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Our Intersectional Model 

Our intersectional model highlights the interweave of the human condition. We understand the impact of early attachment, trauma, underlying biology and our human need for connection. This is why we came up with this model where somethings fit in some areas and others may linger somewhere else and then there is a lot of other meta matter that hovers amongst it all. There are things that can't be fixed, nor do we need to fix as there are some fundamental neurological differences that make us who we are. What we can do though is understand the impact of our experiences and its intersectionality, learn about ourselves and then decide what actions we can, want and / or need to take to live the life we deserve to live... however, lets remember that it must all be in context! 

The below model is by no means an exhaustive list of experiences and differences! We have captured our experiences, and the experiences of others and what is in some of the literature...we also couldn't fit it all in to the circles :) 

Neurodiversity and acceptance of difference is central to everything we do at our practice.  Why? Because your neurotype impacts important things like: 

  • How likely you are to experience a mental health condition, 

  • How likely you are to experience multiple mental health conditions together, 

  • What type of mental health conditions you are most susceptible to, 

  • How much benefit you are likely to get out of typical, evidence-based treatment, and

  • What approaches we need to take to give you a real benefit. 

Most research and information on mental health conditions, diagnostic criteria and treatment protocols have been based on one type of brain only: the typical brain. 

 

New studies have found that people with ADHD and Autistic neurotypes have had the highest needs in mental health settings all this time, and yet, have gained the least benefit from them.

 

We care about that, big time. 

 

More specifically, we care about the links that are being found between neurodivergence, eating disorders and trauma. 

 

Here's what we know: 

 

Autistic traits have been linked (pretty intensely) with all three: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder

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It is estimated that 23% of people who are being treated for Anorexia Nervosa in hospital settings, are Autistic, whether they know it or not [24]. Autistic women's eating disorder symptoms are reported to last longer and start younger [4]. That is a big deal when we consider  the fact that Autistic people with eating disorders report the least positive outcomes from 'gold standard' treatments, like good old CBT [4]. 

 

ADHD traits have also been linked to eating disorders. A 2017 study on 1165 adults with eating disorders found that 35% of those with Bulimia Nervosa scored above clinical cut-offs when screened for ADHD. The same was found for: 

 

  • 37% of people with Anorexia Nervosa (binging/purging subtype), 

  • 26% of people with Eating Disorder Not Otherwise Specified, 

  • 31% of people with Binge Eating Disorder, and 

  • 18% of people with Anorexia Nervosa (restricting subtype) [20]. 

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Autistic traits have an especially high correlation with restrictive eating disorders. ADHD traits have an especially high correlation with binge-purge eating disorders. Yet, both are linked with all eating disorders, more than the neurotypical population. 

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Somewhere between a third and half of all Autistic people also qualify as ADHDer's [18]. A privilege and an honour in some contexts, but in this one, that's another level of eating disorder, and trauma, risk. 

Studies have found that the lifetime prevalence of PTSD is significantly higher among ADHDer's, compared with neurotypical people [2]. 

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Why? 

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On one hand, research is finding that neurodivergent people are more likely to have traumatic experiences in the first place. 

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In one study, 72% of self-identified Autistic people reported that they had experienced sexual or physical assault, and 44% of the sample met full diagnostic criteria for PTSD [14]. 

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Being a minority has something to do with it. The Autistic cis women and gender minorities in that same study reported a significantly higher number of traumas and were significantly more likely than cis men to experience sexual trauma and meet the criteria for PTSD [14]. 

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On the other hand, research is suggesting that neurodivergent people experience triggers and events in such a way that makes them even more traumatic. 

 

One study looked at this and found that, while some neurodivergent people reported traditional traumas (e.g. maltreatment) and forms of social marginalization, others reported traumas related to their environment clashing with their neurodivergent needs (e.g. sensory trauma). All described sources of trauma in interviews that would not be captured by standardized measures [15].

In another study, more than half of the neurodivergent group reported traumatic events that were not recognised as traumatic by the DSM 5, and yet, 40% of these people still met criteria for a PTSD diagnosis [19]. 

 

Overall, both Autistics and ADHDer's have been found to have significantly higher rates of trauma, mental health diagnoses, and suicide [3, 5, 8]. 

 

When it comes to eating disorders, partial or subthreshold PTSD has consistently been found to be of clinical importance [1, 7, 21]. 

