Picture this: You’ve been in eating disorder treatment for a long time. Perhaps many months, perhaps several years. Perhaps even the better part of your lifetime. And you’re in a better place than you were when you first started. Perhaps you’ve regained enough weight that you’re no longer suffering serious medical complications. Perhaps you’ve managed to gain control over some of your eating disorder behaviors, like binging and purging.

But at the end of the day, you’re still suffering. You still count calories or fat grams or carbs. You still avoid certain foods. You still make sure to exercise every day, and you feel anxious and overwhelmed if you don’t. You still hate your body.

And you start to wonder, is this what recovery is? A constant struggle—never feeling at ease in your own body, or in your relationship with food? Struggling every day to find some way to stay alive while still maintaining a sense of control over your body? Out of hell, but still in purgatory?

Have you ever felt this way?

If you have, you are not alone. This is a stage called partial remission, or what I like to call pseudo recovery.

What is pseudo recovery?

The word “recovered” often gets thrown around as though it has a clear-cut definition. Yet in reality, it’s not as simple as “sick” or “recovered.” Recovery happens on a continuum.

In the early stages of recovery, patients work toward recognizing the seriousness of their eating disorder and building motivation to change. In the middle stages, patients begin to make changes—eating more consistently, cutting back on binging and purging, and limiting compulsive exercise. In the final stages of recovery, patients work towards improving their self-esteem and learning to accept their bodies unconditionally (Costin, 2011).

But here’s the catch: many patients get stuck somewhere in the middle stages of recovery. They let go of some eating disorder behaviors, but not others.  They may attain a “normal” BMI but continue to restrict their eating in an effort to ensure that they do not gain any more weight. They may eat three meals each day but continue exercising excessively. They may eat normally but continue to compulsively body check and insult their bodies.

Why do people get stuck in pseudo recovery?

People get stuck in pseudo recovery in part due to the nature of eating disorders, and in part due to problems inherent in the way that eating disorders are treated.

People in pseudo recovery often struggle to acknowledge that they still have a problem, because they feel like things are so much better than they were before. Even those who recognize that they are still sick are often hesitant to make the changes necessary for full recovery, because they fear that letting go of the perceived “control” they have over their weight will make them feel even worse.

In addition, many treatment programs do not adequately encourage patients to pursue full recovery. For patients with anorexia, many treatment programs focus on getting them to eat enough to maintain a minimally normal weight. However, there may be a big difference between the amount of food that is sufficient to keep someone at their target weight and a truly normal diet. This is in part because many eating disorder programs set target weights far too low, so patients have to continue restricting in order to maintain the target weight that was set for them (Boring, 2020).

There is also a push among providers to keep treatment as short as possible, to avoid interfering with people’s lives. Providers are often taught that once people get to a certain place in recovery, they will continue making progress even without any outside support (Fairburn, 2008). This is not necessarily true. Many patients continue to struggle with disordered behaviors and thinking patterns, long after they are weight restored (Van Bree et al., 2023).

What are the risks associated with pseudo recovery?

Patients who only achieve partial weight restoration, those who continue engaging in disordered eating behaviors, and those who continue to struggle with body dissatisfaction are all at higher risk for relapse (Keel et al., 2005; Sala et al., 2023).

Even in cases where patients can control their eating disorder enough to avoid relapse, their quality of life suffers immensely due to the thoughts and behaviors associated with their eating disorder.

Our Approach

We believe it is best to treat the patient’s eating disorder until they are fully recovered, rather than release them from treatment as soon as they are able to survive without us. We try to help people get fully recovered before releasing them from treatment, because we don’t just want people to survive; we want them to live.

We want them to be able to go out for dinner with a friend or a lover without worrying about how many calories are in their meal. We want them to eat cake on their children’s birthdays without feeling guilty afterwards. We want them to go swimming with their friends and be present in the moment, rather than being wrapped up in checking and criticizing their bodies. We want them to go on vacation with their families and enjoy time sleeping in and relaxing on the beach, rather than spending their mornings holed up in the hotel gym.

Survival is not enough; we want freedom.

What can you do if you are in pseudo recovery?

