Eating Is Hard

Eating can be hard. For something that is a basic need, you would expect it to be straightforward, but it has become complicated. We have made it this way with our shaming comments about food choices and body types, diet culture with conflicting diets, and social media messages from people who aren’t qualified to advise. Adding in ADHD or Autism makes eating even harder.

Many of my clients struggle with buying groceries, meal planning, meal preparation, and feeling ashamed about not eating regularly, overeating, or the quality of their food choices. Eating disorders are associated with health consequences. You already know this. What you may not know is how complex eating truly is.

Interoception is the ability to sense our internal organs. Interoception signals provide information about internal body and emotional states, such as the urge to urinate, hunger, temperature, pain, sadness, joy, and anxiety. The lack of interoception experienced by neurodivergents can have a significant impact on hunger and satiety cues.

Autism and Eating Disorders

Avoidant/Restrictive Food Intake Disorder (ARFID) and anorexia nervosa are the most common eating disorders among Autism. There are others, but I am narrowing it down to the most common. ARFID is characterized by limiting the volume and/or variety of foods consumed. However, unlike other eating disorders, food avoidance or restriction is not related to fears of fatness or distress about body shape, size, or weight. Instead, in ARFID, extremely selective eating is motivated by a lack of interest in eating or food, sensory sensitivity, or a fear of choking or vomiting.

It often develops in early childhood and can persist into adulthood. It is easy to see how autistic traits of sensory processing issues, preferred repetitive behaviors, inflexible thinking, and insistence on routines would develop ARFID.

This limited diet may lead to weight loss or stalled growth, significant nutritional deficiencies that vary based on diet, and challenges in relationships or difficulties with engaging at school or work. Many autistics meet the requirements for a diagnosis of Avoidant/Restrictive Food Intake Disorder (ARFID).

Special interests are a common characteristic of Autism. An extreme interest can morph into anorexia nervosa. Anorexia is an obsessive-compulsive eating disorder defined by restriction of food leading to a significantly low body weight. With anorexia, there is either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain. Anorexia is accompanied by body image distortion – it is easy to see how a young, teenage Autistic girl who is mimicking other adolescent girls could get the message that this behavior to “typical.” Autistic girls are masters of masking by mimicking behavior.

While treatment is possible, studies show it takes longer than it does for neurotypicals with these eating disorders. Prevention is critical. Early detection of Autism is helpful to know what parents are dealing with. Additionally, all children learn from what is being modeled around them, whether they seem to be paying attention or not. By observing adults speaking about foods, weight, and exercise, they will develop core beliefs about food. We want these beliefs to be formed without judgment or shame. We aim to model healthy behaviors, including regular exercise and consuming a balanced diet of various foods in moderation.

ADHD and Eating Disorders

Binge eating disorder (BED) and bulimia nervosa are the most common eating disorders among people with ADHD. Again, there are others, but I am narrowing it down. Both are impulsive eating disorders.  

BED is marked by the following:

• Eating, in a short period, an amount of food that is larger than most people would eat during a similar time and under similar circumstances.
• A sense of lack of control over eating during the episode.
• Episodes must occur at least once a week, on average, for three consecutive months.

In addition, to be given a diagnosis, at least three of the following conditions:

• Eating large amounts of food but not feeling hungry.
• Eating more rapidly than usual.
• Eating until feeling uncomfortably full.
• Eating alone because you feel embarrassed by how much you’re eating.
• Feeling disgusted with yourself, depressed, or guilty afterward.

Bulimia nervosa is an eating disorder characterized by binge eating followed by compensatory behaviors, such as self-induced vomiting or fasting, to prevent weight gain. Often, other efforts to lose weight may be used as well, such as diuretics, laxatives, stimulants, water fasting, or excessive exercise. Most people with bulimia are at a normal weight but have a higher risk for other mental disorders, like depression, anxiety, and problems with drugs to alcohol, which are all common comorbid conditions with ADHD as well.

