When working with clients who have both eating disorders and neurodivergence, determining whether behaviors are driven by the eating disorder or neurodivergent traits can be challenging. Since these conditions often co-occur and share similar symptoms, understanding how they interact is essential for providing effective, individualized care.
The Challenges of Eating Disorders
Eating disorders, including anorexia nervosa, bulimia, and binge eating disorder, typically involve restrictive eating, bingeing, purging, and/or compulsive exercise1. These behaviors are often rooted in body image issues, anxiety, and a need for control. People with eating disorders may also experience challenges with emotional regulation, perfectionism, and self-image. Treatment aims to break harmful cycles, address the physical consequences of malnutrition, and help individuals develop healthier relationships with food1.
The Challenges of Neurodivergence
Neurodivergence, including conditions like ADHD, autism, dyslexia, and dyspraxia, can impact eating habits and food-related behaviors2. Sensory sensitivities may make certain foods overwhelming or unappealing, leading to strong preferences or aversions based on texture or smell3. Trying new foods or changes in meal plans can also trigger anxiety. Additionally, challenges with fine motor skills—such as using utensils or manipulating food—along with executive functioning issues, particularly in ADHD, can complicate meal planning and disrupt daily routines3. Impulsivity or hyperfocus may further interfere with regular eating patterns, resulting in missed meals or a reliance on easy-to-prepare foods.
Treatment and management typically focus on creating supportive environments, such as accommodating sensory needs, adapting utensils, and establishing consistent routines. Behavioral therapy, occupational therapy, and strategies to improve executive functioning (such as visual schedules or meal planning assistance) can also be beneficial in supporting neurodivergent individuals and helping them develop healthier eating habits.
The Overlap: How Eating Disorders and Neurodivergent Traits Interact
Eating disorders rarely occur in isolation. Many individuals with these conditions also have ADHD, autism spectrum disorder (ASD), or other forms of neurodivergence, which can complicate both eating behaviors and treatment3,4. Behaviors like skipping meals, avoiding certain foods, excessive movement, or inconsistent eating patterns can be difficult to interpret, as they may stem from either the eating disorder itself or neurodivergent traits—such as sensory sensitivities, executive functioning challenges, hyperactivity, or a need for predictability. Additionally, memory and focus issues may cause clients to forget or overlook these behaviors, which, though unintentional, are often misinterpreted as dishonesty in treatment settings.
Frustration, social rejection, and difficulties with self-regulation—common among neurodivergent individuals—can contribute to low self-esteem, increasing the risk of developing an eating disorder. Moreover, these conditions tend to exacerbate one another: the rigidity of an eating disorder can make it difficult for neurodivergent individuals to adapt to meal plan changes, while a strong need for routine and predictability can hinder flexibility, making it harder to try new foods. Executive functioning challenges further disrupt adherence to structured meal plans, reinforcing disordered eating behaviors.
Special Considerations for Treatment
Treating clients who have both neurodivergent traits and eating disorders requires a thoughtful, flexible approach that acknowledges the complexity of both conditions. The goal is to address each issue without reinforcing disordered eating behaviors, while also adapting to the unique needs of neurodivergent clients. Below are several strategies for differentiating between the two issues and providing holistic support:
- Comprehensive Assessment
Begin with a thorough assessment to identify whether behaviors are linked to the eating disorder, neurodivergence, or both. Consider factors like anxiety, sensory sensitivities, and self-image to pinpoint underlying issues. This ensures that treatment targets the correct causes and avoids misinterpreting neurodivergent behaviors as part of the eating disorder.
- Be Curious
Clinicians should approach treatment with an open mindset, exploring the nuances of each client’s experience rather than assuming eating behaviors are solely caused by the eating disorder. Ask thoughtful questions and encourage clients to reflect on the emotional, sensory, and cognitive factors influencing their eating patterns. As a practical tool, using a weekly sticker chart to track eating and exercise behaviors can help reveal trends, allowing clients to observe their habits and discuss them in a more objective manner.
