Eating Disorders, Interoceptive Awareness, and Trauma in Autistic and ADHD Women

This is a long newsletter about eating disorders and neurodivergence

Let me start by saying that I’m not an expert in eating disorders. We (therapists) are trained to understand how to stay in our lanes. Eating disorders are not my lane. They are deadly and require specialized training and treatment. Often, those programs that treat eating disorders cost a lot of money.

The Project Heal website estimates costs of $80,000 an episode or lower-level treatment costs of $1,500 a week.

Eating disorders are complex, often misunderstood conditions that go beyond issues with food or body image.

For women with autism and ADHD, these disorders are deeply entwined with sensory processing difficulties, trauma, and impaired interoceptive awareness.

Understanding these connections is crucial for providing effective and empathetic treatment.

How much do these clinics know about these connections? I bet nothing.

The Overlooked Intersection: Autism, ADHD, and Eating Disorders

Autistic and ADHD women face unique challenges that increase their vulnerability to eating disorders.

Research indicates that approximately 37% of adults with eating disorders exhibit traits of ADHD, and around 20-30% of individuals with eating disorders also have autism spectrum disorder (Frontiers) (ADHD Foundation Australia).

This significant overlap suggests that neurodivergent women are particularly susceptible to developing eating disorders due to their unique neurological and psychological profiles.

Trauma as a Catalyst

Trauma plays a critical role in the development of eating disorders, especially for neurodivergent women who, of course, have higher rates of trauma.

Trauma refers to an experience characterized by intense fear, horror, or helplessness, such as physical or sexual abuse, accidents, or prolonged neglect. Studies show that 50-80% of individuals with eating disorders have experienced significant trauma (Frontiers).

The prevalence of PTSD (Post-Traumatic Stress Disorder) in women with eating disorders is alarmingly high, with rates around 50%, compared to a general population prevalence of 6.8% (ADHD Foundation Australia).

Despite the known connections between trauma and eating disorders, research in this area is still emerging.

Historically, the focus has often been on the general population, neglecting the specific experiences of neurodivergent women. This gap can be partly attributed to gender biases in research, where women's health issues, especially those of neurodivergent women, are underrepresented and underfunded (Frontiers) (Eating Disorder Hope).

Interoceptive Awareness and Eating Disorders

Interoceptive awareness is the ability to perceive internal bodily signals, such as hunger, thirst, and emotional states. This awareness is often impaired in individuals with autism and ADHD, making it difficult for them to recognize basic bodily cues. This can lead to irregular eating habits and contribute to the development of eating disorders. Neuroscientific research shows that dysfunction in the insula—a brain region crucial for processing bodily sensations—is linked to impaired interoceptive awareness. A study published in the Journal of Abnormal Psychology also found that individuals with eating disorders often exhibit altered insula activity, affecting their ability to accurately perceive hunger and satiety (Frontiers). This suggests that neurodivergent people would be hit doubly hard here.

The Role of Sensory Sensitivities

Women with autism and ADHD frequently experience heightened or diminished sensory sensitivity, which can dramatically affect their eating habits and preferences. Sensory sensitivity refers to how individuals perceive sensory inputs like taste, texture, sound, and light. For some, certain textures or tastes are so aversive that they limit their diet significantly. For others, the sensory experience of eating can be so underwhelming that it fails to register as a rewarding activity, leading to disinterest in food or mechanical eating without enjoyment. Research published in the American Journal of Clinical Nutrition found that sensory sensitivities in autistic individuals are strongly correlated with restrictive eating patterns and food selectivity (Frontiers).

Emotional Dysregulation and Coping Mechanisms

Emotional dysregulation is a common challenge for both autistic and ADHD individuals and significantly contributes to the development of eating disorders. Emotional dysregulation refers to difficulties in managing and responding to emotional experiences. Binge eating, purging, and food restriction can become maladaptive coping mechanisms for managing overwhelming emotions and stress. A study in the International Journal of Eating Disorders highlighted that 78% of participants with eating disorders reported using these behaviors to cope with negative emotions. For neurodivergent women, who may struggle more acutely with emotional regulation, these behaviors can provide a temporary sense of control or relief from emotional distress (Frontiers) (ADHD Foundation Australia).

The Connection Between Trauma, Eating Disorders, and Neurodivergence

The interplay between trauma, eating disorders, and neurodivergence is multifaceted. For many neurodivergent women, traumatic experiences exacerbate the sensory and emotional challenges they already face. One defining feature of trauma is an intense feeling of helplessness or loss of control. In the aftermath of trauma, individuals may attempt to regain control through disordered eating behaviors. For example, restricting food can provide a sense of order and predictability, while bingeing and purging can serve as a way to regulate a nervous system overwhelmed by trauma (Frontiers) (Eating Disorder Hope).

Perhaps considering and understanding these issues would lead to new and more helpful interventions for the neurodivergent population.

Statistical Insights and Treatment Implications

The intersection of eating disorders, trauma, and sensory processing differences in autistic and ADHD women calls for a tailored approach to treatment. Traditional eating disorder therapies often overlook the unique challenges faced by neurodivergent individuals. Incorporating sensory integration techniques, trauma-informed care, and strategies that address the specific executive functioning and emotional regulation challenges of autism and ADHD can significantly enhance treatment efficacy (Frontiers) (Eating Disorder Hope).

Conclusion

Eating disorders in autistic and ADHD women are a manifestation of broader neurodevelopmental and psychological challenges. Understanding the role of trauma, sensory processing differences, and impaired interoceptive awareness is crucial for developing effective interventions. As research continues to uncover the layers of complexity in these interactions, it becomes increasingly clear that a multidimensional treatment approach, sensitive to the nuances of neurodivergence, is necessary to support this vulnerable population.

In light of these insights, healthcare providers, therapists, and caregivers are urged to consider the broader neurodivergent context when treating eating disorders, ensuring that these women receive the understanding and specialized care they deserve. Addressing the intersection of trauma, sensory processing, and emotional regulation in neurodivergent women can pave the way for more effective and compassionate treatment strategies, ultimately fostering better recovery outcomes.

1. Frontiers: https://www.frontiersin.org/articles/10.3389/fpsyt.2015.00124/full

2. ADHD Foundation Australia: https://www.adhdfoundation.org.au/eating-disorders-and-adhd/

3. Eating Disorder Hope: https://www.eatingdisorderhope.com/information/causes/gender