ADHD, Autism and Disordered Eating: What Neurodivergent Women Need to Know

I had a serious eating disorder for fifteen years. I had no idea it was linked to being neurodivergent.

I was a teenager when it started. I got through it without anyone helping me understand what was behind it. Even after I recovered, I felt so ashamed that I didn't speak about it for years.

It wasn't until my ADHD diagnosis that I started to join the dots.

What I've come to understand since is that disordered eating in women doesn't link to just one neurodivergent condition. ADHD and autism both carry a considerably elevated risk, and many women are both.

Why the ADHD brain is vulnerable

ADHD is, at its core, a condition of dopamine dysregulation. The brain doesn't produce or process dopamine the same way a neurotypical brain does, and dopamine is the neurotransmitter responsible for motivation and reward.

When the dopamine system isn't working as it should, the brain goes looking for ways to regulate itself. Food, particularly sugar and highly processed food, produces a rapid dopamine hit. For a brain that's constantly understimulated or dysregulated, food becomes one of the most accessible forms of self-regulation available.

Research published in the International Journal of Eating Disorders found that people with ADHD have an almost fourfold increased risk of developing an eating disorder compared to those without (Nazar et al., 2016). A systematic review published in Clinical Psychology Review identified dopamine dysregulation and emotional dysregulation as the primary mechanisms linking ADHD to disordered eating, with impulsivity playing a significant role too (Kaisari, Dourish and Higgs, 2017).

For many women with ADHD, eating disorders develop not as a pursuit of thinness but as a way of managing a nervous system that never feels calm. Not weakness or vanity, but an ADHD brain trying to cope with a world it didn't have the tools to navigate.

Autism and anorexia

Autism carries a different but equally significant risk. Research has found that up to 35% of women in inpatient anorexia units may be autistic, yet autism is diagnosed on average almost ten years after the eating disorder, meaning the underlying neurology goes unseen while the presenting condition takes all the clinical attention (Brede et al., 2024).

The link between autism and anorexia makes particular sense when you understand how the autistic brain works. Sensory sensitivity to the texture and smell of food, difficulty recognising internal hunger and fullness signals, and rigid thinking as a way of creating safety all create a specific vulnerability to restrictive eating. Where the ADHD brain often turns to food for stimulation and relief, the autistic brain can find security in controlling food: in its predictability, its rules and its structure.

A systematic review published in Psychiatry Research found that anorexia and autism share overlapping features across cognitive and behavioural areas, with direct implications for how treatment needs to be shaped (Boltri and Sapuppo, 2021). Standard eating disorder treatment was not designed with an autistic brain in mind, and for many women, this is exactly why it hasn't worked.

ARFID: The eating disorder that often goes unnamed

Beyond anorexia, there is another eating disorder that is highly prevalent in neurodivergent people and still poorly understood: Avoidant/Restrictive Food Intake Disorder, or ARFID.

ARFID has nothing to do with body image or weight. It's characterised by an extreme restriction of what someone is able to eat, driven either by intense sensitivity to how food looks, feels or smells, by fear of adverse consequences such as choking or vomiting, or by a general lack of interest in eating. It can lead to serious nutritional deficiency, but it's frequently dismissed as fussiness or anxiety rather than recognised as a genuine eating disorder.

The co-occurrence between autism and ARFID is significant. A meta-analysis published in the International Journal of Eating Disorders found autism present in 16% of those with ARFID, and ARFID present in over 11% of autistic groups across clinical studies (Sader et al., 2025). For women who have spent their lives being told their relationship with food was a choice or a personality flaw, understanding ARFID can reframe years of experiences they were made to feel ashamed of.

Why women with ADHD and autism go undiagnosed for so long

The shame that builds around food, eating and the body doesn't exist in isolation. For many women, it sits alongside decades of unrecognised neurodivergence.

Research by Skoglund et al. (2024) documented systemic failure to identify ADHD in women across all life stages. The picture for autism is similar. Women mask more effectively, and their eating behaviours are more likely to be explained as anxiety or perfectionism rather than recognised as the presentation of an undiagnosed neurodivergent brain.

Holden and Kobayashi-Wood (2025) found that women with late-diagnosed ADHD commonly reported shame and low self-esteem that persisted for years. Getting a diagnosis, when it finally came, was described as life changing.

