Why Traditional Eating Disorder Treatment Fails LGBTQIA+ Neurodivergent Folks—And How We Can Fix It
- Becky
- Feb 12
- 4 min read
Updated: Apr 14
There’s so much I want to say about this.
As someone who is both LGBTQIA+ and neurodivergent, and who has worked within NHS eating disorder services, I’ve witnessed how current treatment models often fall short. While there may be some level of acknowledgement, there’s still a lack of clear, consistent action to support these communities in a meaningful way.
Intersectionality Matters
LGBTQIA+ individuals—especially those who are neurodivergent—need an approach that is inclusive, intersectional, and nuanced.
A 2020 study from the University of Cambridge found that transgender and gender-diverse individuals are 3 to 6 times more likely to be autistic than cisgender individuals. A 2018 study also revealed that a third of autistic individuals had their gender identity questioned, which highlights a deeply problematic assumption: that neurodivergent people lack the capacity to understand or express their own identity.
These systemic biases bleed into how eating disorders are understood and treated—particularly when it comes to assumptions about sensory needs, food rituals, and behaviours.
Neurodivergence, Gender Identity & Eating Disorders
It’s vital that services not only recognise both gender and neurodivergent identities but understand how they overlap—particularly when it comes to body image, sensory sensitivities, and social experiences.
We need services to move beyond box-ticking and into true inclusion. This includes:
Hiring and supporting lived experience practitioners from LGBTQIA+ and neurodivergent communities.
Providing training workshops (both clinical and peer-led) to build cultural competence.
Involving service users in shaping how support is delivered.
Trauma, Minority Stress & Mental Health
Stigma, discrimination, bullying, and minority stress must be recognised as contributing factors—not footnotes—in the assessment and treatment of eating disorders for LGBTQIA+ neurodivergent individuals.
Eating disorders don’t happen in a vacuum. Oppression and abuse, particularly around identity, often sit at the root of disordered eating. Trauma-informed care should be the standard, not the exception.
What Needs to Change
Here’s what I believe would make a meaningful difference:
Visible Inclusion: Rainbow flags, pronoun badges, and inclusive signage signal safety. Representation matters.
Sensory-Friendly Environments: Soft lighting, reduced noise, fidget tools, and weighted blankets in inpatient and day hospital settings should be a given.
Gender-Affirming Approaches: Move away from binary body language (“male/female norms”) and centre care around the individual’s identity and lived experience.
Flexible, Adaptive Therapy: Adjust CBT to suit neurodivergent processing styles. Break tasks down. Offer flexibility in routines. Make space for black-and-white thinking to be gently challenged.
Peer and Group Support: Offer therapy and support groups specifically for LGBTQIA+ neurodivergent individuals—spaces where they feel truly seen and understood.
Somatic and EMDR Work: Incorporate trauma therapies that acknowledge the body’s role in healing, especially in clients with complex trauma histories.
Respect Autonomy & Preferences: Sensory and dietary preferences shouldn’t be labelled “treatment resistant.” Collaboration and autonomy are key to long-term recovery.
Language Shapes Experience
We must stop pathologising and stigmatising people through medicalised language. Words like “abnormal,” “symptoms,” “deficits,” and “non-compliant” do harm. Use affirming, respectful alternatives like “traits,” “support needs,” or “processing differences.”
Let’s get rid of the outdated “low/high functioning” labels too. Autism and neurodivergence aren’t linear—they’re dynamic, and how someone presents can vary day to day.
Structural Change Is Non-Negotiable
Eating disorder services must remove the unnecessary barriers that keep people out. This includes:
Simplified referral pathways
Hybrid access (online and in-person)
Jargon-free communication
Flexible session formats and scheduling
Families and allies also need education. We must give them the tools to understand eating disorders, neurodivergence, and LGBTQIA+ identities. They’re part of the recovery ecosystem too.
If we want to create services that truly work, we must stop trying to force people to fit the system—and instead reshape the system to fit the people it serves.
Let’s centre lived experience. Let’s honour identity. Let’s do better.
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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