eat or avoiding eating because one doesn’t feel hungry. Needless to say, this can be a detriment to someone with an eating disorder.
3. Executive Functioning and Meal Planning
Executive functioning looks different for neurodivergent individuals. Tasks such as meal planning and meal prepping might be particularly difficult with these executive functioning differences, making eating disorder recovery more precarious.
For other individuals, hyper-focus or time blindness may lead to forgetting to eat or having difficulty stopping what one is doing to make time for nourishment.
4. Cognitive Rigidity and Food Rules
Cognitive rigidity is a common occurrence for neurodivergent folks and is based out of a need for safety and predictability. It is not “defiance” or “resistance.” Cognitive rigidity often occurs with those struggling with eating disorders as well, arguably out of a similar need for safety and predictability.
When food is seen as “good/bad”, “healthy/unhealthy” and bodies are seen as currency, it becomes difficult to see a middle ground.
What Is Neuro-Affirming Eating Disorder Care?
With the overlaps between neurodivergence and eating disorders, it is important to consider neuro-affirming care. What does neuro-affirming care look like?
Neuro-affirming care aligns with the neurodiversity paradigm, in which neurodivergence is celebrated rather than “fixed.” It must take into consideration how one’s brain functions differently and adapt treatment to best support the individual. Examples include, but are not limited to, providing accommodations, creating sensory safety or structure, and having access to foods that feel safe.
Treatment teams who not only say they are neuro-affirming but personalize care to the individual are critical. Feel free to ask providers about their training, framework, and/or lived experience to get a better sense of their ability to provide competent care.
Why Eating Disorder Treatment Needs a Neurodiversity Approach
Why has eating disorder care historically not implemented a neuro-affirming framework? It is of my opinion and experience that the eating disorder community has long lived by the medical model of neurodivergence, and similarly it has had a “one size fits all” approach for recovery.
Eating disorders are miserable and have the ability to take all joy out of life, so it makes sense that providers have long encouraged the road to recovery…to an extent. What often does not get considered is the nuance—that some people do not want to or are unable to recover; that the eating disorder has provided a sense of safety that an individual has not found elsewhere.
When we begin to believe that there is a “right” way and a “wrong” way (think “neurotypical” vs neurodivergent) to eat, think, or perceive the world, we begin to have a polarized view of the world.
How to Support a Neurodivergent Loved One with an Eating Disorder
For family members watching their loved ones struggling with an eating disorder, practical support strategies can bring a sense of relief and direction.
Providing accommodations for neurodivergent folks is a simple but powerful way build a sense of safety, whether it consists of a change in the eating environment (think soft lights, fidget toys, headphones) or striving to always have at least one “safe” food.
Another way to provide support is by helping create structure, particularly around eating. In today’s day and age, we live busy lives and are not always able to stick to the same routine day after day. Creating as much structure as possible can be a lifeline for neurodivergent people with eating disorders, especially around meal times.
Lastly, it is immensely helpful to look at the language you may use to describe food and bodies. Creating more neutrality for food (nix the “good” food/”bad” food language) and speaking in a respectful way of all bodies, including your own (nix the body bashing), creates a more conducive environment for eating disorder recovery.
Resources for Eating Disorders and Neurodivergence
For additional resources, I highly recommend the book Unmasking Autism or the website Peace Pathway. If you or someone you know is struggling with an eating disorder, reach out for support today. You are not alone.
This blog is for educational purposes only and is not a replacement for therapy.
References
Cobbaert, L., Millichamp, A.R., Elwyn, R., Silverstein, S., Schweizer, K., Thomas, E., Miscovic-Wheatley, J. (2024). Neurodivergence, Intersectionality, and Eating Disorders: A Lived Experience-Led Narrative Review. Journal of Eating Disorders, 12(1), 1–29.
Price, D. (2022). Unmasking Autism: Discovering the New Faces of Neurodiversity. Harmony Books.