Eating Disorder Treatment is Failing Neurodivergent Clients: The Intersection of Carcerality and Neuronormativity
While it may seem abundantly clear, it is still worth naming that current mainstream eating disorder treatment is deeply embedded in ableist understandings of health and wellbeing. And it is not just the end goal that is manufactured in this carceral way, it is also the path on which neurodivergent (ND) clients are expected to travel. Relational carcerality runs rampant in therapeutic experiences in the ways we have delineated here and instills the belief that not only are you doing recovery wrong, but you ARE wrong. For ND folks who have likely heard this messaging across their world, it can be particularly devastating to experience it again in a space that is supposed to be centered on healing.
Non-consensual interventions abound and violate the safety and autonomy of ND clients. Examples of this include exposures around food and clothing, surveillance (including in vulnerable moments like using the restroom or shower), and limited “dislikes” of types of food. Even these approved “dislikes” may be inconsistently respected.
Sensory needs are blatantly neglected and/or invalidated. These may include needs around noise, stimming, fidgeting, and more. It is common for treatment centers to not allow fidgeting and other sensory modulation tactics that ND clients may prefer.
ND traits and experiences are maligned as non-compliance and treatment resistance. ND clients may require more "dislikes" due to sensory needs and may be unable to participate in food or clothing exposures because of sensory sensitivities, need for predictability, and cognitive differences.
Forced high masking in neuronormative treatment environments leads to meltdowns, shutdowns, and abrasive/ “aggressive” behaviors. Neurodivergent clients may become so overwhelmed that they struggle to modulate their emotions and behaviors in neurotypical ways, reinforcing the notion that they cannot achieve recovery through mainstream methods.
Relational carcerality is when a person entraps another person in their own values system and world view, thereby erasing their identities, rights, and agency. Most often this is accompanied by coercion and usurping of decision making privileges.
Neuronormativity is the assumption that neurotypical ways of thinking, behaving, and experiencing the world are the standard or norm, often leading to the marginalization or pathologizing of neurodivergent individuals who deviate from these norms.
See how relational carcerality and neuronormativity go together?
Call to action for providers:
Examine your relationship with ableism and where this may be showing up in your practice or the systems you work in
Identify where you may be imposing your values system on your clients
Do you feel uncomfortable with their communication style?
Do you resent their sensory and/or dietary needs?
Explore your own level of burnout and self invalidation as you operate in problematic systems
Avoid forced exposures, allowing any exposures used to be client led and initiated
Work collaboratively with clients to understand their unique experiences, needs and goals, viewing them as partners in the therapeutic process.
Written by: Victoria Leon and Dr. Jennie Wang-Hall