- Consider Sensory Needs and Motor Abilities
For neurodivergent clients, consider both sensory sensitivities and motor challenges that can impact eating. Structure meals to reflect sensory preferences—such as texture and temperature—while maintaining nutritional balance. Allow clients to choose utensils that suit their motor needs, such as smaller or differently shaped silverware, to make eating more manageable and enjoyable.
- Address Executive Functioning
Many neurodivergent clients struggle with executive functioning, which affects meal planning, time management, and maintaining a regular meal schedule. Clinicians can help clients develop strategies like setting reminders, simplifying meal prep, and creating structured routines. These tools can support a consistent eating pattern while complementing eating disorder treatment.
- Distinguishing Eating Disorder Treatment from Neurodivergent Care
Maintain a clear distinction between treating eating disorders and neurodivergent traits. Eating disorder therapy should focus on emotional regulation, building a healthy relationship with food, and addressing disordered eating behaviors. In contrast, strategies for neurodivergent traits should target decision-making, routine-building, and executive functioning. Unlike eating disorders, the goal is not to cure or change neurodivergence.
- Medication Management and Implications
Many medications, such as stimulants for ADHD, can affect appetite and complicate eating disorder treatment3, particularly when weight restoration is a priority. Still, it is crucial to evaluate the impact of each medication on a case-by-case basis. While stimulants may suppress appetite, they can also enhance focus, helping clients manage daily routines more effectively. Additionally, these medications can reduce distractions or anxiety, making it easier for clients to adhere to their meal plans and recovery goals. Timing meals during periods of peak hunger—when the appetite-suppressing effects of medication are at their lowest—can help ensure adequate nutrition. Offering nutrient-dense, easy-to-eat foods during these times further supports nutritional needs while accommodating the medication’s effects.
- Be Realistic with Goals and Expectations
Adjust treatment goals to align with the unique challenges and abilities of neurodivergent clients. For example, mindful eating, in the traditional sense, may not be feasible for some individuals. Instead, consider incorporating activities like coloring or using a fidget toy during mealtimes. These activities can help alleviate stress or anxiety, creating a more manageable and comfortable eating experience.
- Movement for Sensory Regulation
Encourage movement as a tool for managing sensory overload and reducing anxiety, rather than focusing on exercise or calorie-burning. For neurodivergent clients, movement can serve as a soothing strategy that helps with focus and relaxation throughout the day. Simple activities like gentle stretching, walking, or shifting positions can provide sensory regulation, promote self-soothing, and support overall well-being—without reinforcing compulsive exercise behaviors.
Key Takeaways
Treating clients with both eating disorders and neurodivergence requires a comprehensive approach that recognizes and addresses the unique needs of each condition. By understanding that eating behaviors can stem from both psychological factors and neurodivergent traits, clinicians can develop more effective, compassionate, and neurodiversity-informed treatment plans.
References
- National Eating Disorders Association . Eating Disorders Resources & Education for Individuals – NEDA. National Eating Disorders Association. Published April 3, 2024. Accessed January 10, 2025. https://www.nationaleatingdisorders.org/grace-holland-cozine-resource-center-myself/
- Resnick A. What Is Neurodivergence and What Does It Mean to Be Neurodivergent? Verywell Mind. Published October 6, 2021. Accessed January 10, 2025. https://www.verywellmind.com/what-is-neurodivergence-and-what-does-it-mean-to-be-neurodivergent-5196627
- Crane M. Eating Disorders and Neurodivergence. withinhealth.com. Published July 27, 2023. Accessed January 10, 2025. https://withinhealth.com/learn/articles/eating-disorders-and-neurodivergence
- Klyce M. Eating Disorders and Neurodiversity – National Eating Disorders Association. National Eating Disorders Association. Published March 4, 2024. Accessed January 10, 2025. https://www.nationaleatingdisorders.org/eating-disorders-neurodiversity/