Pseudo recovery is a tough place to be. Some people believe that an eating disorder will always be with someone and they just have to accept it. We beg to differ. If you are stuck in partial remission, there are steps you can take to move in the direction of full recovery.

Identify the behaviors that are keeping your eating disorder going (dieting, body checking, compulsive exercise, etc.), and work with a therapist on eliminating these behaviors completely. The eating disorder is like a weed that grows in your garden, choking the life out of the flowers. If we only trim the leaves off the weeds, they will continue to grow back. We have to tear them out root and stem to give the flowers a chance to grow.

Embrace an anti-diet, Health at Every Size approach. In addition to eliminating eating disorder behaviors, it’s important to challenge the entire ideology that underlies your eating disorder. Recognizing the inaccuracies and inequities inherent in diet culture will help you to let go of these influences for good.

If you are suffering from an eating disorder, you deserve true recovery. We try to help people get to full recovery before ending treatment. We don’t just want people to survive; we want them to thrive.

References:

Cognitive Behavioral Therapy and Eating Disorders by Christopher G. Fairburn

Eight Keys to Recovery from an Eating Disorder by Carolyn Costin

https://onlinelibrary.wiley.com/doi/10.1002/eat.23950

https://www.sciencedirect.com/science/article/abs/pii/S002239562300002X

You’re told to ‘fight aging’ with pricey products, cut carbs after 40, and chase the body you had at 25. But what if all these messages are making you sicker—not stronger?

Diet culture is a belief system that elevates thinness, restricts foods, and moralizes body size and weight. Unfortunately, diet culture is all around us, and it has been well documented to erode physical and mental health.

Ageism involves stereotyping or discriminating against people because of age. Similar to diet culture, we are surrounded by ageist messages.  Research has determined that ageism contributes to poorer self-rated health, higher chronic stress load, and even earlier mortality.

When these dubious forces intersect, older adults receive a double dose of dangerous messages that their bodies are “wrong” unless they remain both thin and ageless. The result? Heightened risk for disordered eating, malnutrition, and delayed medical care.

Contrary to popular belief, large reviews show that 2 %–8% of women over 40 meet full criteria for an eating disorder, with binge eating disorder the most prevalent. Eating disorders do not age out. Eating disorders impact individuals of all ages.

Diet culture and ageist messages and their associated risks

How wellness culture and longevity medicine contribute

If contending with diet culture and ageism weren’t enough, we also must deal with wellness culture and longevity medicine. Wellness culture is a set of values that equates wellness with moral goodness and posits certain behaviors – and a certain type of body – as superior and virtuous compared to others.

Longevity medicine is an emerging field focusing on extending healthy lifespans (healthspans). Longevity medicine aims to prevent aging and delay age-related diseases, encompassing biogerontology, geoscience, and preventive and functional medicine. Longevity medicine includes optimizing diet and supplementation for “healthy” aging.

Both wellness culture and longevity medicine perpetuate the idea that we are solely responsible for, and able to, change and control our health through rigorous effort, and diet and exercise prescriptions. Thinness continues to be an underlying and quiet priority.

It is important to understand and recognize diet culture, ageism, wellness culture and longevity medicine for what they are – billion-dollar industries that prey off our insecurities and cause society more harm than good.  

Practical mindset shifts

Below are a few examples of ways to shift thinking to reflect your values and priorities, while rejecting diet culture and ageism messages.

When to seek professional care

Sometimes conforming to ageism and diet culture can spiral too far and become a dangerous obsession. It is important to seek help if you experience the following:

• Persistent food rules, shame, or body anxiety at any age.
• Rapid weight change (loss or gain) without medical explanation.
• GI symptoms, sleep disruption, or bone pain alongside restrictive eating.

The Eating Disorder Institute of Las Vegas offers weight-neutral, age-affirming nutrition therapy, counseling, and medical oversight. Early intervention preserves bone, muscle, and metabolic health.

Final encouragement

Aging is not a pathology; it is a natural, meaningful stage of life. Nourishing your body—with protein to rebuild, carbs to energize, fats to protect, and micronutrients to heal—honors both your present needs and future potential. Reject the notion that you must stay perpetually “youthful” or “small” to be worthy. Your value is inherent, and wise nutrition is about nourishing the life you do want to live—full of strength, connection, and purpose.

