Autism and eating disorders

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Autistic people are thought to represent up to 37% of those with anorexia nervosa (AN). However, this may likely be an underestimate given that autism is oftentimes un/misdiagnosed in women, trans and non-binary folk, as well as ethnic or racial minorities. Un/misdiagnoses of neurodivergent people can have a variety of negative consequences on mental health. 

While most of the emphasis is placed on the connection between autism and anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID), autistic traits have been correlated with all eating disorder subtypes (e.g., bulimia nervosa, other specified feeding or eating disorder, binge eating disorder). 

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ADHD and eating disorders

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On the other hand, ADHDers are at a greater risk of developing an eating disorder. It is estimated that ADHDers are 3 to 6 times more at risk of struggling with an eating disorder. ADHD is also vastly un/misdiagnosed in women and other minority groups.

While most of the emphasis has been placed on the connection between ADHD and bulimia nervosa (BN) or binge eating disorder (BED), ADHD has been correlated with all eating disorder subtypes. In addition, it is worth noting that autism and ADHD often co-occur. This means that the connections between autism, ADHD, and eating disorders are complex and multidimensional rather than clear-cut. 

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Other types of neurodivergence and eating disorders

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Other types of neurodivergence, such as dyspraxia, dyslexia, intellectual disability, giftedness, or Tourette's syndrome (TS), have also been suggested to correlate with eating disorders, but the research is limited and further investigations are needed. Dyspraxia, for example, impacts on movement and coordination. Sometimes, this can make eating difficult (e.g., using cutlery, sitting straight, chewing, swallowing). It is worth noting that ADHD and dyslexia frequently co-occur. 

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Intersectionality

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Neurodivergent people have been found to experience gastrointestinal issues more frequently than neurotypical people. Gastrointestinal issues can represent a risk factor for developing eating disorders, and eating disorders can make gastrointestinal problems worse. 

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Emerging research suggests that neurodivergent people are affected by immune-related disorders more than neurotypical people. Such health concerns may include Ehlers-Danlos syndrome (particularly hypermobility, hEDS), dysautonomia (e.g., postural tachycardia syndrome, POTS), diabetes and hypertension, irritable bowel syndrome (IBS), polycystic ovarian syndrome (PCOS), dermatitis, and allergies. Immune-related disorders seem to represent a risk factor for developing eating disorders. 

 

Furthermore, neurodivergent people are more likely to also be members of the LGBTQIA+ community. Indeed, autistic people and ADHDers are up to 7 times more likely to identify as transgender or gender non-binary compared to neurotypical people. Members of the LGBTQIA+ community are also more likely to be affected by eating disorders.

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Recent studies have highlighted the under-recognition and lack of post-diagnostic support especially for Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander people have also been suggested to be disproportionately affected by eating disorders, but there is limited awareness of and research conducted about this intersectionality and support systems for autistic Aboriginal and Torres Strait Islander people affected by eating disorders are lacking. 

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Aside from eating disorders, neurodivergent people are also more vulnerable towards other mental health concerns and illnesses, including depression, anxiety, and suicidality. For example, autistic people are 7 times more at risk of dying by suicide compared to non-autistic people and 3 times more likely to engage in self-harm as well. Similarly, ADHDers are also at a disproportionate risk of suicide and self-harm.

Neurodivergent people are at an increased risk of experiencing post-traumatic stress disorder (PTSD). However, post-traumatic stress disorder (PTSD) may have different triggers and presentations in neurodivergent people compared to neurotypical people.

 

In addition, both autistic people and ADHDers experience high rates of burnout. However, neurodivergent burnout presents and manifests differently. For example, autistic burnout can lead to increased a) exteroceptive sensitivity, b) executive functioning difficulties, and c) interoceptive confusion.

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Neurodiversity-Affirming care 

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Current therapy frameworks have been shown, both in academic research and within community advocacy, to be inadequate in meeting the support needs of neurodivergent people with eating disorders. As such, there is growing recognition of the urgent need for widespread neurodiversity-affirming (NDA) and inclusive healthcare provision in relation to eating disorders.

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For more information about Neurodiversity: 

1. Eating Disorders and Neurodivergence: A Stepped Care Approach

2. Neurodiversity: An insider’s perspective

3. Neurodiversity: What is it and why do we care?

4. Neurodivergence and Eating Disorders

5. Neurodiversity-Affirming Therapy

6. The Neurodiversity Affirming Model

7. Neurodiversity: Some basic terms and definitions

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By Laurence, 2022 - updated 2023