Neurodiversity-Affirming Eating Disorder Care: Moving Beyond the Pathology Paradigm
Written by ED and OCD Therapy Founder: Allyson Inez Ford, MA, LPCC
What is Neurodiversity, really?
Neurodiversity has become somewhat of a buzzword recently, but what is it exactly, and what does it mean to be neurodiversity affirming? When you hear the word neurodiversity, you might think of fidgets or noise cancelling headphones. While you're not wrong to think of these things, neurodiversity is also so much more.
At its core, neurodiversity refers to the natural variation in human brains and nervous systems. Just as biodiversity recognizes that ecosystems thrive through difference, neurodiversity recognizes that there is no single “right” way for a brain to work and differences in attention, sensory processing, communication, learning, emotional regulation, cognition, and more, are all part of natural human diversity, not inherently signs of disorder or something negative.
What Is Included Under the Neurodiversity Umbrella?
Neurodiversity is an umbrella term that includes many forms of cognitive and neurological differences. ADHD and Autism are commonly thought of when someone hears the word neurodivergence, however, many scholars and activists consider all forms of mental health diagnosis to be forms of neurodiversity. These may include but are not limited to:
Learning differences such as dyslexia or dyscalculia
Sensory processing differences
Bipolar Disorder
Personality Disorders
Schizophrenia
Whether or not someone identifies their mental health diagnosis as neurodivergence varies and depends on the person. It’s important we don’t name someone’s experience for them, though we can offer language and introduction to a neurodiversity affirming lens and see if it fits for them. Importantly, neurodiversity is rooted in self-identification and disability justice.
For the purposes of this blog post, I will share examples of how eating disorders intersect with autism and ADHD, since these are the neurotypes people will often self identify with in eating disorder treatment.
Beyond The Fidgets
Being neurodiversity-affirming goes beyond offering fidgets in your waiting room or dimming the lights. Being truly neurodiversity affirming rejects the assumption that neurotypical functioning is the gold standard. It asks us to examine how systems like ableism and sanism create distress for neurodivergent people- and how that distress is often mislabeled as individual pathology.
In mental health and eating disorder care, this distinction matters deeply. When neurodivergent traits are misunderstood or pathologized, support can quickly turn into harm. A neurodiversity-affirming approach shifts the focus from “fixing” the person to accommodating the unique needs and abilities of the person.
Neurodiversity and Eating Disorders
Neurodivergent folks experience high rates of eating disorders, yet most eating disorder treatment models were not designed with neurodivergent needs and experiences in mind. This is reflective of the broader mental health system, and a society that privileges neurotypical (“normal”) brains and pathologizes anything outside of what is deemed “normal.” Interestingly, what is considered normal is entirely socially constructed, which is why I am putting it in parenthesis.
Traditional approaches to eating disorder treatment often prioritize behavioral compliance and symptom reduction without exploring whether the function of the eating disorder behavior is related to sensory differences, executive functioning challenges, masking for social safety or other neurodivergent ways of relating to food and the body. At best, standard treatment simply won’t be as effective for neurodivergent clients, but at worst, it can actively harm neurodivergent clients.
Neurodiversity-affirming eating disorder care offers a path to healing that rejects the myth of normality and seeks to understand and support neurodivergent experiences of food and the body - rather than attempting to “fix” neurodivergent traits. This approach centers accommodation, acceptance, and body-mind liberation. Huge shoutout to Naureen Hunani, RD who created the neurodiversity affirming model and brought it to the eating disorder treatment world!
Neurodiversity Paradigm vs. the Pathology Paradigm in Eating Disorder Treatment
The Pathology Paradigm
The pathology paradigm dominates much of Western mental health care, including eating disorder treatment. Within this model:
Neurodivergent traits are framed as deficits, dysfunctions or disorders
Distress is located within the person rather than the environment and systems like ableism
Treatment focuses on ‘normalization’ and behavioral correction, essentially training neurodivergent people to mask
Success is measured by conformity to neurotypical expectations and ability to function within the capitalistic demands of society (i.e. being able to work or go to school)
In eating disorder care, this can show up as rigid meal plans, forced exposure to foods that may cause sensory distress (or even trauma), assumptions that food avoidance is always ‘the eating disorder talking’ or assumptions that clients access hunger and fullness cues in neurotypical ways and thus, leaving neurodivergent clients with interoceptive challenges to feel as if something is wrong with them.