References:

• Equip Health. (2025). What Is Diet Culture? Equip Health.
• Schwartz, J., et al. (2022). Experiences of Everyday Ageism and the Health of Older US Adults. JAMA Network Open. JAMA Network.
• Ober, A., et al. (2023). Update on the Epidemiology and Treatment of Eating Disorders in Midlife. Current Opinion in Psychiatry. PMC.
• Battaglini, C. L., et al. (2021). Exercise Mitigates Caloric-Restriction-Induced Bone Loss in Older Adults. Medicine & Science in Sports & Exercise. PubMed.
• Tarasenko, Y. N., et al. (2024). Body Composition and Menopause Symptoms. Menopause. PubMed.
• Nutter, S., et al. (2023). Perceived Weight Stigma in Healthcare Settings. Obesity Science & Practice. PMC.
• McKinsey & Company. (2024). Trends Defining the $1.8 Trillion Global Wellness Market in 2024. McKinsey & Company.
• Harrison, C. (2023). The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses, and Find Your True Well-Being. Little, Brown Spark.
• Enfield, D. (2025, April). The Intersection of Ageism and Diet Culture: Why Aging Increases Risk for Disordered Eating (but Doesn’t Have To!) [PowerPoint presentation]. EDRD Pro. https://edrdpro.com/courses/the-intersection-of-ageism-and-diet-culture-why-aging-increases-risk-for-disordered-eating/lessons/the-intersection-of-ageism-and-diet-culture-why-aging-increases-risk-for-disordered-eating-webinar/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC10552830/

“I just need to get over it”

“I shouldn’t feel bad, other people have it worse”

“My feelings are irrational”

“I’m just being dramatic”

“I should be happy”

“I’m just being weak, I need to toughen up” 

Sound familiar? Maybe you’ve even had one of these thoughts today? All of these are examples of the things many of us tell ourselves (sometimes daily) that completely invalidate our own emotions. Unfortunately, we live in a society that often drills this kind of messaging into our heads. We’re taught that emotions are bad and we’re supposed to get rid of them right away, otherwise we are “out of control,” undisciplined, irrational, etc. For some, these messages are internalized directly from parents, caregivers, and other loved ones.

This kind of invalidating self-talk can be incredibly damaging. Our emotions exist for a reason and they don’t just go away if we make ourselves feel bad for having them. Emotional invalidation has been identified as a contributing factor in the development and maintenance of a number of mental health problems, including eating disorders. Some folks use disordered eating behaviors to numb emotions, distract from distress, and assert a sense of control. Sometimes, often subconsciously, eating disorders can actually be a means of obtaining both external and internal validation, especially for those who have experienced chronic invalidation.

The Role of Self-Validation in Recovery

The practice of self-validation can serve as a foundation for building healthier coping strategies and fostering recovery. It involves recognizing and accepting one’s own emotions and other internal experiences, without judgement. When we self-validate, we are communicating to ourselves that our emotions make sense and we have a right to feel the way we do. Importantly, self-validation does not mean we are endorsing every behavior or impulsive reaction we may have. It is simply labeling the internal experience as real and meaningful. Once we do that, we are in a much better position to determine which next step could be most effective.

By practicing self-validation, individuals can:

• Reduce internal shame and self-criticism
• Improve emotional regulation
• Strengthen self-compassion
• Enhance resilience during the recovery process

Self-validation helps us to feel empowered to utilize our emotions to better our lives, as opposed to invalidation, which often leaves us feeling stuck and ashamed. Self-validation enables us to meet our emotional experiences with understanding rather than judgment, which is essential in creating lasting change.

Practical Strategies for Building Self-Validation

Below are some strategies for strengthening this skill:

1. Label Emotional Experiences
Research indicates that naming emotions—often referred to as affect labeling—helps reduce emotional arousal and increase emotional clarity. Taking time to accurately identify feelings can reduce distress and provide insight into underlying needs.

