Guest Post by: Stephanie Miodus, PhD, NCSP, Licensed Psychologist and Founder at Next Steps Psychology
Eating and feeding disorders affect millions of people, but they vary in the ways they present, especially in individuals who are neurodivergent. A significant overlap exists between neurodivergence, such as autism and attention-deficit/hyperactivity disorder (ADHD), and eating and feeding disorders, which necessitates a better understanding of this co-occurrence and improved treatment methods for this population.
To support this goal, it is important to understand the specific eating and feeding needs of neurodivergent individuals. Eating concerns can stem not just from body image-related thoughts, but also from factors like sensory sensitivities, a preference for predictability and routines around food, and difficulties with interoception (i.e., the ability to sense internal cues like hunger or fullness). Executive functioning challenges, such as difficulty with planning, organizing, starting tasks, staying focused, and keeping track of steps, can also contribute to disordered eating, as these difficulties may lead to irregular meal patterns or skipped meals.
The role of characteristics associated with neurodivergence can vary depending on the specific eating or feeding disorder, including:
- Anorexia: Several characteristics of autism relate to anorexia (which is characterized by an intense fear of gaining weight and a distorted body image, leading individuals to restrict their food intake and often exercise excessively). A desire for control and predictability, sensory sensitivities, and a concrete, literal thinking style can contribute to restrictive eating, which may then persist and lead to the development of anorexia. This is seen particularly among autistic women.
- Bulimia: Individuals with ADHD often act more impulsively and may struggle to pause before doing something. This can contribute to an increased risk of bulimia, as those with ADHD may have more difficulty regulating eating urges, which can lead to bingeing (eating large amounts of food) followed by attempts to “undo” the eating by fasting, purging, or overexercising. ADHD is also often related to perfectionism and shame when expectations are not met, which can contribute to the binge–purge cycle seen in bulimia.
- Binge Eating Disorder: Binge eating disorder involves frequently eating large amounts of food over a short period of time, accompanied by a sense of loss of control. Unlike bulimia, it is not followed by attempts to prevent weight gain. However, difficulties with impulsivity, as well as struggles with emotional regulation, make individuals with ADHD particularly susceptible to binge eating disorder.
- Avoidant/Restrictive Food Intake Disorder (ARFID): Individuals with ARFID avoid certain foods or eat very little, leading to significant nutritional deficiencies. Unlike anorexia, the eating behaviors in ARFID are not related to body image concerns. This disorder is particularly prevalent in neurodivergent individuals due to sensory sensitivities, selective eating habits related to routine or sensory needs, and disinterest in eating, which may stem from interoception differences.
- Pica: Pica is characterized by eating items that are not food (e.g., dirt) and extends beyond the typical exploratory behavior of a young child. Several autism-related traits may increase the likelihood of pica, such as using non-food items to self-soothe, cope with unmet needs, or seek sensory input. Pica may also be a way to communicate distress in individuals who have difficulty expressing themselves verbally, or related to a preference for familiar, comforting textures or routines. Interoception differences and nutritional deficiencies may also play a role.
- Rumination Disorder: Rumination disorder involves frequently bringing up food from the stomach into the mouth after eating. This is seen at higher rates in autistic individuals and may be related to sensory stimulation or relief, or a response to gastrointestinal (GI) discomfort.
Clinical Example: Navigating ARFID and Autism
To illustrate how eating concerns and neurodivergence can intersect, consider a fictional example based on common client presentations:
A 16-year-old autistic teen came to an evaluation after years of being labeled a “picky eater”. She ate a very limited number of foods, mostly familiar packaged snacks, and often gagged or became distressed when new foods were introduced. Her family had tried various interventions, but nothing seemed to help. Through a comprehensive evaluation, she was diagnosed with autism and ARFID. Treatment involved a collaborative, sensory-informed approach that gradually introduced new textures and allowed her to remain in control of choices. Her therapy also supported building emotion regulation skills and collaboratively creating routines around mealtimes that reduced anxiety. Over time, she expanded the types of foods she would eat and developed a greater sense of confidence around eating.
This example highlights a common pattern: eating and feeding challenges that go unrecognized or misunderstood for years due to the overlap with neurodivergent traits. Eating and feeding disorders in neurodivergent populations are often underdiagnosed or misdiagnosed. Symptoms are sometimes misunderstood as “picky eating” or assumed to be part of autism or ADHD, particularly when professionals are not informed as to the ways eating and feeding concerns uniquely present in neurodivergent individuals. Conversely, eating difficulties may become the focus of care, while co-occurring needs related to autism or ADHD are overlooked. These diagnostic delays can make it harder to access appropriate support that considers the full context of both neurodivergence and eating/feeding needs.
If you are struggling with eating challenges and are also autistic, have ADHD, or identify as neurodivergent, it is important to work with professionals who understand how these experiences overlap. A neurodiversity-affirming approach that recognizes that care should be personalized, respectful, and grounded in collaboration is essential. Many traditional treatment models are not tailored to the specific needs of neurodivergent individuals. The most effective care often includes:
- Therapy that considers sensory needs, communication styles, and personal food preferences, while supporting increased food variety, reduced aversion, and emotional regulation
- Nutritional support that meets you where you are, without pressure or judgment
- Comprehensive evaluations to better understand strengths, challenges, and co-occurring conditions, and to tailor support accordingly
Whether you are looking to explore treatment or better understand your experience, seeking care that integrates both eating/feeding concerns and neurodivergence is an important step toward more effective and affirming support.
