Eating Disorders in Neurodivergent Individuals

Thank you to Andreana for her time and dedication to providing information on Eating Disorders in Neurodivergent Individuals.

 

Eating Disorders in Neurodivergent Individuals

Webinar Title: Honoring Neurodivergent Stories and Rethinking Eating Disorder Treatment
Presenter: Andreana, Clinical Psychologist and Family Therapist

Hello, everyone, and welcome! I’m thrilled to be here with you today for this webinar hosted by Body Wise in collaboration with the National Eating Disorder Recovery Center of Dublin. My name is Andreana, and I’m a clinical psychologist and family therapist with a specialization in eating disorders and neurodivergence.

As part of Eating Disorders Awareness Week, this webinar focuses on the theme All Stories Matter. Today, we’ll explore the topic Honoring Neurodivergent Stories and Rethinking Eating Disorder Treatment. Over the past three years, my work with the National Eating Disorder Recovery Center has centered on tailoring treatment plans for neurodivergent clients, ensuring that their unique needs and strengths are recognized and supported.

Agenda

To keep us on track, here’s the agenda for today’s session:

  1. Principles of Neurodiversity-Affirming Practice
  2. Risk Factors for Eating Disorders in Neurodivergent Individuals
  3. Accommodations and Tailored Treatment Approaches
  4. Q&A and Discussion

I’ll aim to conclude within an hour, leaving 5–10 minutes at the end for your questions and comments.

Introduction to Our Service

Our center offers three main programs designed to meet the diverse needs of individuals with eating disorders:

  1. Adolescent Program (12–18 years):
    • Includes individual therapy sessions, available both onsite and online.
    • Family therapy to support the entire family system.
    • Group sessions such as Dialectical Behavior Therapy (DBT) skills training and parenting groups to equip parents with tools to support their children.
  2. Adult Program (18+ years):
    • Runs Monday to Friday, 10 AM–5 PM.
    • Provides access to two main meals and snacks daily, supervised by dietitians.
    • Offers psychology sessions, dietetics, family therapy, and group sessions focusing on CBT, DBT, and peer support.
  3. Inpatient Residential Program (18+ years):
    • A 24/7 program offering intensive support for individuals requiring a higher level of care.
    • Includes psychiatry, occupational therapy, and group sessions to address the multifaceted nature of eating disorders.

Over the past three years, our service has grown significantly, both in the number of clients we support and the size of our multidisciplinary team (MDT). We’ve recently introduced occupational therapy to better meet the needs of neurodivergent clients, recognizing the importance of addressing sensory and executive functioning challenges in their recovery journey.

Principles of Neurodiversity-Affirming Practice

Neurodiversity represents a paradigm shift away from the medical model, which pathologizes neurological differences, toward a more inclusive and socially aware perspective. It recognizes cognitive differences as natural and valuable aspects of human diversity.

Key principles of neurodiversity-affirming practice include:

  1. Valuing Diversity:
    • Recognizing the strengths and unique perspectives of neurodivergent individuals.
    • Celebrating differences rather than viewing them as deficits to be corrected.
  2. Empowering Clients:
    • Ensuring their voices are heard and respecting their language preferences (e.g., “autistic person” rather than “person with autism”).
    • Encouraging self-advocacy and autonomy in treatment decisions.
  3. Systemic Change:
    • Moving away from deficit-based approaches and creating inclusive systems that accommodate differences.
    • Advocating for societal changes that promote equity and inclusion for neurodivergent individuals.
  4. Strengths-Based Focus:
    • Highlighting how neurodivergence can be a source of strength and empowerment.
    • Helping clients identify and leverage their unique abilities in their recovery journey.

The Double Empathy Problem

Research by Milton (2012) challenges the notion that neurodivergent individuals struggle with empathy. Instead, it highlights a mutual communication gap between neurodivergent and neurotypical individuals. This gap is similar to misunderstandings between people from different cultural backgrounds. Neurodivergent individuals often connect more easily with others who share their neurotype, demonstrating meaningful and engaging interactions.

For example, autistic individuals may find it easier to communicate with other autistic individuals, as they share similar communication styles and sensory experiences. This underscores the importance of fostering environments where neurodivergent individuals can connect with peers who understand their unique perspectives.

Eating Disorders in Neurodivergent Individuals

Neurodivergent individuals are at higher risk for certain eating disorders due to overlapping traits. Below is a detailed overview of the most common presentations:

  1. Anorexia Nervosa
  • Characterized by extreme weight loss, fear of gaining weight, and distorted body image.
  • Risk factors in autistic individuals:
    • Sensory Sensitivities: Discomfort with hunger, fullness, or the physical act of eating.
    • Rigid Thinking: Difficulty shifting from detailed, rule-based thinking to a broader perspective.
    • Social Challenges: Anxiety around eating in public or fear of bullying.