2. Acknowledge That Emotions Are Understandable
Rather than judging or dismissing emotions, it is helpful to view them as understandable reactions to life experiences. This perspective creates space for self-compassion and reduces shame.

3. Practice Nonjudgmental Self-Talk
Replacing harsh internal dialogue with supportive, compassionate statements strengthens emotional resilience. Consider, how would I respond to a friend or loved one in this situation.

4. Normalize Emotional Struggles
We all have emotions and we all have trouble dealing with them sometimes. Viewing emotional setbacks or challenges as part of the human experience reduces isolation and fosters perseverance.

5. Reflect Through Writing
Journaling can be a great way to validate and process our emotions. Writing without judgment allows us to recognize and honor our internal experiences.

Final Reflections

Developing self-validation is not an overnight process. For many individuals in recovery from eating disorders, years of self-criticism and emotional avoidance cannot be undone instantly. However, with intentional practice and therapeutic support, self-validation can become a powerful tool for healing.

Acknowledging emotions without judgment provides the emotional foundation necessary to sustain recovery efforts. It allows individuals to move away from the cycle of shame and secrecy that so often accompanies eating disorders, and instead move toward resilience, authenticity, and well-being.

Recovery is not only about changing behaviors; it is also about cultivating a compassionate, accepting relationship with oneself. Through the practice of self-validation, that relationship can be nurtured and strengthened, offering a lasting pathway toward health and wholeness.

References:

• Fairburn, C.G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509-528.
• Goss, K., & Allan, S. (2009). Shame, pride and eating disorders. Clinical Psychology & Psychotherapy, 16(4), 303-316.
• Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.
• Lieberman, M. D., et al. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421–428.
• Mountford, V. A., Haase, A. M., & Waller, G. (2007). Is there a measure of the function of eating disorder symptoms? Clinical Psychology & Psychotherapy, 14(4), 329–335.
• Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101.
• Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), The Oxford Handbook of Health Psychology.

The holidays can be an especially challenging time to struggle with body image for many people. We’re around friends and family whose opinions we care about, we’re surrounded by novel foods and body/diet talk…it can all be overwhelming! So here are some tips and tricks from an eating disorder therapist on how to make this holiday season more comfortable, physically and emotionally.

1) STOP BODY CHECKING

            Body checking involves doing repetitive behaviors to assess your body’s shape or weight. Body checking behaviors include:

• Frequently weighing
• Measuring your body, either with measuring tools or your hands
• Pinching and squeezing “problem” areas
• Staring in the mirror for long periods of time, especially from all angles
• Taking multiple pictures to compare to your past or future self, or to assess current body shape/weight

Body checking behaviors can make us feel like we’re in control of our body shape because we are constantly aware of it, and they contribute dramatically to lower body image satisfaction. A commitment to avoiding these behaviors and replacing them with other, more effective coping strategies can get our bodies off our minds long enough for us to either not hate them, or not think about them obsessively.

For more info on how to understand and correct body checking behaviors, see https://emilyprogram.com/blog/body-checking-and-body-avoidance/.

2) EXPOSURE THERAPY

            Practice practice practice. Do the things that scare you! Start by making a body image fear pyramid from least scary at the bottom to most scary at the top. Examples can include: being in photographs, wearing a bathing suit at the beach with family, wearing shorts or more revealing clothing when it’s hot outside (or just because you want to!), attending a fun event even though you’re feeling insecure, etc.

Here is how an exposure pyramid would work in practice: If wearing a tank top is hard for you because you feel insecure about your arms, wear a tank top around the house when you’re alone. Do this frequently until you are used to what your body looks and feels like in more revealing clothing. Then, wear a tank top to a low-stakes environment like the grocery store, and work your way up to wearing a tank top at work or school in front of people you know and like.

3) DIVERSIFY SOCIAL MEDIA AND TV CONSUMPTION

            The media we consume matters! Celebrities, reality stars, and influencers are often heavily edited, either by filters and photoshop, and/or by cosmetic procedures like plastic surgery, fillers, veneers, spray tans, and Botox. This is not a condemnation of any of these things—do what you want to with your body! It is just not helpful to compare our unedited bodies to edited bodies.

