Wise Wednesday Guest: Jodie Mainstone
This week, we’re joined by psychotherapist Jodie Mainstone, who brings a unique and deeply personal perspective to the conversation around neurodivergence and eating disorders. Her reflections blend lived experience and clinical expertise to shine a light on an area that’s still widely misunderstood.
It’s time to talk neurodivergence and eating disorders
I’ve worked in mental health for just over twenty years now, and during that time, I’ve been fortunate to have a varied career working across different services and later in private practice. A significant part of those years has been spent supporting people with eating disorders.
But honestly, it’s only in more recent years that we’ve really begun to have meaningful conversations about how neurodivergence, particularly autism and ADHD, intersects with eating disorders.
And when you look at the numbers, it’s quite shocking that it’s taken this long.
Research shows that between 29% and 35% of people with anorexia meet the criteria for autism (Westwood & Tchanturia, 2017). People with ADHD are nearly four times more likely to develop an eating disorder such as bulimia, binge eating disorder (BED), or anorexia (Nazar et al., 2016). In cases of ARFID (Avoidant/Restrictive Food Intake Disorder), around 16% of those diagnosed are autistic, and approximately 11% of autistic individuals meet the criteria for ARFID (Koomar et al., 2023).
These overlaps are significant. Yet for far too long, neurodivergence has been overlooked (or misunderstood entirely) within eating disorder treatment spaces. Rather than adapting care to suit different ways of thinking, feeling, and experiencing the world, many people have been expected to mould themselves around systems that simply weren’t built with them in mind.
For me, this isn’t just a professional interest – it’s deeply personal too.
For far too long, neurodivergence has been overlooked (or misunderstood entirely) within eating disorder treatment spaces. Rather than adapting care to suit different ways of thinking, feeling, and experiencing the world, many people have been expected to mould themselves around systems that simply weren’t built with them in mind.
I developed anorexia at the age of 11 and was hospitalised multiple times but thankfully, reached recovery by 23. But I often wonder how different that journey might have been if my own neurodivergence (ADHD and sensory processing differences) had been recognised and supported early on.
At school, I constantly felt confused by how other people just seemed to know how to do things. Things that felt natural to them felt totally out of reach for me. My school reports always said things like, “Jodie is bright but easily distracted and doesn’t work to the best of her ability.” At home, homework became a battleground. What were actually meltdowns from overwhelm were seen as tantrums. I was labelled difficult, dramatic, and attention-seeking.
I was often called a “fussy eater” but looking back, I now know that was ARFID driven by sensory aversions. I wasn’t trying to be difficult; I was just struggling in ways no one could see.
I wasn’t diagnosed until I was in my forties. That diagnosis brought clarity to so many parts of my life, including my eating disorder. Suddenly, things that had never quite added up started to make sense.
I was often called a “fussy eater” but looking back, I now know that was ARFID, driven by sensory aversions. I wasn’t trying to be difficult; I was just struggling in ways no one could see.
For me, anorexia was a way to feel “enough” in a world that often felt like too much. It gave me structure. It quietened my overstimulated, anxious brain. It was also a way to get care I didn’t know how to ask for, because I didn’t even realise I needed it. A fragile body, after all, sends a clear message: Handle me gently. Thanks to my ADHD, I could hyperfocus on food and numbers in a way that probably LOOKED like willpower but was actually desperation.
Now, in my work as a therapist specialising in trauma, eating disorders, and neurodivergence, I see just how common this overlap is. And while everyone’s experience is unique, there are clear patterns that come up time and time again.
Here are just a few of the many neurodivergent eating disorder patterns I’ve noticed:
1. Meal plans often don’t work for ADHD brains
Planning, shopping, cooking, and remembering to eat all rely on typical executive functioning – something many of us experience differently. This isn’t about being “non-compliant”. It’s about needing support. We need to co-create systems that work with someone’s cognitive style, not against it.
2. Hunger cues aren’t always reliable
A lot of neurodivergent people don’t feel hunger in the typical way. They could also be so engrossed in something, or managing sensory overwhelm, that eating just doesn’t register. Then by the end of the day, they’re depleted, starving, and more vulnerable to dysregulated eating. Stimulant medication for ADHD can also suppress appetite, which adds another layer of complexity.
3. Masking is exhausting
Many clients spend their entire day pretending to be “okay” in environments that don’t accommodate their neurodivergence. By the time they get home, they’re emotionally and mentally drained. That’s when something called “restraint collapse” can happen; where all the feelings they’ve been holding in come rushing out. Food can become a way to cope or self-soothe, and sometimes that leads to shame, purging, or further restriction.
4. Standard treatment models often miss the mark
Group therapy can be overwhelming for some autistic clients. Asking someone to eat a food they’re sensory-averse to can feel traumatic, not therapeutic. Some people need to move to process their emotions. Others struggle with abstract emotional language but respond well to more concrete, body-based approaches. These aren’t signs of resistance, they’re signs that the system needs to adapt.
Here’s what I’ve come to believe:
We don’t need to change neurodivergent people to make treatment work. We need to change the treatment.
Neurodivergence isn’t a barrier to recovery – it’s a vital part of the picture. When we acknowledge and support someone’s sensory needs, communication preferences, cognitive processing, and emotional style, recovery becomes not just possible, but sustainable.
So, let’s stop asking people to mask, shrink, or squeeze themselves into systems that weren’t built for them. Let’s create systems that recognise, affirm, and support who they truly are!
If this sounds familiar, don’t hesitate to reach out to discuss what support you might need.