The Neurodiversity-Affirming Paradigm
The neurodiversity movement, rooted in disability justice and autistic self-advocacy, understands neurological differences as a natural and valuable part of human diversity, the same way race and body size are a natural form of human diversity that should be celebrated.
From an affirming lens:
Neurodivergence is morally neutral
Distress often arises from lack of accommodation and having to live in an ableist world, not due to inherent dysfunction
Support prioritizes autonomy, accessibility and quality of life
Neurodivergent folks are the expert on their lives, and get the final say on what works for them.
In eating disorder treatment, this paradigm shifts the clinical question from “How do we eliminate this behavior?” to “What purpose does this behavior serve, and how can we support adequate nourishment without harming the person or adding to the ableism they already experience?”
Eating Disorders and Autism: Common Characteristics and Affirming Care
Autistic folks experience high levels of eating disorders and disordered eating, particularly in restrictive eating and ARFID-like presentations.
Autistic Traits That Often Get Labeled as Eating Disorder Behaviors:
Strong food preferences related to texture, temperature, taste or smell (sensory needs)
Limited food variety that is predictable and offers safety and satisfaction in routine (monotropism) rather than fears of weight
Difficulty identifying hunger, fullness, or thirst cues due to interoceptive differences
Distress or shutdowns when access to food routine changes unexpectedly
Affirming Support Looks LIKe:
Pathologizing approaches may label these patterns as resistance or avoidance. Neurodiversity-affirming eating disorder care instead:
Validates sensory needs as legitimate
Recognizes routine as nervous system regulation, not pathology
Collaborates around food expansion only when desired and safe, offering alternative ways to get nutritional needs met when accessible food options are limited
Prioritizes nourishment over ‘normative’ eating expectations
TLDR: Affirming care does not force autistic clients to abandon coping strategies that help them function.
Eating Disorders and ADHD: Understanding Executive Functioning Differences
People with ADHD are also at elevated risk for eating disorders, differences in stimulation needs, executive functioning and dopamine regulation all play a role here.
Common Eating Challenges for ADHD Folks
Skipping meals due to time amnesia or hyperfocus
Eating inconsistently throughout the day due to difficulty with task switching or task initiation
Impulsivity around food followed by shame or self-criticism, particularly when using food to meet stimulation needs and having the belief from diet culture that we should only eat when hungry or that food is only fuel
Difficulty planning and preparing meals
Internalized narratives of laziness or lack of discipline that fuels shame around eating patterns and body image
Neurodiversity-Affirming Support Looks Like:
Rather than emphasizing willpower or insisting the client is making up excuses, affirming care looks like:
Supporting executive functioning challenges with creative accommodations (visual cues, task pairing, body doubling, etc)
Separating impulsivity from moral judgment, collaboration on identifying a variety of tools a person can use to meet stimulation needs (including food!)
Focusing on adequate intake, not perfection
Identifies interoceptive and proprioceptive differences that impact hunger, fullness and body image
For many ADHD clients, eating struggles reflect the need for support around executive functioning and stimulation needs, not further blame for being “difficult.”
Key Takeaways and Final Thoughts
Across neurotypes, neurodiversity-affirming eating disorder treatment often includes:
Collaborative, client-centered treatment planning
Curiosity about the function of behaviors rather than immediate elimination or labeling as disordered
Respect and accomodation for sensory, cognitive and communication differences
Awareness of how systems of oppression shape food and body struggles, with a focus on ableism and neurotypicality
Autonomy in food choices, normalization of “same foods” and encouragement to embrace autistic food culture
Centering lived experience perspectives over textbooks or self proclaimed experts with no lived experience.
This approach does not ignore medical risk and is not about colluding with the eating disorder. It simply refuses to frame neurodivergent bodies and minds as inherently a problem to be fixed. You can accommodate neurodiversity and work to get nutritional needs met! This work might look different than someone who is not neurodivergent, but with an affirming approach, it is entirely possible to have a more peaceful relationship to food and your body.
Please check out the work of Stacie Fanelli LCSW, Naureen Hunani, Reece Thomas CMHC, Jocelyn Lam LMFT, Shira Collings LPC , Kevin Jarvis , and Livia Sarah for more lived experience perspectives on neurodiversity and eating disorders.
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If this resonated and you want to learn more- please reach out to schedule a free 15 minute phone consultation with us. We would be honored to support you or your loved one. We provide in person therapy in San Diego, as well as virtual therapy throughout CA, WA, UT, FL, TN and MD. We also provide recovery coaching worldwide.