Follow people who are your size or larger (even MUCH larger). When we diversify the kinds of bodies we’re seeing on a consistent basis, the urge to compare can decrease and we can become more used to seeing cellulite, rolls, acne or skin pigmentation, etc., which then in turn can help us to feel okay about having those features ourselves.

Avoid or limit media that contributes to body dissatisfaction, envy, and/or comparisons. A TV show that may not bother one person may create intense feelings of envy and self-loathing in another person. Notice how you’re feeling as you scroll social media, and as you watch TV and movies. Are you feeling sad? Insecure? Envious? Are you comparing your body to on-screen and off-screen bodies more often after consuming this media? Check in with yourself about how much you can handle.

Unfollow anyone who does not make you feel neutral or better about yourself. Hate-following is not helpful. Following someone with a much smaller body is only going to perpetuate body dissatisfaction and obsessive thoughts. It can be difficult to let go of your favorite accounts or TV shows, and their impact should be considered if your body image plummets when viewing this media.

4) WEAR CLOTHING THAT FITS AND IS FUNCTIONAL

            Throw out clothes that no longer fit you. Cleaning out our closets can illicit so many emotions—fear, anger, insecurity, sadness, grief and longing, to name a few. Take it slowly if you need to, but get rid of those pants that haven’t fit in two years. They are a reminder that your body has changed and may even be encouraging unhealthy behaviors such as restriction, purging, and/or over-exercising so that you can fit into those clothes again.

            Buy comfortable clothing in a bigger size if needed (yes, even underwear!). Being physically uncomfortable in our clothing only draws our attention even more to our bodies and how they look/feel. It can be similar to having a rock in our shoes—if our pants are too tight, we are going to fixate on that discomfort and think of little else. Wearing clothing that fits appropriately and is comfortable will allow you to get out of your brain and into your life! This includes wearing shorts instead of pants in the summertime. You deserve to feel comfortable and confident in your clothes no matter your size. Thrifting can be a great way to expand your wardrobe without hurting your wallet.

            Try on clothing without facing a mirror. Focus on the fit and function—is the fabric comfortable, or scratchy? Can you sit, stand, kneel, walk without issue in the item? Is it too small? No need to stare in the mirror at all the places the garment might not fit well. Is it too big? No need to keep it on! Once you are satisfied that the clothing meets your needs, then see if you like how it looks.  

5) PRACTICE BODY NEUTRALITY AND NON-JUDGMENTAL STANCE

            If your thoughts about your body are consistently negative, judgmental, and bullying, it can feel inauthentic to look in the mirror and tell yourself that you love your body. Instead of attempting to shift your thinking from loathing to loving, shift your thoughts to neutral with factual, descriptive statements.

Examples include: “I have a body”, “I have two eyes; they are brown”, “My hair is curly”, “My thighs are touching”, “My arms have cellulite”, “I am tall”. This practice can help us to focus less on perceived flaws or even body aspirations, and more on the reality of what our body looks like in the moment without judgment. Realistically, as we are looking at our bodies, we cannot immediately change much about them. We cannot shrink at will or wish away our stretch marks. Acknowledging our bodies as they are can help shift us away from criticism and into neutrality and even gratitude.

We can improve your body image, I promise! A commitment to changing even one of these things can improve quality of life. For further information about improving body image, check out More Than a Body by the Kite sisters. If you believe you or someone you know is struggling with body image distress, body dysmorphia, or an eating disorder, please contact us or other eating disorder professionals who follow a Health At Every Size and anti-diet treatment model.

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).

CONTINUE to READ the FULL ARTICLE ONLINE HERE

Former trainee of the Eating Disorder Institute, now licensed psychologist

National surveys suggest that nearly 30 million Americans will develop an eating disorder at some point in their lifetime. Most eating disorders will begin during adolescence. One of the myths about eating disorders is that they are caused by families. By the contrary, families can be a great source of allyship. In fact, the most science-supported treatment for adolescents with eating disorders is Family-based Treatment, in which parents take responsibility for restoring the health of their adolescent.

Families can also take an active role in preventing eating disorders. Here are six ways parents can set up a supportive home environment that may help to inoculate children from developing eating disorders.

