What is Neurodiversity? 

Neurodiversity is a term used to describe the broad range of differences in people’s brains. Just like bodies come in different sizes, shapes, and colors, each brain is unique and works in its own way. The term “neurodiverse” is often used to refer to people who have neurodevelopmental conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, motor disorders (e.g. Tourette’s syndrome), and specific learning differences (e.g. dyslexia.) For the purposes of this post, I will focus on Autism Spectrum Disorder and ADHD, as these are two of the most common neurodevelopmental conditions, and they often impact people’s relationship with food and body image. 

Eating Challenges Associated with ADHD & Autism 

ARFID & Other Sensory Sensitivities

One eating issue that is particularly common in neurodiverse people is Avoidant Restrictive Food Intake Disorder (ARFID). People who suffer from ARFID have difficulty eating for reasons that do not stem from concerns about their body image. There are three primary presentations of ARFID:

1. Sensory sensitivity – Some people with ARFID eat only specific types of food, because they find the sensory characteristics (i.e. the smell, taste, texture, etc.) of other foods aversive. People with this type of ARFID often tend to eat plain foods, such as chicken nuggets, french fries, and crackers. They may become deeply upset or disgusted when faced with foods that do not align with their preferences. People with this condition may develop nutritional deficiencies as a result of their restrictive diet. 
2. Fear of aversive consequences – Another presentation of ARFID involves difficulty eating due to concerns about choking, vomiting, or having an allergic reaction. Many people who suffer from this type of ARFID have experienced a traumatic event related to food, such as choking on food or contracting an illness that resulted in vomiting. This type of ARFID can be highly impairing and can result in nutritional deficiencies and weight loss. 
3. Lack of Interest in Food – The final presentation of ARFID involves low appetite and a general lack of interest in eating. People with this presentation often report that they do not feel hungry or do not enjoy eating in the same way that others do. People with this condition may also find the sensation of fullness very uncomfortable, and they may only eat small amounts of food as a result. People with this type of ARFID may have difficulty growing and maintaining an appropriate weight. 

There are several hypotheses as to why ARFID may be more common in neurodiverse individuals. Many neurodiverse people are highly sensitive to sensory stimuli, which may make them more likely to develop the sensory sensitivity type of ARFID. People with autism often have rigid and stereotyped interests, which may extend to their relationship with food; they may become fixated on a particular dish (e.g. eating spaghetti for dinner every night.) People with ADHD may be more likely to suffer from ARFID because they can become distracted or engrossed in other activities, leading them to forget to eat. Some neurodiverse individuals have difficulty eating due to sensory stimuli that are not directly related to food. This may include the smell, lighting, or sounds in their environment at mealtimes. 

Difficulty planning and preparing meals

Neurodiverse people often experience difficulties with executive functioning (i.e. planning, focusing, remembering things, and juggling various responsibilities). Executive dysfunction can lead to difficulties with meal planning and preparation. For many neurodiverse people, planning meals, purchasing ingredients, cooking, and cleaning up afterwards takes a tremendous amount of time and effort. Neurodiverse people may find it very difficult to juggle these tasks while also managing their work, relationships, and other responsibilities. As a result, many neurodiverse individuals find it difficult to eat a sufficient and balanced diet. 

Eating problems associated with stimulant use 

Many people who have ADHD use medication to help manage their symptoms. The primary type of medications used to treat ADHD is stimulants. Unfortunately, many people who use stimulants experience side effects, including low appetite and weight loss. These side effects may make certain people more vulnerable to developing restrictive eating disorders, such as anorexia. Others may develop irregular eating habits—undereating during the day (while the stimulants are in full effect) and then overeating in the evening, after the stimulants wear off. Stimulants also carry a high risk for misuse, and some people with eating disorders misuse ADHD medications in an effort to control their weight or body shape (Pedersen et al., 2024). 

Body image and self-esteem issues associated with ADHD & Autism 

The Minority Stress Model posits that the chronic stress associated with living as a minority leads to health problems. In some cases, this may include eating disorders. Living in a world that was not built to accommodate you is very stressful. Neurodiverse individuals are often bullied or ostracized by people in their peer groups. They may also have difficulty in school, in large part because many schools do not accommodate their needs. As a result of these stressful life experiences (and perhaps due to neurological differences associated with their conditions,) many neurodiverse individuals suffer from low self-esteem. Low self-esteem and body dissatisfaction are some of the primary risk factors for the development of eating disorders. 

