Eating Disorders and the Intersection With ADHD & Autism: The Importance of Neurodiversity-Affirming Therapy

By: Olivia Kline, EDC Administrative Assistant
Reviewed by & Written In Collaboration with Jennifer Rollin, MSW-LCSW-C

There is a big intersection for those struggling with eating disorders who are also autistic and/or have ADHD. At The Eating Disorder Center in Rockville, MD, our neurodiversity-affirming eating disorder therapists are passionate about this intersection.
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Neurodivergent individuals often face challenges related to ableism in our society, and many neurodivergent individuals have experienced trauma as a result of ableism. It’s so important for therapists to be neurodiversity-affirming providers, so they can empower and validate neurodivergent folks. Variance among humans should be celebrated — not seen as a flaw or problem. Neurodivergent individuals often have a unique set of strengths, which is important to highlight and explore in therapy.

As therapists, we want to acknowledge both the strengths and challenges that neurodivergent individuals may face. Over the past decade, there has been an increased societal recognition of neurodiversity, and the media has also shined light on this. While this attention to neurodiversity is a great way to educate us on what neurodiversity is and its prevalence, there is also a gap in the discussion about the co-occurring challenges faced by neurodiverse populations (including autistic individuals and individuals with ADHD). Please note that we use the word ‘autistic,’ as that is generally the preferred term for folks. However, of course, we respect the terminology that individual clients use.

Autistic individuals often face challenges when engaging in social and communicative interactions (Longhurst & Clark, 2022). This can be a challenge due to how our society is pretty geared towards neurotypical individuals. Additionally, autistic individuals often experience sensitivity to noises, smells, tastes, and/or touch. This experience of sensitivity to the texture or taste of foods can impact food intake, and it may result in a diagnosis of Avoidant Restrictive Food Intake Disorder (ARFID). ARFID is an eating disorder where individuals only eat a select number of foods and may have a low interest in food overall. ARFID diagnoses occur in 1.5% of the general population. However, in autistic populations, 12.5% to 33% have an ARFID diagnosis (Harris et al., 2019). In other words, ARFID is diagnosed 12 to 33 times more in autistic individuals than in others. While reading this statistic can feel daunting, being informed of this association can also help us obtain resources to elicit better outcomes for autistic populations. Additionally, it’s important to note that other eating disorders can occur in autistic individuals, such as anorexia, bulimia, binge eating disorder & OSFED. Eating disorders do not discriminate and may impact people of diverse neurotypes. 

Other forms of neurodiversity, such as Attention Deficit/ Hyperactivity Disorder (ADHD), are also associated with eating disorders. ADHD is characterized by symptoms of inattention, impulsivity, and hyperactivity. In a nationwide sample, a study found that individuals diagnosed with ADHD were also more likely to be diagnosed with an eating disorder or to experience symptoms of an eating disorder (Bleck et al., 2015). Specifically, those with ADHD were about 8 times more likely to report an eating disorder or symptoms of a clinical eating disorder. These results exhibit an association between ADHD and eating disorders, but they do not mean ADHD causes eating disorders. Being aware of the association between eating disorders and ADHD can help clinicians recognize the symptoms and connect clients with support.

ADHDers often struggle with executive functioning, which can make meal planning and cooking challenging. Additionally, some ADHDers find it harder to notice and interpret hunger cues, and therefore may experience challenges when it comes to this. Further, at times, hyperfocus in ADHD may cause it to be hard for ADHDers to “break away” from what they are doing at the moment to eat a meal. Moreover, some folks with ADHD may hyperfocus on negative thoughts about their body. It’s important for therapists to be aware of how ADHD can impact someone’s relationship with food and their body.

From a clinician’s perspective, it is important to consider ways to affirm neurodiversity and to alter eating disorder treatment so it’s more effective for neurodivergent individuals. Research suggests that being aware of clients’ challenges and strengths can help clinicians adjust treatment plans for more successful outcomes (Li et al., 2021). For example, clinicians could enhance treatment for autistic clients who prefer schedules and routines by making plans that build off of this strength. Likewise, treatment adaptations can be implemented for clients with ADHD. Clinicians can acknowledge and adapt to clients’ attention spans, while encouraging the use of mindfulness techniques to stay present. Adding structure or helping individuals make plans can also improve treatment outcomes for clients seeking help related to impulsivity. 

It is important to receive treatment from a clinician who understands the different obstacles that impact treatment in neurodiverse populations and who knows how to build on the strengths that come with neurodiversity. At The Eating Disorder Center, we have clinicians on our team with experience working with neurodiverse populations on their eating disorder recovery journeys. We are neurodiversity-affirming therapists, and we are passionate about the intersection of neurodiversity and eating disorders.
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We can help you start your recovery and support you in recovery from an eating disorder! We have therapists who provide neurodiversity-affirming eating disorder therapy in Rockville, Maryland, as well as virtually throughout Maryland, DC, Virginia and Florida. Plus, we have eating disorder recovery coaches worldwide to assist you through your journey. 
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Interested in a free 15-minute consultation with one of our clinicians? Fill out our contact form  or give us a call at 301-246-6856!

*Disclaimer: As a neurodiversity-affirming provider, The Eating Disorder Center respects clients’ preferred terms.

Schedule a free 15 min consult for eating disorder therapy in MD, VA, DC, NY, FL, or recovery coaching worldwide.
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The Eating Disorder Center is a premier outpatient eating disorder therapy center founded by Jennifer Rollin. We specialize in helping teens and adults struggling with anorexia, binge eating disorder, bulimia, OSFED, and body image issues. We provide eating disorder therapy in Rockville, MD, easily accessible to individuals in Potomac, North Potomac, Bethesda, Olney, Silver Spring, Germantown, and Washington D.C. We also provide eating disorder therapy in Arlington, Virginia and virtually throughout Virginia. Additionally, we offer eating disorder therapy virtually in New York (NYC), Florida, and California. We provide eating disorder and EMDR trauma therapy in Rockville, Maryland and virtually throughout Maryland. We provide eating disorder recovery coaching via Zoom to people worldwide. Connect with us through our website at www.theeatingdisordercenter.com

References: 

• Bleck, J. R., DeBate, R. D., & Olivardia, R. (2015). The comorbidity of ADHD and eating disorders in a nationally representative sample. The journal of behavioral health services & research, 42, 437-451.
• Harris, A. A., Katzman, D. K., Norris, M. L., & Zucker, N. L. (2019). 1.50 Avoidant/Restrictive Food Intake Disorder (ARFID) AND ASD. Journal of the American Academy of Child & Adolescent Psychiatry, 58(10, Supplement), S162–S163. https://doi.org/10.1016/j.jaac.2019.08.072
• Li, Z. , Halls, D. , Byford, S. , & Tchanturia, K. (2022). Autistic characteristics in eating disorders: Treatment adaptations and impact on clinical outcomes. European Eating Disorders Review, 30(5), 671–690. https://doi.org/10.1002/erv.2875
• Longhurst, P., & Clark, L. (2022). Integrating the Autistic Experience Into Existing Models for Disordered Eating. Frontiers in Psychology, 13, 926415.
• Modestino, E. J., Blum, K., Oscar-Berman, M., Gold, M. S., Duane, D. D., Sultan, S. G. S., & Auerbach, S. H. (2015). Reward Deficiency Syndrome: Attentional/Arousal Subtypes, Limitations of Current Diagnostic Nosology, and Future Research. Journal of reward deficiency syndrome, 1(1), 6–9. https://doi.org/10.17756/jrds.2015-002