Guideline 1: Encourage regular, intuitive, flexible eating

Infants are born with the ability to eat intuitively – to eat based on hunger cues, preferences, and satiety. Children often lose this ability, particularly when adults consistently exert control over their innate cues. Certain behaviors like forcing children to finish everything on their plate or restricting their eating prior to reaching satiety, make it difficult to remain an intuitive eater.

Intuitive eating has an incredible number of benefits for children and adults. According to the data, intuitive eating is associated with improved cardiovascular functioning, weight management, better emotion regulation, healthier body image, less anxiety when eating, and more pleasure when eating (Bruce & Ricciardelli, 2016; Camilleri et al., 2016; Hawks, Madant, Hawks, & Harris, 2005; Smith & Hawks, 2006; Spoor & Madanat, 2016). It is also negatively associated with eating disorders, whereas rigid control of food intake is positively associated with eating disorders.

Parents can facilitate children’s innate, intuitive wisdom by providing them with a variety of foods and encouraging them to check in with hunger and fullness levels. Remind your child that it’s ideal to consume a wide variety of foods – which includes both nourishing and play foods. Make sure your child eats on a somewhat regular schedule (i.e., avoid skipping meals), so they don’t feel as though food is not readily available to them. Encourage developmentally appropriate autonomy and responsibility.

Guideline 2: Encourage physical activity to move the body, not to burn calories, change size, weight, or shape

In our society, so many people focus on exercising for the purpose of losing weight or to achieve a desired body shape. This is inherently problematic for children to see and hear. Parents should encourage their children to engage in movement of the body, without emphasizing the movement as “exercise”. Parents should also avoid emphasizing calories burned or making eating contingent on exercise (i.e., eating is “earned” through exercise).

Parents can encourage and support movement for so many beneficial reasons, such as stress management, increased mood, fun/play, enhanced quality of life, restful sleep and increased cardiovascular health. Children pick up on what parents do, so it’s important to model a healthy relationship with movement for your child. Emphasize the health benefits of movement, while de-emphasizing the relationship between exercise and weight/shape control.

Guideline 3: Avoid judging, criticizing, or shaming bodies based on size, weight or shape

Many parents know that making comments about your child’s shape or size is harmful. But what many parents don’t realize is that this includes making comments about their own bodies, and the bodies of others. Children are perceptive, and when you make comments about body weight, shape, or size, they will learn that their parents’ value certain bodies over others.

Bodies naturally come in different shapes and sizes. Commenting on bodies continues to perpetuate the thin ideal, which moralizes body shapes as “good” or “bad.” Internalizing this thin ideal is a critical point in eating disorder development, so it’s crucial that you avoid making these comments so that your child does not associate bodies with moral value or intrinsic worth. Additionally, focusing on your child’s weight leads to weight cycling and increased weight gain over time in children, adolescents, and adults.

Give your child praise unrelated to appearance. For example, tell your child you are proud of them for never giving up, that you value their kindness, or that you enjoy their sense of humor. Promote talk that associates bodies with functionality (what your body can do), rather than appearance. Minimize appearance-related comments, because helping your child cultivate a positive body image protects against the development of eating disorders.

Guideline 4: Avoid dieting, talking about dieting, or promoting diets to others

Avoiding dieting and diet talk is probably the most crucial guideline for protecting your child from developing an eating disorder. Dieting is consistently one of the most prominent factors in eating disorder development. Teenagers who practice moderate and extreme dieting are 5x and 18x more likely to develop an eating disorder compared to those who do not diet.

Dieting sets up an internal threat of starvation. When our bodies are not fed regularly, our biology kicks in to reduce the threat by slowing down our metabolism and actively seeking nourishment. This also occurs when we cut out or limit access to certain foods.

Continue to encourage intuitive, flexible eating patterns. Ensure your child is eating regularly (3 meals and 2-3 snacks per day) and adequately. Try to keep a variety of foods available in the home at all times – that includes whole foods and play foods.

