Neurodivergence and Eating Disorders: Are They Related?

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The implication that eating disorders and neurodivergence share common pathways has circulated for years, despite little research. But psychotherapists and folks who suffer from an eating disorder can attest to what often seems a convergence of conditions.

“I feel so different from everyone else,” bemoaned Tara, a psychotherapy client (whose name is changed to protect confidentiality). “Holding on to my eating disorder helps me cope with the kids at school and my worries about grades. I know I don’t fit in… but at least I have my eating disorder.”

In my psychotherapy practice, I have worked with hundreds of clients over the past 40 years who struggled with an eating disorder – mostly women, but also men and those who identify as non-binary. Their intelligence, drive to excel, heightened sensitivity, and depth of thinking are striking. Some have a diagnosis of ADHD (attention deficit hyperactivity disorder) or social and emotional reactivity associated with ASD (autism spectrum disorder). Some are perfectionistic and impatient; others are impulsive and engage in self-harm. Many are highly anxious, self-conscious, and despondent about social injustice; frequently, they are cognitively gifted (with an IQ of 130 or higher).

This begs the question: Is neurodiversity or giftedness a trigger for an eating disorder?

First, a quick overview:

Neurodivergent individuals process information differently from what is typical. Gifted cognitive abilities, autism, ADHD, sensory processing difficulties, and learning disabilities are common examples, and often there is some overlap among these conditions.

Anorexia, bulimia and binge eating disorder are the most commonly recognized eating disorders, with hallmark features that include:

• a preoccupation with food, weight and body image.

• an unhealthy change in eating patterns, such as restrictive eating, compulsive overeating, or a cycle of binge eating and compensatory attempts to prevent weight gain through use of purging behaviors or excessive exercise.

• psychological effects, such as obsessive thinking, anxiety, low self-esteem, depression, a distorted body image, and shame and secrecy about the disorder.

• medical complications, including extreme weight loss (or gain), cessation of menstrual periods, gastrointestinal disturbances, or an electrolyte imbalance.

ARFID (avoidant/restrictive food intake disorder) is another condition, but is not accompanied by body image disturbance and more frequently occurs among young children. Obesity is not necessarily associated with an eating disorder, although eating disorders can be overlooked, especially when restrictive dieting is perceived as a virtue rather than a risk factor.

According to the non-profit eating disorder advocacy group ANRED, the estimated prevalence of anorexia is 1% and bulimia is 4%. Although commonly viewed as a disorder found among privileged, white women and girls, eating disorders are represented among men (approximately 5-10% of individuals with anorexia and 10-20% with bulimia are male), persons of color, LGBTQ+ populations, and even military veterans.

While a genetic or biochemical predisposition is often necessary for the development of an eating disorder, other risk factors include dieting, depression, anxiety, body image dissatisfaction, or a history of sexual abuse or severe physical abuse. Although it might seem counterintuitive, gaining control over food intake is often an attempt to suppress emotions. For example, worrying about calories, planning restrictive meals, or finding a secret place to binge can be a distraction from other distressing feelings.

The convergence of eating disorders and neurodiversity

There is little research about the convergence of neurodiverse conditions and eating disorders. In their review of the few available studies, researchers Kathrin Nickel and colleagues concluded that neurodiversity “may constitute a vulnerability factor for eating disorders.” They also note that eating disorders typically develop during puberty – a stressful time due to hormonal, social, and academic challenges, which can be particularly difficult for neurodivergent individuals.

In an earlier literature review, researchers Vanessa Huke and colleagues reported a greater prevalence of autism spectrum disorder among individuals with eating disorders, as opposed to healthy control participants. And in another review, researchers Filippo Maria Villa and colleagues found that 20% of children with ADHD develop an eating disorder. Despite limited research, the intersection between eating disorders, giftedness, and neurodivergence is often evident in psychotherapy, as I discussed in a recent interview on the Exceptional Girls podcast.

