Supporting your Neurodivergent clients with Eating Disorders

Supporting your Neurodivergent clients with Eating Disorders

Firstly, if you haven't read this blog please do as it will make sure we are both on the same page before we look at how you can help as a practitioner*. (*Please note that this blog is primarily aimed at UK psychotherapists, therapists, and counsellors.)

So now you know how significantly the ND population are at risk of developing eating disorders and how commonly they are co-occurring conditions, what do we do? Which one do you notice first? Which one do you work with first? Can you separate the Neurodiversity from the Eating Disorder?

Some things to consider ...

Your Competency
Does this work fall within your competency? Now I will add here that sometimes we do need to work with something to have the skills necessary, learning through experience if you will. But do consider carefully the level of risk that may be present in this work. Anorexia for instance has the highest mortality rate of any mental health condition, so please don't work with a client without proper and thorough consideration. As with all areas we work in, we must ask ourselves 'Will I cause harm?'. Of course, I know you don't want to, but do you know enough to work with this client without potentially causing them harm? Are you completely new to working with neurodivergent clients and with eating disorders? If so, is this the right place to start?

Appropriate Supervision
Similarly, to above do consider if you have adequate and appropriate supervision for this work. Does your supervisor have the knowledge and experience to support you through this work? Does your supervisor have the knowledge and experience with this level and type of risk? If not, consider reaching out to an appropriate supervisor to offer additional support while you work with this client. You do not have to change your supervisor for all of your work, but it is important that quite specialised work is supported by someone that understands the work.

Supporting your Neurodivergent clients with Eating Disorders

See the Individual
'When you've met one Autistic person ... you've met one Autistic person.' This is a saying for a reason, and you can most certainly swap 'Autistic' here for Neurodivergent. We have things in common as a population, sure but we are also uniquely ourselves. Just like the neurotypicals. Get to know your client and who they are as their own unique person. Get to know their style of communicating and adapt wherever you can. I instinctively offer multiple explanations to clients to illustrate my points and I think this is due to reading people and finding the one that lands with them. Not everyone loves a metaphor like I do but I often find you just need the metaphor that is within the frame of reference for that person and not wildly abstract. We know that lots of neurodivergent people don't deal well with motivational interviewing or open ending questions. Work with them in an affirming, non-shaming way. They aren't stupid or difficult you just haven't asked the right question or in the right way.

Check Your Own Anti-Fat Bias
This really does deserve its own blog but for now I'll just ask you to check your own response to fatness and how much of a subconscious (or even conscious) anti-fat bias you may hold.
(We never stop doing that uncovering work do we! Nope, never.)
If you haven't done this important work, I would urge you not to work with eating disorders. It cannot help but impact your approach to this work. It's not our fault, anti-fatness is big business, and we live within a structure that profits from our unconscious commitment to being anti-fat.
It's not our fault, but it is our responsibility as humans and even more so as practitioners that are working in this area.

Check Your Assumptions
While we are on the topic of checking ourselves, check your assumptions of both eating disorders & neurodivergent people. What are you holding as your beliefs around these words? And let's be frank, I've heard lots of them so we both know there are some unpleasant words bubbling up to the surface ... manipulative ... difficult ... hard work? What honestly comes up for you? It may not be what you truly believe but this is a word association game you must play to uncover what's there. The words I listed are not what I believe but they are words that I have heard in association with eating disorders for example. When you don't acknowledge what is in your shadow, that is when harm is likely to happen. Great supervision can also help with this

Supporting your Neurodivergent clients with Eating Disorders

Is It Sensory
Consider if or how much the client's sensory experiencing is interplaying with their eating difficulties.
Is the person affected by too much sensory stimuli when trying to eat or cook and this is actually causing a significant difficulty? Eating alone could be a suitable solution for a client experiencing this but if you (or they) are waiting to function by neurotypical standards this may not be an option that feels acceptable.
Interoception, the perception of sensations from inside the body is often a difficult for neurodivergent humans, either being too heightened or too dull and sometimes both at different times. This can make sensing hunger cues difficult for instance. This can lead to the person not trusting their body signals and becoming 'overly reliant' on external sources for reassurance. But perhaps that 'over reliance' is a healthy accommodation to meet their needs? Other healthy accommodations might be to move away from three main meals a day and have more frequent smaller meals. If they feel full quite quickly why, can't they eat more often so that they sustain themselves? Setting timers to reminder them to eat is perfectly acceptable and should be encouraged rather than shamed. Some of these issues demonstrate why mindful eating may not be accessible to neurodivergent people and practitioners should be careful about suggesting this as it could be a source of shame.

Cooccurring Medical Conditions
Firstly, lets note how a small shift from using 'comorbid' to cooccurring de-medicalises us. Isn't that nice, let's do that from now on please. Back to the point ...
When working with neurodiverse clients who are dealing with eating disorders consider any cooccurring medical conditions that may also be part of the picture such as gastrointestinal issues or chronic fatigue. These are going to impact the spoons that client has to deal with their life and their eating. We must ensure that our work is not stigmatising or shaming.
A change or advancement in the condition itself or medication that the client is taking for these conditions may also be impacting their food difficulties. As this would be outside of our scope to work with, encouraging clients to talk to their GP would be helpful. While also remembering that clients may need support to access affirming and supportive medical care. They may also need to work through trauma they have experienced in the medical community before they are able to advocate safely for themselves in that setting.

Supporting your Neurodivergent clients with Eating Disorders

Executive Functioning Issues
As with spoons executive functioning is not only different from person to person but also moment to moment for that individual and depends on a number of factors. It can affect a person's ability to prepare food; have food available at home; get timings right when cooking; and even task initiation. When holding this in awareness we are less likely to shame our clients.

Emotional Eating
In our culture today, I would say eating for emotional reasons is generally viewed as weak and the person lacking some moral integrity. But I argue that it is a valid way to eat, especially for a population that struggles with emotional dysregulation. What if your client does not realise their body needs fuel until they are irritable or anxious or restless? The emotion is their cue. What if your client uses food to stim? Or maybe it's the only way they remember to eat? Do we need to shame them for this?

Be affirming; have flexible strategies and don't make assumptions.

I hope you have found this short blog useful. You can find me here on Instagram and let me know!