At EDAC we are committed to making research accessible. Our Plain Speaking Summaries include plain language text on published papers and an interview with the authors. In this Plain Speaking Summary, Laurence Cobbaert introduced their paper that was published in 2024 and is interviewed by an Ellen Maloney, EDAC peer researcher. Laurence Cobbaert (she/they) is the Chair of Eating Disorders Neurodiversity Australia and a PhD candidate at the University of New South Wales in Sydney, Australia. They are neurodivergent and have lived experience of an eating disorder.
Paper Synopsis
The full paper can be found here.
AIMS:
The aim of the narrative review is to provide a conceptual, lived experience-led foundation for future empirical work regarding the associations and psychopathological mechanisms that underlie eating disorders (EDs) in the context of neurodivergence. The review intends to build upon previous work, diverging from some by taking a wider lens to investigate neurodivergence using a neurodiversity-affirming theoretical framework and considering intersectionality. It also aims to provide a broad descriptive framework for this topic, which is suitable considering the limited literature published to date.
KEY FINDINGS:
The review highlights that autistic individuals and those with ADHD are at higher risk for eating disorders, with other neurodivergent groups also showing high rates of disordered eating. Intersectional factors contribute to this risk, yet research on ED development, maintenance, and relapse remains limited. ND individuals often have poorer treatment experiences, and current therapies may not be fully effective for them. There is a call for neurodiversity-affirming care that validates ND traits rather than aiming to "normalize" them. Sensory processing differences, particularly involving the thalamus, may play a key role in ED vulnerability. Participatory and lived experience-led research is emphasized as essential for improving treatment and outcomes.
METHOD:
The methodology used in the narrative review involved several key steps. The narrative review provides a broad descriptive framework on the topic, incorporating the lived experiences of neurodivergent researchers and clinicians. Database searches (PubMed, Google Scholar) were conducted using terms combining neurodivergence (e.g., autism, ADHD) with eating or feeding disorders. Recent systematic reviews and meta-analyses were prioritized, with gaps in research highlighted. The review analysed ED risk factors related to neurodivergence, drawing from both research and community insights. Thematic contributions were structured by sensory processing and executive functioning differences, followed by individual characteristics (e.g., gender, giftedness) and intersectional factors like systemic discrimination and chronic illness. The authors follow a neurodiversity-based approach, questioning research that treats neurodivergence as a disorder, uses a one-size-fits-all view of the brain, or unfairly dismisses the experiences of neurodivergent people.
RESULTS:
Literature search identified 831 original articles, with which 19 publications met inclusion criteria. Outside of 2 articles, all publications demonstrated moderate to high quality. Three studies investigated exteroception, in which sensory over-responsiveness was similarly highlighted across AN samples. AN and BN differed in sensory over-responsiveness relative to healthy controls, but also across ED groups. Acros studies, there were no publications examining exteroception in those with BED, OSFED or ARFID that fell within study inclusion criteria. Seventeen publications reported on interoception, reporting distinct characteristics of interoception in relation to different ED diagnoses. Those with BN reported the highest levels of interoceptive difficulties relative to those with AN or BED.
DISSEMINATION:
The study aims to improve eating disorder (ED) care and research by guiding future studies, enhancing treatment with a more inclusive approach, and promoting neurodiversity-affirming care. It emphasizes the value of lived experience, supports ethical research practices, and addresses systemic biases in ED treatment. Additionally, it raises awareness of the challenges neurodivergent individuals face and advocates for more inclusive and reflective research.
SUMMARY:
The review concludes that neurodivergent individuals face a high risk of eating disorders due to various overlapping factors, emphasizing the need for personalized, lived experience-led care. Current treatments often fall short, with limited long-term success. More research is needed to improve prevention and treatment, while addressing biases in existing approaches. Neurodiversity-affirming care should respect ND traits rather than pathologizing them, and clinicians must remain open to different ways ND individuals experience eating and self-perception. While promising frameworks exist, research gaps remain, especially beyond autism and ADHD. The authors' lived experience informs the review's perspective.