Getting Support: What Exists and What Doesn't

Neuroaffirming eating disorder support in the UK exists, but provision is patchy.

Standard NHS eating disorder treatment was developed for neurotypical presentations. CBT-E (Cognitive Behavioural Therapy Enhanced) is a form of CBT developed specifically for eating disorders, but along with family-based approaches, it wasn't designed with an ADHD or autistic brain in mind. For many neurodivergent women, this means going through treatment that doesn't account for how they think or experience the world, and this mismatch between need and provision needs to be accommodated and adapted for their needs.

The PEACE pathway, developed at King's College London and the Maudsley, represents a genuine step forward. It's a specialist model adapted specifically for autistic people with eating disorders, and it has shown real promise. But it isn't universally available across NHS trusts, and waiting times can be long.

For ARFID in particular, adult provision within the NHS is severely limited. Many adults are told their difficulties don't meet the threshold for eating disorder services, or are passed between services without anyone taking clear ownership of their care.

This is not good enough. The women who have struggled with food their whole lives only now understand why and they deserve better than a system that still doesn't fully see and acknowledge them. The organisations listed below are a starting point for those looking for support.

What Getting the Right Support Looks Like

Eating disorders are still treated too often in isolation from the full neurological picture. When ADHD or autism goes unidentified, treatment addresses the symptom but not what's underneath it. Women can go through years of recovery work that isn't fully effective because there have never been accommodations and adaptations for the neurodivergent brain.

Getting the right support starts with the right understanding of what is happening and neurodivergent women deserve treatment that is built around how their brain works.

If you're struggling with your mental health right now, support is available. Call Samaritans free on 116 123, day or night. Call 111 and select the mental health option. Or text SHOUT to 85258.

Further Support and Information

BEAT (beateatingdisorders.org.uk): the UK's leading eating disorder charity, offering helpline support, an online community and specific information and resources about ARFID. Their helpline is free to call on 0808 801 0677.

ARFID Awareness UK (arfidawarenessuk.org): a UK charity dedicated to raising awareness and providing information and support for people with ARFID and their families, including adults.

The PEACE Pathway (peacepathway.org): free resources and information about autism-informed eating disorder care in the UK, developed at King's College London and the Maudsley. Includes resources for patients, families and clinicians.

References

Boltri, M. and Sapuppo, W. (2021) 'Anorexia nervosa and autism spectrum disorder: a systematic review', Psychiatry Research, 306, p.114229. Available at: https://pubmed.ncbi.nlm.nih.gov/34798485/

Brede, J., Babb, C., Jones, C.R.G., Serpell, L., Hull, L., Adamson, J., Baker, H., Fox, J.R.E. and Mandy, W. (2024) 'The clinical characteristics of autistic women with restrictive eating disorders', BJPsych Open, 10(5), e148. doi: 10.1192/bjo.2024.65

Holden, E. and Kobayashi-Wood, H. (2025) 'Adverse experiences of women with undiagnosed ADHD and the invaluable role of diagnosis', Scientific Reports. doi: 10.1038/s41598-025-04782-y

Kaisari, P., Dourish, C.T. and Higgs, S. (2017) 'Attention Deficit Hyperactivity Disorder (ADHD) and disordered eating behaviour: A systematic review and a framework for future research', Clinical Psychology Review, 53, pp.109-121. Available at: https://pubmed.ncbi.nlm.nih.gov/28334570/

Nazar, B.P., Bernardes, C., Peachey, G., Sergeant, J., Mattos, P. and Treasure, J. (2016) 'The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis', International Journal of Eating Disorders, 49(12), pp.1045-1057. doi: 10.1002/eat.22643

Sader, M., Weston, A., Buchan, K., Kerr-Gaffney, J., Gillespie-Smith, K., Sharpe, H. and Duffy, F. (2025) 'The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): a prevalence-based meta-analysis', International Journal of Eating Disorders, 58(3), pp.473-488. doi: 10.1002/eat.24369

Skoglund, C., Sundström Poromaa, I., Leksell, D., Ekholm Selling, K., Cars, T., Giacobini, M., Young, S. and Kopp Kallner, H. (2024) 'Time after time: failure to identify and support females with ADHD – a Swedish population register study', Journal of Child Psychology and Psychiatry, 65(6), pp.832-844. doi: 10.1111/jcpp.13920