Guideline 5: Avoid classifying food as “good” or “bad”

In addition to avoiding diet talk, parents should also avoid discussing the makeup of food in a negative or rigid manner, or moralizing certain foods as “good” or “bad.” Talk of diets, calories, carbs or fat grams leads to increased social comparing and reduced body satisfaction. Calorie counting is predictive of eating restraint and eating disorder symptoms.

The American Dietetic Association says that “all foods can fit into a healthful eating style,” and so parents will want to discourage their children from making the association that calories, fats, or carbohydrates are inherently “bad.”

When anywhere from 34-60% of adolescent girls are dissatisfied with their bodies, we don’t need to continue to encourage diet talk.

Focus on the function of food, without moralizing certain foods as “good” or “bad.” Food is fuel for the body, but viewing food only as a mechanism for health misses some important functions of food that are important for children. For example, some food is to be enjoyed and savored. Food helps us connect with loved ones, and food can even provide pleasure and fun. As a parent, encourage your child to be unmindful of food makeup, keep a variety of foods in the house, reinforce the idea that all kinds of foods are fine to eat, and emphasize all the different functions of food.

Guideline 6: Use and encourage talk that is validating and compassionate

Eating disorders are often maintained by self-criticism, perfectionism, and negative self-talk. Alternatively, self-compassion is associated with better well-being and lower eating-related guilt. As a parent, it’s critical that you are able to catch this type of talk and help to modify it. Often what helps self-criticism is validation.

Validation is a way to show your child that you understand where they’re coming from. Validation can help soothe pain, without getting stuck in arguments about what’s “right.” Validation includes active listening, reflecting and checking that you understand the message, and communicating that your child’s emotions make sense given the context or their learning history. For example, if your child says, “I feel fat today,” rather than responding with “You aren’t fat,” instead try “It’s hard to feel uncomfortable in your body. I’m here for you.” This might lead to a discussion about the ways in which the diet industry profits on all of our insecurities, or the negative impact of viewing unrealistic images in social media. Or you can communicate understanding by helping your child to label their emotions by saying “It’s okay to feel sad.”

Here is a step-by-step guide to using validation with your child.

The takeaway

Being a parent is incredibly challenging. There are so many things to protect your children from, eating disorders included. But there’s hope, and families are a great resource for this purpose.

One of the best things you can do for your child is to raise them as intuitive eaters who listen and trust their hunger cues, eat a variety of foods, and balance health foods with play foods. Emphasize the mood and cardiovascular benefits of movement, rather than associating exercise with food or burning calories. Avoid judging the morality of food and bodies, and avoid diet talk and dieting.

As a parent, it is important to not only teach these behaviors, but to model them yourselves. Children pick up on more than we realize. Parents are in an incredibly unique position to cultivate holistic habits early in life that can help protect children from succumbing to toxic messages and pressure they will face to manipulate their eating and their bodies. By arming yourself with these strategies, you can help support your child in having a fulfilling life without eating and body image concerns.

Resources

If you or a loved one are struggling with an eating disorder, there are resources that can help.

National Eating Disorders Association (NEDA): NEDA is the largest non-profit organization dedicated to supporting individuals and families affected by eating disorders. NEDA offers a toll-free helpful to connect you or a loved one with support, resources, and treatment options. Call (800) 931–2237.

ANAD Helpline: The Association for Anorexia Nervosa and Related Disorders (ANAD) also has a helpline if you or a loved one would like personal encouragement and support. The helpline is available Monday-Friday from 9am-5pm CT. Call (630) 577–1330.

F.E.A.S.T: F.E.A.S.T is a global community for supporting parents and families affected by eating disorders. They also have an online forum for direct support.

Maudsley Parents: Maudsley parents is a volunteer organization of parents who have helped their children recover from anorexia and bulimia through the use of Family-based Treatment (also known as the Maudsley approach).

Intuitive Eating Website: Learn about intuitive eating, find community providers, find resources, and discover the benefits of intuitive eating.

National Suicide Prevention Lifeline: If you or a loved one are considering harming yourself or others, support is available. Call 1(800) 273-TALK (8255).

*Special acknowledgment to Megan Shope, MA, and Lindsey Ricciardi, Ph.D. for their contributions to this post.