Considerations for Supporting Neurodivergence in Treatment for Eating Disorders

Blog Post by Dr. Tempest McDonald and Leslie Forrest, LCSW

Neurodiversity affirming treatment can be defined as supporting challenges and harnessing strengths associated with neurodivergence while focusing on treatment goals. This can include differences in needs and preferences related to spontaneity and routine, movement, sensory needs, social interactions, communication, and strong interests. Additionally, neurodivergent people are more likely to have experienced challenges with acceptance or feeling supported during treatment or in medical settings.

Incorporating a Neurodiversity Model within Multiculturally-Competent Practice

Neurodiversity is a term that broadly describes differences in the ways that people think and experience the world (McDonald, 2023). For some, neurodiversity is simply a different mix of strengths and challenges. Bradshaw and colleagues (2021) describe these differences as similar to different operating systems:

“Just because a Playstation cannot read an Xbox game does not mean it is broken or has a processing error - it is just a different operating system”

Similarly, Temple Grandin describes autism as “different, not less.” Grandin describes ways in which autism helped her become a leader in cattle ranch design, such as through being a visual thinker able to fully envision designs before putting ink to paper. But, she also describes ways that she experienced autism as a disability, such as through challenges in communication and socializing with others. Still others may view their neurodivergent condition as primarily a disability or, even, solely as a strength.

Language Use: Identity or Person First? Depends on the Individual!

How a person views their condition plays a role in the language they prefer to reference the condition. For example, people who view autism as a difference or as a strength may prefer identity first-language, such as “autistic” or “Autist.” People who view autism as an inseparable part of their selfhood use identity first language- similar to identifying with a gender, race, or ethnic group. Some people who view their condition as a disability may prefer person-first language, to show that they are not defined by their disability. Cultural competence practice will prioritize the language most preferred by each individual.

Supporting Neurodivergence in Eating Disorder Treatment and Recovery

People experiencing eating disorders, such as anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant, restrictive, food intake disorder (ARFID), are more likely to also have neurodivergent conditions such as autism and ADHD (Nickel et al, 2019). Girls and women are more likely to be underdiagnosed or receive later diagnoses of autism and ADHD. This means some people experiencing eating disorders may have one or more undiagnosed neurodivergent conditions! 

Facts about Eating Disorders & Neurodivergence:

● 20–35% of women with Anorexia Nervosa meet criteria for autism and are overrepresented among people in eating disorder treatment.

● 22.5% of eating disorders developed in childhood are ARFID and often associated with Autism (Nicely et al., 2014).

● Individuals with an ADHD diagnosis are 4x more likely to be diagnosed with an eating disorder compared to those without. ADHD has the highest correlation with bulimia nervosa and binge eating disorder. (Fernandez-Aranda, 2013; Nazar et al., 2016).

● Autistic women die by suicide at a rate 13 times higher compared to nonautistic women

● Less than 20% of females with autism have a diagnosis before age 18

Although it is currently unclear why the relationships between eating disorders and neurodivergence exists, experts agree that neurodivergent clients need neurodiversity-affirming treatment approaches to better support autistic needs during treatment 4-5. Effective treatment for eating disorders needs to account for the needs and preferences of both diagnosed -and undiagnosed- people with neurodivergent conditions.

Putting it into Practice at Aster Springs

At Aster Springs, we understand that every client is unique. We strive to support neurodivergent traits and needs viewed as important to the individual as clients make progress with ED recovery. As part of our individualized approach, we work with clients to explore ways that neurodivergent traits and strategies can overlap with eating disordered thoughts and behaviors. This may include experiences with masking, desire for control, desire for physical movement, and/or strong interests/obsessions. We work with clients to discover ways that neurodivergent needs can be met through alternative outlets of expression as part of the recovery process. We empower clients to hone self-advocacy skills in both individual recovery and/or through family therapy.

About the Contributor:

Aster Springs is a residential and outpatient treatment program that offers tailored eating disorder treatment that meets the needs of the individual by using a compassionate approach. Aster Springs is excited to announce the creation of a taskforce to improve best practices and outcomes for treating the neurodivergent population with eating disorders. The intersection between neurodivergence and eating disorders can often present complicated case studies that require the utilization of an interdisciplinary approach. Aster Spring’s multidisciplinary task force consists of physicians, therapists, dietitians, psychiatrists, occupational therapists, as well as neurodivergent communities. Including the neurodivergent community in this endeavor is Aster’s way of supporting their commitment to individualized care and clinical excellence.

Citations

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Brede, J., Babb, C., Jones, C. et al. “For Me, the Anorexia is Just a Symptom, and the Cause is the Autism”: Investigating Restrictive Eating Disorders in Autistic Women. J Autism Dev Disord 50, 4280–4296 (2020). https://doi.org/10.1007/s10803-020-04479-3

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Neurodiversity Australia (EDNA).  Eating Disorders and Neurodivergence: A Stepped Care Approach. Work commissioned by the National Eating Disorders Collaboration (NEDC)

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Grandin, T., & Scariano, M. (1986). Emergence, labeled autistic. Novato, CA, Arena Press.

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