There is so much I would like to say about this question. There is a high prevalence of neurodivergent individuals within the LGBTQIA+ community. I am myself a member of this community and during my NHS Eating Disorders Service experience I felt there was more that could have been done in this area, with some acknowledgement of the issues but a lack of a clear plan of action to support this.
LGBTQIA+ needs an intersectional, nuanced and inclusive approach. A (2020) study from the University of Cambridge showed that transgender and gender-diverse individuals were 3.03 to 6.36 times as likely to be autistic than were cisgender individuals.
A (2018) study showed that a third of respondents said their gender identity had been repeatedly questioned due to their autism. This leads to ongoing, systemic prejudice towards neurodivergent individuals, as it makes assumptions that they are not competent enough to understand their own identity and leads to bias and prejudice which can then extend to making assumptions about food sensitivities and eating behaviours.
There needs to be a recognition in healthcare services of gender identity and neurodiversity identity and then there needs to be a recognition of the overlap between the two and that these impact body image, sensory processing, and social experiences.
Having lived experience practitioners from these communities would help increase representation and relatability. I think clinical staff need to be onboard with training workshops to improve cultural competence in this area, some more formal, some peer led as well as service user involvement to get a broader range of knowledge of what is needed.
Stigma, discrimination, bullying, and minority stress need to be recognised as part of assessment and treatment of eating disorders in neurodivergent clients within this community, along with recognition that oppression and abuse like this can be a trigger or risk factor for an eating disorder.
It’s important to show visible support within services including rainbow flags and pronoun use. Creating a sensory friendly environment by using soft lighting, minimising noise and using sensory aids like fidget toys and weight blankets in inpatient or day hospital settings would be helpful if this isn’t already available.
Body dysphoria needs to be addressed in ways that affirm the client’s gender identity and avoid binary language around bodies and weight (e.g., “male/female” norms) and acknowledge the impact of societal expectations on LGBTQIA+ individuals. I definitely think this isn’t happening at present in mental health services from my experience of working in them.
High rates of trauma occur in both neurodivergent and LGBTQIA+ individuals, I would ensure treatment is trauma-informed and staff are trauma trained. Using somatic therapies and EMDR would be amazing to support with this, which I currently do in private practice. Adapting CBT for neurodiversity processing with cultural competence, this could include breaking tasks into smaller, more manageable steps and allowing flexibility in food routines. Rigid thinking patterns like black and white thinking will need exploring to develop strategies to allow more adaptive flexibility.
Group therapy or support groups specifically for neurodivergent LGBTQIA+ individuals with eating disorders could be important, providing a space where they feel understood and accepted.
Systemic issues, such as fatphobia, heteronormativity, and ableism actually exacerbate body image concerns and eating disorders. We live in a society that rewards these systemic issues, so advocating for societal change will help with acceptance and reduce stigma for the LGBTQIA+ community.
Using strengths based approaches with individuals can help use hyperfocus, pattern recognition or other neurodivergent traits in therapy along with emotional regulation techniques would be important too, including sensory grounding. Ultimately it’s important to ask individuals what is working and what isn’t working for them. We need to validate and support diverse communication styles, including non-verbal methods.
It’s important to respect sensory and dietary preferences without framing individuals as ‘treatment resistant’. Collaboration and being person centred gets better outcomes and clients feel more motivated and empowered to make changes, rather than having things done to them.
Clinical research and more specifically lived experience-leg research remains sparse, despite it’s critical for improving eating disorder care that is nuanced and individualised. There are documented overlaps between ADHD and Autism, also known as AuDHD, for example, and yet research through transdiagnostic approaches is rare regarding this overlap.
A neurodiversity and gender affirming approach is needed throughout services. We need to get rid of pathologizing and stigmatising phrases that are from a purely medical model such as, ‘abnormal’, ‘symptoms’, ‘deficits’, ‘impairments’, ‘tantrums’, ‘attention seeking’, ‘dramatic’, ‘treatment resistant’, or ‘non-compliant’. More affirming language would be ‘traits’, ‘features’, ‘characteristics’, ‘support needs’, ‘differences’, ‘atypical’, ‘challenges’, or ‘difficulties’ I would love to see the ‘low/high functioning’ phrase go too as these perpetuate monolithic stereotypes - autism isn’t just a linear construct, it has a dynamic and fluctuating nature.
Improving accessibility and resources to eating disorders services is really important. This involves removing barriers to meeting eating disorders services criteria. Simplifying referral processes could help with this and provide online or in-person access to services based on individual needs. Use clear, jargon free communication in all materials and during therapy sessions. Flexible scheduling would allow for more time in sessions or provide shorter or more frequent appointments for those with attention or processing challenges
It’s important to educate families and allies with workshops or resources to educate loved ones about eating disorders, neurodivergence, and LGBTQIA+ issues, as well as advocate for rights to ensure equitable access to healthcare, addressing systemic barriers that disproportionately affect marginalized groups.
Hi, I’m Becky Grace Irwing, I’m a BABCP Accredited CBT & EMDR qualified Therapist and qualified Mental Health Nurse. I spent 8 years as a Mental Health Nurse and 3 years as a CBT Therapist. I have worked across many mental health services for 14 years including acute, forensic and CAMHS services as well as University Mental Health and Disability Services and a London talking therapies service. I have a background history as a Fitness and Yoga Instructor of 10 years, and worked in the fitness industry from the age of 17 to 35.
I specialise in Eating Disorders, Neurodiversity and complex trauma issues and the link between those. I have a lived experience of binge eating for nearly 30 years, recovered for 7 years. I have ADHD and self diagnosed with Autism.
I’m also a dog Mum of two sausage dogs, human first, like to knit and I’m sustainability conscious.
My career highlights are being nominated for student nurse of the year for the Nursing Times and working in University Mental Health Services for 4 years; I loved working with students who were neurodivergent with a complex background of mental health and disability difficulties the most.
I'd love to hear from you for a free 20 minute introduction call to see how I can help you.
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