Originally written for The HLP App
Trigger warning/Content warning:
This article mentions various eating disorders and body image disturbance. We know that these topics can be stressful, so we advise discretion.
Navigating the world of eating disorders is hugely challenging on its own, and factoring in neurodivergences such as ADHD and ASC can make diagnosis and treatment a challenge. It helps to have light shone on these issues, and whilst there’s no clear cut answers, we want to explore the established links between neurodivergence and eating disorders in order to make things a little clearer.
In order to talk about neurodivergence and eating disorders, we need to define comorbidity. This rather unpleasant sounding word refers to the presence of two or more medical conditions or diseases in a person. We’re going to be looking at comorbidity a lot in this article as we examine the relationships between neurodivergence and eating disorders.
What do we mean when we say ‘neurodivergence’?
When talking about neurodivergence, we will mainly be referring to ADHD and ASC. It’s important to note that both of these conditions are extremely diverse, affecting each individual differently, so not everything mentioned here will apply to each individual with certain comorbidities. Everyone is different, even if we share the same condition.
The links between neurodivergence and eating disorders are well established, but hard to wrap ones head around. Due to the complex and varied nature of both worlds, the symptoms of either condition can make diagnosis and treatment difficult. Let’s start by looking at ADHD.
ADHD
ADHD has established links with eating disorders, in particular Binge Eating and Bulimia. A common shared symptom between these 3 conditions is impulsivity, making snap and potentially extreme decisions. Because of this, the initial stages of spotting any of these conditions becomes more difficult when comorbidity is a factor.
In addition to this, the impact of being low-weight can affect your executive functioning and also be described as ADHD-like, which can confuse the diagnostic process. During starvation, the body will pour all of its energy into keeping itself conscious and running, which can dramatically decrease attention and focus, as well as cause severe sleep disruption due to the restlessness.
The diagnosis of ADHD in patients with comorbidity can also become a problem due to the effects of medication. Generally speaking, patients with Bulimia have much lower electrolyte and potassium levels, which can lead to heart problems down the line. ADHD medication increases your pulse, which can become dangerous if you combine the two.
As you can see, there are a lot of barriers to quick and effective treatment when presenting with both ADHD and an eating disorder. There are, however, some positives, as treatment for one can often be effective for the other.
When both disorders are properly identified, ADHD medication can significantly improve engagement in treatment for eating disorders. In addition to this, ADHD treatment can reduce severity of something called Rejection Sensitive Dysphoria (RSD). RSD causes individuals to experience severe emotional pain due to a fear of rejection. Due to the nature of eating disorders, RSD can exaggerate the negative feelings of perceived rejection. This means that ADHD treatment can also make eating disorders much more treatable.
Let’s talk about eating disorders and ASC.
ASC
ASC has established links with anorexia and body dysmorphia, as well as Avoidant/Restrictive Food Intake Disorder (ARFID). Particularly with ARFID, this is usually down to sensory/texture issues with the food itself. The particularities of ASC can severely limit choices when it comes to food, which can make the impact of eating disorders more extreme.
The nature of ASC means that change can be difficult. Adjusting to new routines, habits, and ways of approaching situations is part-and-parcel of treating eating disorders, which can make things doubly challenging for individuals with this comorbidity.
Food fussiness and extreme shyness can also make treatment seem scary, as withdrawal of food can be seen as a way of self-soothing.
Because of this, treatment of eating disorders with ASC is more likely to be focused around stabilisation. This means that practitioners will look to keep someone’s weight the same as opposed to making high demands of them. This is to keep patients engaged with treatment, as well as look after their wellbeing.
Practitioners do not take comorbidity lightly; it can take months or even years to analyse each individuals relationship with food, as everyones experience of neurodivergence is different. Tonnes of evidence is needed to prevent snap diagnosis, including school reports; this is to ensure their approach is consistent and they know all the facts.
Language
Treatment can only be effective when the patients environment is a calm and supportive one. One way to remove triggers is to consider the language we use when we approach eating disorders and neurodivergence.
Dr. Kirsten Ellis tells us that it is important to separate the disorder from the person, as “the disorder wants you to be alone”. “It’s important to enable responsibility without judgement, as collaboration is only possible once successful treatment begins to take shape. Praise their efforts, their weight or how they look. Phrases like “you’re looking well” and “you’re making progress” can easily be taken as code for weight gain”.
If you have ever experienced any of the above, then we’d like to give you a gentle reminder that, even by reading this article, you’re on the right track.
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