In the midst of the many challenges that neurodiverse people face, body image may emerge as one area in which they feel they can be perceived as “normal” and thus be accepted by others. This may create increased pressure for neurodiverse people to attain a body type that they believe others will find acceptable. In some cases, they may try to achieve this body type by engaging in disordered eating behaviors. Other neurodiverse people, particularly those in larger bodies, may experience bullying based on their body size as well as their neurodevelopmental condition. This may contribute to low self-esteem and lead them to engage in disordered eating behaviors in an effort to attain a body type that will be accepted by their peers. 

What you can do to help a neurodiverse person having challenges with food?

For friends and family: 

If you are a friend or family member of a neurodiverse person and you want to help them maintain a healthy relationship with food and body image, there are several things you can do to help. First, it is important to model the behaviors that you would like your loved one to develop. Practice regular eating (eating 3 meals and 2-3 snacks throughout the day). Model a positive relationship with your body; do not make negative comments about your body or others’. Make sure to avoid making judgmental comments about your loved one’s body or their eating habits. 

Never try to restrict your loved one’s food intake or force them to eat certain types or amounts of food against their will. If you are concerned that your loved one may have an eating disorder, you can help them search for a therapist or dietician who understands their neurodevelopmental condition. 

For people who are neurodiverse:

If you are a neurodiverse individual, you may have first-hand experience with the eating issues explored in this article. Although coping with these eating challenges may be difficult, there are tools that can help you. 

If you are struggling with eating as a result of difficulties with executive functioning, focus on eating regularly and sufficiently, rather than trying to achieve a perfectly balanced diet. If you need to rely on executive dysfunction-friendly options such a frozen meals, prepared foods, and takeout, that’s okay! Don’t beat yourself up about it. You are doing the best you can. Remember, fed is best! 

If you find it difficult to eat due to sensory sensitivities or if you think you may be struggling with an eating disorder, make sure to reach out for help. There are many therapists and dietitians who understand the eating challenges associated with neurodevelopmental conditions. 

Be sure to check out the following resources 

For finding a therapist who understands your condition: 

• https://www.psychologytoday.com/us/therapists

• https://www.eatingdisorderhope.com/directory

• https://www.edreferral.com/easysearch

For executive functioning difficulties: 

• Facebook group: “Executive Dysfunction Meals” 

• https://workweeklunch.com/executive-dysfunction-a-guide-to-eating

• https://lifeskillsadvocate.com/blog/10-ways-to-make-cooking-executive-functioning-friendly

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425787

Easton, E. (n.d.). What is ARFID? eating disorder symptoms & treatment. Eating Recovery Center. https://www.eatingrecoverycenter.com/conditions/arfid

Gibbs, E. L., Kass, A. E., Eichen, D. M., Fitzsimmons-Craft, E. E., Trockel, M., & Wilfley, D. E. (2016). Attention-deficit/hyperactivity disorder-specific stimulant misuse, mood, anxiety, and stress in college-age women at high risk for or with eating disorders. Journal of American college health : J of ACH, 64(4), 300–308. https://doi.org/10.1080/07448481.2016.1138477

McConnell, E. A., Janulis, P., Phillips, G., 2nd, Truong, R., & Birkett, M. (2018). Multiple Minority Stress and LGBT Community Resilience among Sexual Minority Men. Psychology of sexual orientation and gender diversity, 5(1), 1–12. https://doi.org/10.1037/sgd0000265

Pedersen, A. B., Edvardsen, B. V., Messina, S. M., Volden, M. R., Weyandt, L. L., & Lundervold, A. J. (2024). Self-Esteem in Adults With ADHD Using the Rosenberg Self-Esteem Scale: A Systematic Review. Journal of attention disorders, 28(7), 1124–1138. https://doi.org/10.1177/10870547241237245

Smith, M. H. (n.d.). Towards an understanding of self-esteem and eating disorders – center for change. Center for Change. https://centerforchange.com/towards-understanding-self-esteem-eating-disorders/

Written by Dariya Smith, LMSW, CSW-I

EDI Clinical Social Work Intern Therapist

In 2023, Holmes and Ma shared their views about the development of gender and beauty ideology for young Chinese females. Specifically, young Chinese women are expected to have white skin, thin bodies, and a youthful appearance. For example, many young Chinese women use various diet methods to lose weight and purchase beauty products that lighten their skin. Many of my Chinese female friends talk about their body dissatisfaction and ways they have been considering losing weight. Our lunch or dinner gatherings usually end with statements such as: “I want to eat more, but I am going to stop because I don’t want to gain weight” or “I have been lazy lately not controlling my weight, so I am not going to eat more.” These statements reveal how weight has been associated with discipline, control, and character (i.e., hard-working vs. lazy).

