People with autism and those with ADHD are more likely to suffer from eating disorders. Here’s why – and how it affects their treatment

It is estimated that more than 1.1 million Australians live with an eating disorder. About a third of these people are neurodivergent.

So why are neurodivergent people, like people with autism and those with ADHD, more likely to suffer from eating disorders than the general population? And what impact does this have on their treatment?

First of all, what is neurodivergence?

Neurodivergence, or the neurodivergent state, is a term for people whose cognitive functioning differs from what society considers “typical.” Many conditions fall largely under the umbrella of neurodivergence, including (but not limited to):

• autism
• attention deficit/hyperactivity disorder (ADHD)
• dyslexia
• Tourette syndrome.

Our understanding of neurodivergence has come a long way. Neurodivergence was once considered a linear “spectrum” from least to most neurodivergent.

We now know that each neurodivergent person will have a unique experience across a range of dimensions. This includes sensory processing, motor skills, and executive functioning (working memory, cognitive flexibility, and inhibition).

Conceptualizing these differences ends up looking more like a color wheel.

What are eating disorders?

Eating disorders are complex and life-threatening mental health problems. They cause persistent and significant disturbances in thoughts, feelings, and behaviors related to body weight, eating, and/or eating.

Many factors can contribute to the development of an eating disorder. But research shows that neurodivergent people are disproportionately affected.

One study found that about 22.9% of people with autism suffered from an eating disorder, compared to 2% in the general population. In another review, people with ADHD were four times more likely to be diagnosed with an eating disorder than people without ADHD.

Why are eating disorders more common in neurodivergent people?

Science has not identified the exact reason why eating disorders are more common among neurodivergent people. But here’s what we know so far.

Neurodivergent people are more likely to experience eating difficulties, sensory sensitivities, and eating disorders.

A US study assessing the eating behavior of neurodivergent children found that around 70% of autistic children exhibited “atypical” eating behaviors. This includes food selectivity and hypersensitivity to food textures. This compares to 4.8% of neurotypical children.

Similarly, children with autism may choose or reject foods based on their texture more than other children. They may prefer foods with a consistent texture, bland taste, and neutral color (for example, chicken nuggets, plain pasta, and rice).

Selective eating (having limited accepted foods and food aversions) has been associated with avoidance/restriction of food intake disorder (ARFID). It is an eating disorder characterized by avoidance and aversion to food and eating that is unrelated to body image. ARFID is commonly associated with autism, with one study estimating that 21% of autistic people will suffer from it in their lifetime.

Other neurodivergent traits, such as perfectionism and a preference for routine, have been associated with disordered eating and eating disorders.

Research on adolescent girls has found that those who suffer from anorexia nervosa are more likely to exhibit neurodivergent (in this case, autistic) traits and behaviors. These include rule-making, resistance to change, and a hyperfocus on body weight. These features are commonly seen in anorexia nervosa, an eating disorder characterized by restricted food intake, intense fear of weight gain, and body image disturbances.

Meanwhile, impulsivity symptoms of ADHD have been linked to binge eating disorder. This may involve recurring episodes of eating large quantities of food over a short period of time. Impulsivity may also be linked to bulimia nervosa, characterized by compensatory behaviors aimed at preventing weight gain after a binge (such as excessive exercise).

Some studies indicate a link between ADHD, alexithymia (difficulty feeling, identifying, and expressing emotions), and overeating behaviors such as emotional eating.

Finally, neurodivergent people are more likely to identify as part of the LGBTQIA+ community, experience trauma, and also suffer from a mental health issue. Each of these considerations increases the likelihood that a person will suffer from an eating disorder.

How does this affect treatment?

Despite the overlap between eating disorders and neurodivergence, current treatment approaches do not address the diverse needs of affected individuals.

Treatment for eating disorders is often moderately successful at best. For neurodivergent people, outcomes are worse than for their neurotypical counterparts.

Cognitive behavioral therapy (CBT), a broad range of treatments based on the interplay between thoughts, feelings, and behaviors, is less beneficial for neurodivergent people. Yet it is often part of the treatment of eating disorders. Autistic women have suggested that CBT is less accessible due to its holistic approach and the assumption that they have the skills to benefit from it.

Organizations such as the National Eating Disorders Collaboration and lived experience advocates have called for improving access to neurodiversity-affirming models of care for neurodivergent people affected by eating disorders.

Such care safely recognizes and addresses the multiple ways in which neurodivergence is linked to diet and eating behavior.

Research suggests that eating disorder treatment can be successfully adapted for neurodivergent people based on the following principles:

1. equal partnership. Include neurodivergent people as equal partners in their care and as decision-makers, and value their own experiences

2. accept and celebrate differences. Neurodivergent traits should not be viewed as a deficit, or something to be “treated” or “corrected.” Rather, neurodivergent traits should be celebrated to nurture a positive sense of identity.

3. accommodation. Neurodivergent traits and preferences are respected and taken into account. For example, this could include reducing sensory input (smell, sounds and lights) in a dining room, or a meal plan that is predictable and takes into account a person’s sensory sensitivities.

Eating disorder treatment should also be gender-affirming (interventions that support and affirm a person’s gender identity) and trauma-informed.

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If this article has raised concerns for you, free resources and support are available from the National Butterfly Helpline by calling 1800 ED HOPE (1800 33 4673) or by visiting Eating Disorders Neurodiversity Australia or Autism Connect.