Eating Disorders, Autism, and ADHD

Eating Disorders, Autism, and ADHD: Research Gaps

Research has shown a significant overlap between eating disorders, autism, and ADHD, but treatment and support don’t always meet the needs of neurodivergent people. Some research suggests about one in three people with anorexia meet the criteria to be diagnosed as autistic (Inal-Kaleli et al., 2024), and people with ADHD are nearly 4 times more likely to have a diagnosis of an eating disorder as compared to people without ADHD (Nazar et al., 2016)

Despite this clear link, current eating disorder services are usually designed with neurotypical people in mind, and support for eating disorders may not be meeting the needs of this group of people.

This research summary considers some of the reasons behind why interventions for eating disorders are less effective for autistic or ADHD people and outlines the results of a recent priority setting project that can guide future research in the field. Understanding how best to support autistic people and people with ADHD who experience eating disorders is important for clinicians and caregivers and will lead to better outcomes for people with lived experience.

What does the research say about current treatment approaches?

Current treatment for eating disorders is mostly individual or group eating-disorder focused cognitive behavioural therapy (CBT-ED) (National Institute of Clinical Excellence, 2020). Clinical guidance also recommends the Maudsley Anorexia Nervous Treatment for Adults (MANTRA) and Specialist Supportive Clinical Management (SSCM). For young people with restrictive eating disorders or bulimia, clinical guidelines recommend family therapy. However, national clinical guidelines do not currently offer autism or ADHD-specific treatment. This is an issue because research suggests that standard treatments may not be meeting the needs of autistic and ADHD service users.

Cognitive remediation therapy (CRT) is less effective in people with autistic traits who have anorexia (Tchanturia et al., 2016), and autistic women with anorexia feel their needs are not met by standard eating disorder treatments (Kinnaird et al., 2019). Autistic women with restrictive eating disorders also rate both inpatient and outpatient eating disorder services as less beneficial than non-autistic women (Babb et al., 2022).

Although less is known about the impact that ADHD has on eating disorder treatment, one study showed ADHD symptoms may influence eating disorder treatment indirectly through increasing eating disorder symptom severity (Testa et al., 2020). Another found that women with ADHD were less likely to be recovered a year after treatment (Svedlund et al., 2018).

The reasons behind the ineffectiveness of standard treatment approaches for eating disorders in neurodivergent people are not well understood. It may be that the form in which treatment is typically delivered is not accessible for them, and their neurological differences aren’t considered. This is made more difficult by misconceptions and lack of understanding from clinicians. For example, for autistic people and those with ADHD:

• Healthcare settings can trigger sensory overload – bright lights, noise, and uncertainty can be difficult.
• Unpredictable appointments and last-minute changes can cause distress and makes treatment less accessible.
• Accessing support can be confusing, and this can take an additional toll on the individual and those around them. They may struggle more with sensory sensitivities and ability to cope, for example.
• May belong to other underserved groups (e.g., being from a minoritised ethnic background, being part of the LGBTQIA+ community, and experiencing financial and social challenges).

Additionally, autistic women with eating disorders report that their eating disorder behaviours are often less about body image or desire to lose weight, as is often assumed. Instead, they are more related to factors like sensory difficulties, social confusion, challenges with cooking and food shopping, and using restrictive eating as a way to cope with distressing emotions or experiences. Many of these factors are linked to the challenges of living in a world largely designed for neurotypical people (Brede et al., 2020; Kinnaird et al., 2019).

These differences help explain why treatment outcomes for neurodivergent people with eating disorders are less positive, as standard treatment approaches are potentially not addressing the issues that neurodivergent people face. However, we still need to better understand why neurodivergent people are more vulnerable to developing disordered eating, and why current support may not be as effective.

Some important work has been done to these ends; in the UK, the PEACE pathway has been developed to adapt eating disorder treatment for autistic individuals. However, there are no agreed clinical guidelines, and there is not yet an evidence base to demonstrate how effective the adapted treatment is. Little to no work has been done adapting treatment for people with ADHD.

While projects like the PEACE pathway are beginning to make progress in clinical care, much less is known about where future research should focus. Before scientists can begin to answer these important questions, it is vital to ask people with lived experience where they believe researchers should focus first. This helps ensure that new studies are driven by the needs of those most affected.

This short PEACE+ animation explains how ADHD can influence eating experiences — and why this is not anyone's fault”.

The Priority Setting Project

To identify the most important research questions in this area, we carried out a Priority Setting Project involving people with lived experience of both neurodivergence and disordered eating.

We used a two-step process based on the approach of the James Lind Alliance, a non-profit organisation that helps bring together patients, carers, and professionals to identify top priorities for health research.

We invited people to take part if they had a diagnosis of autism or ADHD, or if they identified as having these conditions, and had past or current experience of disordered eating. We included people without formal diagnoses, as many neurodivergent people don’t receive one until much later, or sometimes not at all, and often face barriers in seeking diagnosis (Westwood & Tchanturia, 2017).

Similarly, we used the term "disordered eating" instead of "eating disorder" to make our study more inclusive. By disordered eating, we mean things like only eating certain foods, going long periods without eating, or feeling out of control while eating. We know that not everyone who experiences these things gets a formal diagnosis, and this can be due to reasons such as limited local services or bias within the healthcare system.

Summary

We hope these findings help researchers, clinicians, and policymakers understand what matters most to neurodivergent people with experience of disordered eating. If researchers take these priorities forward, we’ll be better able to explain why autistic people and people with ADHD are more at risk—and, more importantly, how to support them in ways that are meaningful and effective. Better understanding and tailored support can help neurodivergent people lead healthier, happier lives.

Lived Experience Spotlight:

“This research matters to me because a deeper understanding and training in this area would have led to me being able to recover from my eating disorder in a much less painful and quicker way; working with me to understand how my personality and who I was intertwined with my eating disorder would have helped me feel understood.

Understanding my distress, sensory overload, and dysregulation, and adapting the approach to stop me feeling isolated (as people backed off whilst I cried out for support) or overwhelmed (as people overloaded me with professionals and pressure) would have helped me to work alongside the professionals, whether they were experts in ADHD / Autism or not. I wanted to fight my eating disorder but my eating disorder felt safer and made me feel normal and understood when professionals made me feel different, too much, and often beyond help.

The evidence in this is that I was doing really well with a professional who isn't an expert in ADHD / Eating Disorders but offered a compassionate, patient led, trauma informed approach. That person left the job, and I had several years of becoming more and more unwell through harmful approaches that were re-traumatising, and approaches which were well intentioned but caused me more distress. I discharged myself whilst quite unwell, sought private care and I am well on my way to full recovery - this person isn't an ADHD / Autism expert they are just providing me with compassionate, consistent, patient led and trauma based care which doesn't shame or re-traumatise me.

Last week I ate a three-course meal in public with no distress, no reactive eating disorder symptoms before, during or after for the first time in over ten years. This makes a difference. It isn't always about the person being experts, it is about listening to the person as another human being, an equal in the fight against the eating disorder and providing compassionate care aligned with who they are in line with the "approach that works".”