Individuals with ADHD also experience challenges with interoception, which can lead to missing hunger cues when they are hyper-focused. Overeating can stem from ravenous hunger because the more subtle signs weren’t recognized. The ADHD brain wiring also lends itself to these eating disorders:

• ADHD brains have lower levels of GABA, a neurochemical that is important for inhibition, so impulsive eating happens.
• ADHD brains don’t produce enough dopamine, so there is reward deficiency syndrome. Some may seek satisfaction or stimulation through food.
• ADHD brains may take longer to absorb glucose, which can lead to increased consumption of sugar and simple carbohydrates (which are converted into sugar in the body).
• Purging can be euphoric. For brains that are seeking dopamine, this can become a problem quickly.
• Planning and decision-making aren’t strengths for the ADHD brain, which means meals are often not prepared, frequently leading to impulsive eating or skipped meals.
• Poor interoception can lead to poor self-regulation, making it difficult to perceive or understand the quantity of food eaten accurately.  
• Irregular eating habits and poor sleep patterns can disrupt metabolism.
• Habitualization or boredom with food may add to challenges.
• Eating is sometimes not about hunger, but rather about finding relief from intense emotions and low self-esteem, or overeating as a form of self-punishment.  

Intuitive Eating

Intuitive eating is an approach to eating that focuses on internal cues, how you feel, and aims to repair our relationship with food and diet culture. It’s about acceptance, not shaming.

It may seem unusual to suggest this as a method for neurodivergent individuals who struggle with interoception. Still, I have demonstrated that the way people with some neurodivergencies think about food could benefit from reframing.

For a complete understanding of Intuitive eating, read the book. But here are the ten principles:

1. Reject diet culture – it may seem daunting because following someone else’s plan eliminates the need to make decisions, which can be a challenging aspect. However, when you think about it, following their plan was also hard because our bodies crave what we tell them they can’t have.
2. Honor Your Hunger – What does feeling hungry feel like in your body? For some, it is hunger pangs in the abdomen, but that isn’t the only way. For others, it is being hangry, feeling faint, or having a headache, and keeping a journal with essential questions, such as ‘How does my body feel?’ and ‘What does it need right now?’ Initially, you may need to do this every three to four hours, with reminders from an alarm or a body double.
3. Make Peace with Food – This step is a process; give yourself the time you need to allow it to unfold. If needed, create a permission slip that allows you to eat all foods. If you have restricted choices because of ARFID, add a tiny bit of something that seems safe.
4. Discover the Satisfaction Factor – Here is where you can start tracking how foods affect your brain wiring, as well as your physical, mental, and emotional well-being. The goal is to identify which foods help you move better, think more clearly, and make you feel safe, happy, and satisfied with your choices. Sometimes, the challenge of your brain wiring might prevail, and that’s okay. Notice that it happened and adjust to get back on track to achieve your goals.
5. Feel Your Fullness – What does feeling full feel like in your body? Try to slow down your eating by putting your fork down between bites, taking a sip of your drink, and eating with someone, and enjoy the conversation, and ask yourself questions about the food or how your body is feeling.  
6. Challenge the Food Police – ‘Can’t’, ‘shouldn’t’, ‘must’, and ‘have to’ are all shaming words. Dump them and the idea that foods are good or bad. Stop following social media that tells you what to eat.
7. Cope with Your Emotions with Kindness – Neurodivergents have intense emotions and strong negative brain bias; many have been using food, whether overeating or restricting food, in ways that aren’t helpful. That was the past; forgive yourself for doing the best you could at that time with what you knew and where you were. What are other ways to cope with strong emotions? Who can you co-regulate with? What activities allow you to process emotions instead of avoiding them?
8. Respect Your Body – A significant part of my coaching is about embracing all aspects of who my clients are. That includes what your body looks like and how it reacts to different types of food. Your body is trying to tell you something. Listen to it and
9. Movement – Feel the Difference – Finding ways to move your body that feel good and that you enjoy. There is no need to go to the gym and track your progress unless that is something you enjoy. Movement can include going for a walk, line dancing, swimming with your kids, or playing pickleball. Just something you like – it can be a structured event if you need it to be, or it can be something new and novel.  
10. Honor Your Health-Gentle Nutrition – If you are going to follow any food rules, it should be to eat food that you like. You may like how it tastes, how to makes you feel, or how it is connected to a culture or tradition. Nutrition means you aren’t eating sugar all day, but it doesn’t mean you aren’t eating sugar at all, either. If you listen to your body, it will tell you what it needs to move, think, and sleep well.

There is a lot out there that tells people with Autism and ADHD how to eat. There isn’t a single diet that works for everyone. People have different needs. Intuitive eating may be an option. I hope you will think about it as an option.