The convergence of giftedness and eating disorders seems like a perfect storm. Gifted individuals, with their propensity toward overthinking, perfectionism, heightened sensitivities, and overexcitabilities may be at risk for developing eating disorders. Other than anecdotal accounts or clinical case studies, little research is available. However, researchers Sally Beisser and Catherine Gillespie recently studied a sample of gifted teens and found that 20% held negative attitudes about body image and eating behaviors, which can be risk factors for onset of an eating disorder.

Twice-exceptional individuals, who are both gifted and neurodivergent, may be at even greater risk. In a qualitative dissertation study of the lived experience of twice-exceptional, highly sensitive adults, eight of the thirteen participants reported a history of anorexia, reported researcher Sandra Clifton.

How can you help your child (or friend, student or family member) if they have an eating disorder?

An individual’s neurodivergence or giftedness impacts who they are… and it also will play a role in eating disorder treatment and recovery. An understanding of giftedness or twice-exceptionality (where giftedness coincides with a neurodivergent condition) is essential for family, friends, educators, and treatment professionals in order to help any gifted or neurodivergent person struggling with an eating disorder.

National Eating Disorder Awareness Week is a reminder that identification and treatment of eating disorders is critical. (See resources listed at the end of this article for more information.)

Here are a few tips:

1. Insist that your child (or other loved one) get help. Don't take no for an answer. The sooner the problems are addressed, the easier the path to recovery. Addressing the underlying cause and taking active behavioral steps to change are essential. Eating disorders treatment requires a team approach. Outpatient treatment typically includes individual and family therapy, nutrition counseling, group support, and medical monitoring. If outpatient therapy is not enough, sometimes inpatient or day treatment programs are helpful for symptom reduction.

2. Find a comprehensive treatment team. This should include a licensed mental health professional, registered dietitian, and physician who specialize in eating disorders. I have encountered troubling situations where a therapist overlooked the severity of symptoms or where a physician downplayed the problem, commenting to the patient that “you don’t look too thin.”

Check with your pediatrician, school counselor, spiritual leader, or other trusted sources for referrals for psychotherapy, nutrition counseling and possibly, inpatient or day treatment programs. Some online sites, such as EDReferral, also may provide some resources. Your insurance company may be the worst referral source, though, since they frequently offer recommendations without regard to your specific needs.

Steer clear of advice from a personal coach or unlicensed nutritionist or fitness trainer who lacks training in the field and may offer advice that could worsen the condition. For example, dietary "cures" sometimes touted by those untrained with eating disorders or the nutritionist at your gym who focuses on weight loss can backfire and add fuel to the fire. Trust your child's and your own instincts about a therapist, even if the referral comes from someone you trust. This is an investment in your child's health, and all of you need to feel comfortable with whomever you choose.

3. Develop a plan if your child refuses therapy. If you have concerns about their health (e.g., weight loss, purging behaviors), take your child to their pediatrician, who can evaluate their symptoms and encourage them to participate in treatment. See if other trusted adults can speak with them about going to therapy.

If they still refuse to see a psychotherapist, they might be more open to meeting with a registered dietitian, who can work with them collaboratively to develop a healthy meal plan. If they cannot follow the meal plan, then you have more data to point out the need for additional treatment. Another option might be to suggest family therapy so they don’t feel targeted as the one with a problem. You might let them know that meeting together with a family therapist might help you understand their perspective. If they see that they are not blamed and that dialogue about how their eating affects the family is not threatening, they may be more open to additional treatment.

4. Get support for yourself. While it is important to respect your child's privacy, ask them if you may speak with a close family member or friend. When your child struggles, you suffer as well. As I have stressed in my book, The Gifted Parenting Journey, parenting support is essential. If you need additional guidance, therapy, eating disorders support groups, or even online groups can be helpful. As difficult as it is, know that your involvement and concern send a powerful message of support and encouragement to your child and aids in their eventual recovery.

Websites with helpful information and resources about eating disorders:

National Eating Disorders Association

Anorexia Nervosa and Associated Disorders

Anorexia Nervosa and Related Eating Disorders

Some passages from this article were previously published on my blog, Gifted Challenges.

Please share your thoughts, ideas, or suggestions in the comments section below.