For example, an autistic teenager may avoid eating in the school cafeteria due to sensory overload (e.g., noise, smells) and social anxiety, leading to restrictive eating patterns.

  1. Bulimia Nervosa
  • Involves cycles of binge eating followed by purging behaviors.
  • Risk factors in ADHD individuals:
    • Impulsivity: Difficulty resisting the urge to binge eat.
    • Executive Functioning Challenges: Struggles with planning meals and recognizing hunger cues.

For instance, an adult with ADHD may forget to eat during the day due to hyperfocus on a task, leading to intense hunger and binge eating later in the evening.

  1. ARFID (Avoidant/Restrictive Food Intake Disorder)
  • Driven by sensory sensitivities (e.g., texture, smell, or taste) or fear of choking.
  • Common in autistic individuals due to:
    • Sensory Overload: Difficulty tolerating unpredictable food experiences.
    • Preference for “Safe” Foods: Reliance on familiar foods that provide a sense of predictability.

For example, a child with ARFID may only eat plain crackers because they find the texture and taste of other foods overwhelming.

  1. Orthorexia
  • Obsession with eating foods perceived as healthy, leading to severe dietary restrictions.
  • Often seen in autistic individuals due to rigid thinking patterns.

For instance, an autistic adult may develop strict rules around eating only organic foods, leading to nutritional deficiencies and social isolation.

Risk Factors for Eating Disorders in Neurodivergent Individuals

Autistic Neurotype

  • Sensory Sensitivities: Hypersensitivity to hunger, fullness, or the physical act of eating.
  • Social Challenges: Anxiety around eating in public or fear of bullying.
  • Rigid Thinking: Difficulty shifting from detailed, rule-based thinking to a broader perspective.

ADHD Neurotype

  • Executive Functioning Challenges: Procrastination, time blindness, and difficulties with planning.
  • Sensory Seeking: Craving high-dopamine foods (e.g., sugary or processed foods).
  • Impulsivity: Leading to binge eating episodes.

AuDHD (Autism + ADHD)

  • Combines traits from both neurotypes, such as sensory sensitivities, impulsivity, and challenges with executive functioning.

Accommodations and Tailored Treatment Approaches

General Accommodations

  • Sensory-Friendly Environments: Soft lighting, minimal clutter, and access to fidget toys or sensory rooms.
  • Visual Aids and Summaries: Providing session summaries and reminders to support memory and communication.
  • Structured Routines: Creating predictability in sessions to reduce anxiety.

For Autistic Clients

  • Incorporate special interests into treatment.
  • Use visual tools to explore emotions and energy levels.
  • Focus on improving interoceptive awareness and flexible thinking.

For ADHD Clients

  • Provide psychoeducation on ADHD and its impact on eating behaviors.
  • Use external reminders and visual tools for meal planning.
  • Address impulsivity and improve decision-making skills.

For ARFID

  • Use CBT and exposure therapy paired with sensory profiles.
  • Gradually introduce new foods while respecting sensory preferences.
  • Focus on meeting nutritional needs rather than enforcing variety.

Practical Strategies for Clinicians

In One-to-One Sessions

  • Provide sensory boxes and fidget toys.
  • Avoid open-ended questions and use clear, literal language.
  • Send session summaries and reminders via email.

In Group Settings

  • Allow movement breaks and alternative activities (e.g., coloring or knitting).
  • Adapt mindfulness exercises to sensory needs.
  • Encourage anonymous feedback to foster a sense of safety and inclusion.

Conclusion

Thank you for joining me today! By adopting a neurodiversity-affirming approach, we can create more inclusive and effective treatment plans that honor the unique strengths and experiences of neurodivergent individuals. I’ll now open the floor for your questions and comments.

Thank you to Bodywise for supporting eating disorder awareness week, Other videos from eating disorder awareness week 2025

Eating disorder recovery is possible

If you would like to discuss the concerns you have about a love one, contact NEDRC in confidence. We are happy to listen and guide you through.

NEDRC can help you and your loved one take that vital step to regain a happy, healthy life. Please use the contact details below to find out about our eating disorder treatment options available to you and your loved one. Contact NEDRC

Telephone: 01 564 4450 or Mobile: 087 7755996 / Email enquiries@nedrc.ie

For referrals from Healthcare/ Therapeutic professionals please contact via : referrals@nedrc.ie or healthlink@nedrc.ie or online via Healthlink

Healthmail users can send referrals to healthmail@nedrc.ie