 

Why? 

 

There may be a functional association between the two, where eating disorder behaviours serve as a way to block and avoid traumatic triggers and memories. 

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A study that looked into this found evidence to support it. Specifically, thought-suppression, hyperarousal, distressing thoughts and moods, and purging were all revealed as key players in the eating disorder-PTSD link [16]. 

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When researchers have tried to understand how this link works, the following have stood out: 

  • Self-criticism 

  • Low self-worth 

  • Guilt 

  • Shame 

  • Depression 

  • Anxiety 

  • Emotion dysregulation 

  • Anger 

  • Impulsivity/compulsivity [13]. 

Beyond that, childhood trauma has been linked to eating disorders through the following mediators [22]: 

  • Pathological dissociation 

  • Difficulty with emotion-regulation 

  • Body dissatisfaction 

  • Negative affect/depression 

  • Anxiety 

  • General distress 

  • Self-criticism 

  • Alexithymia 

Unfortunately, many of these are also common experiences amongst neurodivergent people. 

 

To touch on one, final, layer of complexity, there is a known overlap between neurodivergence and members of the LGBTQIA+ community [10, 23].  

 

That's cool. Except for the fact that LGBTQIA+ adults and adolescents experience a greater incidence of trauma, eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Gay, bisexual, and transgender people of all ages are at increased risk for eating disorders and disordered eating behaviors [6, 17].  

 

Neurodivergent people are often multiply neurodivergent. They are part of a minority, and are often part of other minorities at the same time. When they have a mental health condition, it is rarely the only one they have, and the severity levels are often higher than expected. They have a higher than expected prevalence of trauma and eating disorders, and tend to respond much less favourably to traditional treatment approaches. 

 

So, there's a lot to consider when it comes to neurodivergent people in psychological treatment settings. At Treat Yourself Well Sydney, we are committed to sitting with this, learning about it, talking about it, and doing something about it. 

 

If you have never heard of the neurodiversity affirming model, here's a rundown:  

 

  • It is the opposite of ableism 

  • It puts neurodivergent voices on top 

  • It is acceptance and strengths based 

  • It is trauma-informed 

  • It supports disability rights, body freedom, racial justice, and of course, neurodiversity.

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That's what we follow, and that's what we will continue to follow. For good reason. 

References: 

