When treating individuals with eating disorders, it is critical to consider the presence of neurodivergence. One way to approach this is through a functional behavioral assessment. Namely, what is the cause behind the restricting/binging/purging behaviors? For a neurotypical person, a common response might be something related to appearance, such as, “I am restricting my calories so that I can achieve a thigh gap and see the protrusion of my collarbones.” Whereas a neurodivergent individual may be limiting their food intake due to sensory aversion. Taking the time to conduct a thorough functional behavioral assessment will help you to appropriately and effectively address the underlying cause of the maladaptive eating rather than assuming that the same symptoms are attributable to the same cause.
PDA and eating disorders
Another important factor to consider is the common presentation of pathological demand avoidance (PDA, or from a strengths-based approach, persistent drive for autonomy) when conceptualizing the eating disorder. For those who aren’t familiar, PDA is a profile within the autism spectrum that describes a high need for personal agency and choice. When it comes to eating disorders, PDA may play a role in the form of resistance to the internal demands to eat, or to eat certain types of foods. If 12:00 rolls around and a PDA-er has the thought, “I should eat lunch right now,” this may be met with resistance. The function of skipping lunch isn’t to restrict their food intake to lose weight, it’s to resist this internal demand and increase feelings of agency. In this example, an appropriate response to the PDA-er would be to brainstorm ways they can increase feelings of autonomy around their food choice. This could look like DoorDashing a fun meal, or popping a frozen entree in the microwave for increased convenience and accessibility.
Sensory aversion and cognitive rigidity in eating disorder presentations

Sensory aversion should also be explored when conceptualizing eating disorder treatment for neurodivergent folks. Common types of sensory aversion include specific textures or tastes, which can result in a restricted number of foods that the individual is willing to eat. Similar to the approach with PDA, it is important to explore the underlying function of the restricted food groups rather than automatically assuming that the reason is appearance related. Another important note is the role that cognitive rigidity plays in restricted eating patterns. Individuals on the spectrum may gravitate towards routine and sameness, resulting in a rigid approach to food. This may look like eating at designated times each day, or eating only a limited group of foods. Once again, it is important to thoroughly explore the function of the restricted eating behaviors rather than assuming a monolithic cause.
When working to determine if the cause of the food restriction is due to sensory preferences, ethical issues (as with vegans/vegetarians), or for weight loss, it is helpful to identify the timeline of the food preferences. For example, if someone has exhibited aversion towards animal proteins since childhood, before the onset of the identified eating disorder, this is likely a genuine preference, and not a symptom of the eating disorder.
Another important consideration is the highly comorbid avoidant/restrictive food intake disorder (ARFID) and neurodivergence. We will be delving in depth to this topic in another blog post, so stay tuned.
A huge THANK YOU to Jenna Stone, LMSW for taking the time to share her knowledge about the different considerations for neurodivergent folks in eating disorder treatment. Jenna is therapist with the Zen Psychological Center and is well-versed in providing neurodivergent-affirming eating disorder treatment.
For more information or to seek support for an eating disorder, reach out to us today.
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