A deadly survival mechanism

From Twiggy in the 60s to the TikTok filters of today, concerns around body image have been present for decades. One area that’s under increasing investigation is the link between eating disorders and neurodiversity. Melissa Holmes finds out more

A picture of a hand holding a fork with a tape measure on it wrapped like spaghetti. The background is yellow.

Sensory issues. Repetitive habits. Fixed mindset. Executive dysfunction. Negative self-image… Separately, these can all be traits of neurodivergence (ND) but, combined, they may be a recipe for an eating disorder (ED).

Emerging research shows ND people have an increased risk of developing ED: a 2020 study found that elevated Autistic Spectrum Disorder traits are present in around a third of people with anorexia, while research from 2007 found that females with ADHD are nearly four times more likely to develop an ED. Nearly 20% of individuals diagnosed with avoidance or restrictive food intake disorder (ARFID) also have autism.

A VICIOUS CYCLE

Suzie – diagnosed with ADHD at 37 – grew up in the 90s, a time of heroin chic and intense tabloid scrutiny. Body image was everything, and Suzie’s mum was into exercise videos and faddy foods. “I was born into this diet culture,” she explains. A GP appointment for her preteen ‘puppy fat’ led to restricted packed lunches and enforced exercise. Into adulthood, Suzie struggled with binge eating disorder. “If something bad happened, I’d order a huge takeaway and eat and eat. I’d feel sick and guilty so I’d buy a gym membership, book every class, and show up to maybe two. And I’d feel sad that I’d not been to the gym, so I’d binge… It was a punishing cycle.” 

Comedian Juliette Burton had similar experiences in childhood: “I was very overweight from age 8 to 11 and was regularly taken to hospital to be weighed and measured, which created an obsession with food and weight,” she explains. At 14, she was diagnosed with anorexia, and at 17, she was sectioned when her condition became life-threatening.

Several mental illness diagnoses followed, including depression, PTSD and bipolar disorder, along with bulimia and binge eating disorder. Juliette says: “I used to see my eating disorders as monsters I needed to fight, but now I see them as trying to protect me; helping me survive overwhelming feelings.”

For some ND people, Eds provide a coping mechanism; a way of controlling something in a life that feels out of control. Food can also be used to self-soothe or stim – to get them through something boring, to create focus, or to have something in their mouth or hand. Disordered eating can often manifest due to sensory sensitivities, anxiety, or poor interoception, like not picking up on hunger cues or feelings of fullness. 

Image of the comedian Julie Burton. She wears a red dress and is visible from the waist up. She stands in front of a plain yellow background.

ON A HIGH

There can be biological causes, as Suzie reveals: “My psychiatrist said ADHD and binge eating disorder are closely linked because you’re constantly looking for that dopamine hit. For some ADHD people it’s alcohol or drugs. For me, it’s food.” 

Writer Kat Brown was diagnosed with ADHD at 37, after years of depression, insomnia, anxiety and binge eating. Her book ‘It’s Not a Bloody Trend: Understanding Life as an ADHD Adult’ is released in February. Almost everyone Kat spoke to for her book had experienced issues with food: “One chap had never used alcohol or drugs, but biscuits were his thing. He’s pre-diabetic and trying to improve his health.” As Kat explains, food is so easy to access, and processed food is specifically designed to hit the body’s pleasure receptors – a perfect storm for ADHDers. 

So how can we support people with ND to live with or recover from ED? Medication can help: although not without its side effects, Suzie’s prescription curbs her bingeing and minimises other elements of her ADHD. Kat refers to the “golden triangle of treatment – medication, therapy and coaching.”

PERSON-CENTRED APPROACH

Stuart Lyons is a Senior Behaviour Specialist at Autism Together. He supports people with learning disabilities and autism, so his person-centred approach accommodates the needs of the individual and enables them to live with their ED. “For someone with Pica, we keep their environment safe so there’s nothing inedible around that will be dangerous if ingested,” he explains. “With social anxiety, we plan out the person’s day so they can eat in private at a time that suits them.” Dieticians can help people get the right nutrients when they’ll only stick to ‘safe’ bland foods. Stuart also suggests supporting people with cooking and ensuring they have agency over other aspects of their life, so they feel less of a need to control food.

Greater awareness and acceptance is a gamechanger too. “Raising understanding will lower people’s fear around people with differences,” says Stuart. “The more people are aware, the more understanding they are.” That’s an approach Juliette would agree with. Her shows sell out at the Edinburgh Fringe and she runs community and corporate workshops around comedy and mental health. Comedy is her main source of ‘therapy’: “I use comedy as a survival mechanism. It’s a way of finding light in the darkness. Life is hard enough,” Juliette admits, “and we need more laughter. It loses its power if you’re laughing at it.” 

FOR MORE INFORMATION

If you need support or advice, visit Autism Together, or if you are struggling with an eating disorder, visit Beat or support. 

You can also follow Juliette and Kat on instagram.

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