Feeding and eating disorders are more common in neurodiverse individuals. In this article, we’ll explore what it means to be neurodiverse, the challenges associated with eating as a neurodiverse person, and what helps neurodiverse people with eating problems.
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:
- 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.
- 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.
- 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:
For executive functioning difficulties:
- Facebook group: “Executive Dysfunction Meals”
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
