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A third of people with an eating disorder are neurodivergent, yet traditional eating disorder research and treatments haven't factored this into the equation.

About one-third of people with an eating disorder areÌý. And while traditional eating disorder treatments haven't factored this into the equation, there's a push for that toÌý.

In recent years, as public awareness of autism and ADHD has grown, the links between neurodivergence and eating disorders have progressively attracted researchers' and clinicians' attention.

As manyÌýÌý²¹²Ô»åÌýÌýhave argued, it's time for eating disorder clinicians to meet the individual and intersectional needs of their neurodivergent clients.

Eating disorder links for autism and ADHD are clear

Ìýand those withÌýÌý(also called ADHDers) are more likely than neurotypicals (people whoseÌýÌýaligns with the majority) to develop an eating disorder.

About one in three people withÌýÌýare also autistic, as are one in every two people with anÌýavoidant/restrictive food intake disorder.

³§¾±³¾¾±±ô²¹°ù±ô²â,ÌýÌýare four times more likely to have anorexia nervosa or a binge eating disorder, and over five times more likely to develop bulimia nervosa, compared to people without ADHD.

Whilst combined autism and ADHD (also calledÌý) is frequentlyÌý, there is no data specifically investigating this overlap in relation to eating disorders in adults. Additionally, although associations between eating disorders andÌý,Ìý, andÌýÌýhave emerged, further investigations are needed.

Beyond stereotypes: How autism and ADHD impact eating

Neurodivergent people experience the worldÌýÌýto neurotypicals — including in relation toÌýÌý²¹²Ô»åÌý.

For example,ÌýÌýpeople with a restrictive eating disorder are less likely than non-autistic individuals to report that the main driver of their restriction is the desire to control their weight or body shape.

Instead,Ìýkey contributing factorsÌýfor autistic folks include differences inÌý,ÌýÌý(difficulty in verbally expressing feelings),ÌýÌý(high levels of stress associated with being in a minority group),Ìý, and the use of food restriction as a form of '' (also called '') to increase social acceptance.

Autistic people often prefer toÌýÌý(sometimes known as '') because the selected foods predictably meet their sensory needs, help with self-regulation, and can support an adequate energy intake. Anecdotal lived experience accounts of ADHD suggest thatÌýÌýis a relevant phenomenon amongst ADHDers, too.

Ìýindividuals andÌýÌýmay find remembering to eat challenging due to differences in sensory processing and cognitive processes. Moreover, executive functioning differences may lead toÌýÌýchoosing what to eat, sourcing ingredients, and preparing meals.

³§´Ç³¾±ðÌýÌýpeople may also find the task of eating boring and not enjoyable. What's more, some preferÌýeating aloneÌýrather than eating socially to avoid sensory overwhelm such as in relation toÌýÌý(where certain sounds trigger strong responses) and/or other hypersensitivities.

Where traditional treatments fall short

Given these different underlying factors, it isn't surprising that traditional eating disorder treatments, specifically cognitive behavioural therapy, dietetics, and inpatient care, have been found to be significantlyÌýÌý²¹²Ô»åÌý.

For example, cognitive behavioural therapy, theÌýÌýto treating most eating disorders, may be problematic for neurodivergent individuals.

"Focusing on the thought surrounding their sensory sensitivities and aversion to food and then labelling this thought as distorted … would invalidate this individual's lived experience," US-based clinician with lived experienceÌý.

On the whole, the 'evidence-based' psycho-behavioural treatments often held up as the 'gold standard' only succeed at supportingÌýÌýof people with an eating disorder intoÌý.

The problem of psychological interventions not meeting the needs of neurodivergent people is not limited to the field of eating disorders. For example,ÌýÌýfound there are no mental health interventions that can claim to be neurodiversity-affirming.

Care that's not just informed, but intersectional and affirming

Encouragingly, there has been increased awareness of the need for eating disorder services to improve their ability to meet the unique needs of autistic individuals, such as theÌýÌýin the UK.

Unfortunately, similar initiatives have not yet been realised in relation to the intersections of ADHD or other forms of neurodivergence and eating disorders.

As we argued in our recent technical report,Ìý, eating disorder stakeholders need to radically rethink all aspects of eating disorder research and care if they are to meet the needs of neurodivergent people.

At a bare minimum, clinicians should know about the links between eating disorders and autism, ADHD, or other forms of neurodivergence.

It would be helpful for them to have an understanding of how domains such asÌý,Ìý,Ìý,Ìý,Ìýcognitive processes,Ìý, andÌýÌýcan impact the ways eating and body image are experienced differently by neurodivergent people.

But best practice for neurodivergent folks doesn't stop there.

It also means providing care that is neurodiversity-affirming — viewingÌýÌýas a valuable form of diversity and rejecting the idea that there is a singular normal neurocognitive style. This kind of approachÌýchallengesÌýthe traditional dehumanising pathologising of neurodivergence and instead focuses on holistically meeting the individual, and self-determined, human rights and unique support needs of neurodivergent people.

Moreover, neurodiversity-affirming eating disorder care means moving beyond the indiscriminate use of compliance- and exposure-based psycho-behavioural approaches. Invalidation ofÌý, for example, can beÌýÌýand experienced as a form ofÌý. Likewise, coercing or forcing an autistic person to eat aversive foods can result inÌý.

Furthermore, accusing anÌýÌýor anÌýÌýperson of wilful non-compliance and/or attention-seeking for executive functioning challenges (for example, forgetfulness orÌýÌýthat are outside of their control can be deeply stigmatising and traumatic.

In practice, delivering authentically affirming care requires eating disorder clinicians first engage in deep self-reflection to challenge biases andÌýÌýbeliefs. It thenÌýÌýthat eating disorder stakeholders seek out, respect, and elevate theÌý, concerns, and priorities of neurodivergent people — stepping forward with humility and courage to collaborate withÌýÌýon improving eating disorder care for all.

If this article has raised issues for you, or if you’re concerned about someone you know, visitÌýÌýor contact your local health provider.

Laurence Cobbaert (she/they) is the Chair of Eating Disorders Neurodiversity Australia and a PhD candidate at the University of New South Wales. Laurence is also the Chair of Australia and New Zealand Academy for Eating Disorders' (ANZAED) Neurodiversity special interest group. They are neurodivergent and have lived experience of an eating disorder.

Anna Rose (they/them) is the Deputy Chair of Eating Disorders Neurodiversity Australia, an Accredited Practising Dietitian, Credentialled Eating Disorder Clinician, and a PhD candidate at and holder of research scholarship from Bond University. They are neurodivergent and have lived experience of an eating disorder.

They have undertaken lived experience consultation for the Australian Eating Disorders Research and Translation Centre (AEDRTC) and professional development consultation for ANZAED.

The authors co-host theÌý.ÌýOriginally published underÌýÌýbyÌýâ„¢.