Many Asian women in the U.S. face the stress of wanting to fit into the dominant culture while maintaining or connecting with their native culture (Akoury et al., 2019; Zhou et al., 2022). However, skinny, fragile, and pale are the prevailing beauty standards in Asian culture, contributing to developing and maintaining disordered eating among Asian women. My mother has repeatedly told me that I need to lose weight to improve myself; otherwise, my fatness is going to scare away my husband and bring negative health outcomes. Prior to learning about eating disorder treatment, I, too, was bought into the idea that weight was a reflection of physical health and personal strength/weakness. Every time I wanted to enjoy food, my mother’s judgmental voice appeared in my mind. However, my wise mind informed me that I should be able to enjoy food and respect my body. Recognizing this conflict led me to pursue my curiosity about eating disorders and become a clinician in training at the Eating Disorder Institute Las Vegas (EDI). I am fortunate and privileged to learn about the concepts of intuitive eating, felt safety, and radical acceptance.

I began to explore my connection with food by tracing back to my earlier memories of food with my Chinese family. When I was in kindergarten, my grandfather usually picked me up from school and bought me snacks on our way home. After we got home from school, my grandparents began preparing dinner for the larger family with my uncles, aunts, cousins, and parents. At dinner time, we enjoyed our time together by discussing our school days and sharing food. Food used to represent love and care in my family. But as I transitioned into adulthood, food started to be framed as an enemy. Where food used to symbolize love and connection, now my parents cautioned me from eating too much and pushed me to exercise when I went back home for a vacation. Sadly, even when I have tried to educate them on the harm of diet culture and myths about weight gain, they continued to impose their ideology upon me. Fortunately, I have supportive friends and colleagues who build a safety network for me. I believe this has prevented me from developing disordered eating or negative self-talk around my body.

In a 2023 TED talk with over 2000 views, Jiang shared her story as a Chinese woman living with an eating disorder. Similar to my experience, she also pointed out how Chinese culture connects weight, food intake, and success. She also spoke about mental health stigma being a main barrier when it comes to seeking professional support. I related to her when she talked about mental health literacy among Chinese individuals and the lack of information about eating disorders or any mental health disorders in Chinese language/writing. When I shared my knowledge about mental wellness and mental disorders with my parents, they quickly switched topics; when they shared stories about relatives having mental health concerns, my parents usually made comments about how my relatives could not “just get over it.” I tried to make culturally appropriate recommendations about enhancing mental wellness, but my parents often disputed my sharing by saying that I was only “textbook smart.”

ne of the many barriers. Jiang also talked about the lack of culturally relevant practices and representation for Chinese women with eating disorders. In my career journey of becoming a health service psychologist, I am either the only one or one of the two Asian females in the classrooms or training sites. Many of the evidence-based treatments available for treating various mental health disorders are based on research studies on White individuals. Despite the development and promotion of culturally relevant, evidence-based practices in the field, the access to and quality of care for Chinese individuals is concerning. Jiang shared an example of how the meal plan provided by her treatment team was hard for her to follow because Chinese food could not be easily examined in terms of its fat, carbohydrate, and protein.

In sum, Chinese females must face many obstacles along their path of identification, assessment, and recovery from an eating disorder and/or other mental health disorders. Therefore, here are my recommendations for mental health providers working with people of color with an eating disorder:

• Spend time exploring and understanding our clients’ cultural identities and social positions (e.g., gender identity, sexual orientation, class, nationality)
• Explore existing research and literature on eating disorders and mental health disorders among marginalized individuals and communities
• Engage in self-reflection about our privileges, biases, and prejudices about food, weight, and mental health
• Participate in continuing education to learn about up-to-date information about eating disorders and culturally relevant, evidence-based treatment
• Conduct research to understand the experiences of Asian individuals with diverse gender identities, which will inform clinical practices centered on healing and empowerment.

References

Akoury, L. M., Warren, C. S., & Culbert, K. M. (2019). Disordered eating in Asian American women: sociocultural and culture-specific predictors. Frontiers in Psychology, 10, 1950. https://doi.org/10.3389/fpsyg.2019.01950

Cheng, Z. H., Perko, V. L., Fuller-Marashi, L., Gau, J. M., & Stice, E. (2019). Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eating Behaviors, 32, 23–30. https://doi.org/10.1016/j.eatbeh.2018.11.004

Holmes, S., & Ma, H. (2023). A feminist approach to eating disorders in China: a qualitative study. Journal of Eating Disorders, 11(1), 157-173. https://doi.org/10.1186/s40337-023-00883-z

Jiang, A. (2023, February). Fat, Asian and living with an eating disorder [Video]. TED Conferences. https://www.ted.com/talks/anne_jiang_fat_asian_and_living_with_an_eating_disorder?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 51(6), 518–526. https://doi.org/10.1002/eat.22846

Zhou, Z., Liew, J., & Luo, W. (2022). Acculturation and disordered eating among Asian American College students: the role of objectification through a sociocultural lens. International Journal of Environmental Research and Public Health, 19(21), 13967. https://doi.org/10.3390/ijerph192113967

Written by Yin Cai, MS, M. Ed

EDI practicum student

            I get it. Diet culture and wellness culture frame hunger as a bad thing, subtly signaling that if you’re not 100% certain you’re hungry, you probably shouldn’t eat. We paint eating in this context as inappropriate, immoral, or even harmful. Slowly we learn to second guess our internal cues. We’re told, “You can’t be hungry. You’re probably just bored or thirsty.” Understandably, we begin to doubt ourselves and look to external sources, like the clock or calories, to police our appetite.