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1.Adela Scharff, Shelby N. Ortiz, Lauren N. Forrest & April R. Smith (2021) Comparing the clinical presentation of eating disorder patients with and without trauma history and/or comorbid PTSD, Eating Disorders, 29:1, 88-102, DOI: 10.1080/10640266.2019.1642035  2.Antshel KM, Kaul P, Biederman J, Spencer TJ, Hier BO, Hendricks K, Faraone SV. Posttraumatic stress disorder in adult attention-deficit/hyperactivity disorder: clinical  features and familial transmission. J Clin Psychiatry. 2013 Mar;74(3):e197-204. doi: 10.4088/JCP.12m07698. PMID: 23561240.  3.Au-Yeung, S. K., Bradley, L., Robertson, A. E., Shaw, R., Baron-Cohen, S., & Cassidy,S. (2019). Experience of mental health diagnosis and perceived misdiagnosis in autistic,  possibly autistic and non-autistic adults. Autism, 23(6), 1508–1518.https://doi.org/10.1177/1362361318818167  4.Babb, C., Brede, J., Jones, C. R. G., Serpell, L., Mandy, W., & Fox, J. (2022). A comparison of the eating disorder service experiences of autistic and non-autistic  women in the UK. European Eating Disorders Review, 30( 5), 616– 627. https://doi.org/10.1002/erv.2930  5.Balazs J, Kereszteny A. Attention-deficit/hyperactivity disorder and suicide: A systematic review. World J Psychiatry. 2017 Mar 22;7(1):44-59. doi: 10.5498/wjp.v7.i1.44. PMID: 28401048; PMCID: PMC5371172.  6.Bell K, Rieger E, Hirsch JK. Eating disorder symptoms and proneness in gay men, lesbian women, and transgender and gender non-conforming adults: comparative levels  and a proposed mediational model. Front Psychol. 2019;9(2692).https://doi.org/10.3389/fpsyg.2018.02692.  7.Brewerton, T.D. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 10, 162 (2022). https://doi.org/10.1186/s40337-022-00696-6  8.Cassidy, S., Au-Yeung, S., Robertson, A., Cogger-Ward, H., Richards, G., Allison, C., ... & Baron-Cohen, S. (2022). Autism and autistic traits in those who died by suicide in England. The British Journal of Psychiatry, 221(5), 683-691.  9.Craig, S. G., Bondi, B. C., O’Donnell, K. A., Pepler, D. J., & Weiss, M. D. (2020). ADHD and exposure to maltreatment in children and youth: A systematic review of the past 10 years. Current psychiatry reports, 22, 1-14  10.Davidson, J., & Tamas, S. (2016). Autism and the ghost of gender. Emotion, Space and Society, 19, 59-65.  11.Gesi, C., Carmassi, C., Luciano, M., Bossini, L., Ricca, V., Fagiolini, A., . . . Dell’Osso, L. (2017). Autistic Traits in Patients with Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder: A Pilot Study. European Psychiatry, 41(S1), S100-S100. doi:10.1016/j.eurpsy.2017.01.310  12.Huke V, Turk J, Saeidi S, Kent A, Morgan JF. Autism spectrum disorders in eating disorder populations: a systematic review. European eating disorders review: the journal of the Eating Disorders Association. 2013;21(5):345–51. doi:10.1002/erv.2244.  13.Karen S. Mitchell, Erica R. Scioli, Tara Galovski, Perry L. Belfer & Zafra Cooper (2021) Posttraumatic stress disorder and eating disorders: maintaining mechanisms and  treatment targets, Eating Disorders, 29:3, 292-306, DOI: 10.1080/10640266.2020.1869369  14.Katherine E. Reuben, Christopher M. Stanzione, and Jenny L. Singleton.Interpersonal Trauma and Posttraumatic Stress in Autistic Adults.Autism in Adulthood.Sep 2021.247- 256.http://doi.org/10.1089/aut.2020.0073  15.Kerns, C. M., Lankenau, S., Shattuck, P. T., Robins, D. L., Newschaffer, C. J., & Berkowitz, S. J. (2022). Exploring potential sources of childhood trauma: A qualitative  study with autistic adults and caregivers. Autism, 26(8), 1987–1998. https://doi.org/10.1177/13623613211070637  16.Liebman RE, Becker KR, Smith KE, Cao L, Keshishian AC, Crosby RD, et al. Network analysis of posttraumatic stress and eating disorder symptoms in a community sample of  adults exposed to childhood abuse. J Trauma Stress. 2020. https://doi.org/10.1002/jts.22644.  17.Parker, L.L., Harriger, J.A. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord 8, 51 (2020). https://doi.org/10.1186/s40337-020-00327-y  18.Rong, Y., Yang, C. J., Jin, Y., & Wang, Y. (2021). Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis. Research in Autism Spectrum Disorders, 83, 101759.  19.Rumball, F., Happé, F. and Grey, N. (2020), Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM-5 and Non-DSM-5  Traumatic Life Events. Autism Research, 13: 2122-2132.https://doi.org/10.1002/aur.2306  20.Svedlund, N.E., Norring, C., Ginsberg, Y. et al. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients. BMC Psychiatry 17, 19 (2017). https://doi.org/10.1186/s12888-016-1093-1  21.Vidaña, A. G., Forbush, K. T., Barnhart, E. L., Chana, S. M., Chapa, D. A., Richson, B., & Thomeczek, M. L. (2020). Impact of trauma in childhood and adulthood on eating-disorder symptoms. Eating behaviors, 39, 101426.  22.Rabito-Alcón, M. F., Baile, J. I., & Vanderlinden, J. (2021). Mediating Factors between Childhood Traumatic Experiences and Eating Disorders Development: A Systematic  Review. Children, 8(2), 114. https://doi.org/10.3390/children8020114  23.Warrier, V., Greenberg, D.M., Weir, E. et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun 11, 3959 (2020).https://doi.org/10.1038/s41467-020-17794-1  24.Westwood H, Eisler I, Mandy W, Leppanen J, Treasure J, Tchanturia K. Using the autism-spectrum quotient to measure autistic traits in anorexia nervosa: a systematic  review and meta-analysis. J Autism Dev Disord. 2015; https://doi:10.1007/s10803-015-2641-0

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