            But the truth is, from the moment you were born, you had the instinct to eat. (Otherwise, you wouldn’t be here now). Long before you were able to rationalize, you trusted physical sensations that indicated your energy was waning, then you fussed, or cried, or even screamed to let your caregivers know you were hungry. And when you’d had enough, no amount of cajoling could get you to eat more. This reliance on our internal cues is called interoceptive awareness and it’s the way we were meant to relate to our biological needs.

            You did not feel self-conscious about the sensation you were feeling or responding to as an infant. You did not need others around you to also be hungry to give you permission to eat. Nor did you refer to Instagram or TikTok to reassure yourself. You trusted your body, even if it had only been a short time since you last ate, no matter how many calories you had eaten. You trusted your gut, so to speak.

            Trusting your interoceptive awareness is key to Intuitive Eating and has all sorts of positive physical and mental health benefits, like improved quality of life, improved metabolic panels, and protection against developing or relapsing from an eating disorder. Plus, eating enough and eating regularly are key to maximizing your metabolic efficiency, advice you will rarely, if ever, hear from a wellness influencer, or even your medical doctor, but it’s true.

Let’s review the potential signs and symptoms of hunger, so you know what to look for:

• Thinking about food
• Headaches
• Irritable or easily annoyed
• Bad breath or a weird taste in your mouth
• Nausea
• Hiccups
• Salivating
• Burping
• Trapped gas
• Bloating
• Difficulty making decisions
• Losing focus
• Heartburn or acid reflux
• Feeling increasingly agitated, uncomfortable, or restless
• Fatigue
• Sweating (without being in a hot place)
• Anxiety or panic
• Stomach growling, gurgling, or rumbling

            This blog post would not be complete without including a caveat: people with active eating disorders should never attempt to go straight to Intuitive Eating because they have unreliable hunger and fullness cues, or sometimes none at all. Typically, this is a result of consistently denying these signals throughout the course of the disorder as well as problematic low energy availability. Early satiety (a.k.a. false fullness) brought on by slowed digestion, extreme hunger, prolonged periods of time with no nutrition, and anxiety, help us to understand why we also can’t trust our fullness at this point.

            And it’s not just people with active eating disorders who will have difficulty relying on interoceptive cues. Dysregulated hunger and fullness cues are also likely if you have been on a diet, lost weight in the last couple of years, or if you have had a history of disordered eating. Keep in mind that interoceptive awareness can also be more complicated for folks who are neurodivergent, and for those who take certain medications, such as stimulants, which can greatly impact appetite. Stress, illness, depression, and pain, can also make it difficult to mindfully attune to our bodies’ internal cues.

            For anyone with dysregulated interoceptive cues, regular eating in the absence of hunger is essential to being properly nourished and healing from the trauma of deprivation! Hence, why meal plans and regular, consistent eating (three meals and two to three snacks per day) are such a common and necessary part of the recovery process.

            So, the next time you notice one of the potential signs and symptoms of hunger, and you are tempted to ignore it, consider trusting your gut. Try eating a hearty meal or snack and see if the feeling resolves. If so, this is likely a sign of hunger, even if you don’t think you “should” be hungry. And remember, honoring your hunger is a health promoting behavior, no matter what size body you reside in.

Also, Dr. Ricciardi was just featured in this online article in the UNLV News Center on this topic: “Lindsey Ricciardi’s dedication to treating eating disorders and serving the community makes her stand out as the Liberal Arts Alumna of the Year.”

Lindsey Ricciardi:
’01 MA Clinical Psychology, ’05 Doctorate Clinical Psychology
College of Liberal Arts Alumna of the Year

Lindsey Ricciardi has devoted her adult life to a singular noble mission: Uplifting those who suffer from eating disorders and related concerns while striking down the associated psychological and social stigmas.

She’s done it as a UNLV student (graduate and doctorate), a postdoctoral fellow, a licensed clinical psychologist, a clinical eating disorder specialist, a business owner, and through various leadership positions with the Nevada Psychological Association (including serving as president).

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