The Importance of Reasonable Adjustments in Eating Disorder Treatment
“As an autistic young woman who experienced anorexia from the age of twelve to twenty-six, with nine inpatient admissions during that time, the most crucial and often missed element of treating eating disorders is working with each person as an individual.
This means that every patient needs individualised care planning, but specifically, those with neurodivergence need reasonable adjustments to be made.
To reduce additional sensory overwhelm, emotional dysregulation, avoidance, and refusals, neurodivergent individuals may have specific needs that should be met so they feel more comfortable and capable of engaging with treatment.
Whether this involves meal planning, mealtimes, attending therapy and multidisciplinary team meetings, or feeling socially safe amongst peers, simple adaptations to the blanket rules often used in hospitals can make treatment far more accessible. These changes can help neurodivergent individuals feel safer and more receptive to the programme.
Examples of Reasonable Adjustments
- Allowing flexibility around mealtimes depending on when meals and snacks are usually eaten at home.
- Using specific cutlery, plates, cups, or bowls that the service user prefers or finds easier to use.
- Extending mealtime allowances where there is a valid reason. For example, I had delayed gastric emptying syndrome, which caused me to feel full very quickly. I was only given thirty minutes to eat a meal and fifteen minutes for a snack, after which any remaining food would be replaced with a high-energy supplement drink or an NG tube feed if refused.
For context, it took me 162 minutes to digest a scrambled egg. At mealtimes, I could be expected to eat a sandwich, a bag of crisps, and a chocolate bar, or four Weetabix and two slices of toast with peanut butter, all within thirty minutes.
- Staff informing the service user when their usual meal option is unavailable and asking what replacement they would prefer instead. Many autistic people rely heavily on consistency with food. Knowing what to expect at a particular meal, how it will look, taste, smell, and be presented alongside other foods can make the process of eating feel easier, or at least safer.
- Allowing neurodivergent individuals more flexibility than the standard limit of three “dislikes.” In many eating disorder treatment pathways, patients are only allowed to choose three foods or drinks they will never consume. After that, they are expected to eat or drink everything else.
This approach can be unreasonable for someone with neurodivergence who may struggle not only with taste, but also with the smell, texture, appearance, or even sound of certain foods and drinks.
For example, I have a phobia of orange squash and juice. I cannot even look at it without feeling nauseous. I cannot sit at the same table with it, and I can smell even a drop of it from across the room. In practical terms, those two items alone would take up two of my allotted dislikes, leaving only one remaining for hundreds of other foods and drinks, including some I may never have tried before.
- Accommodating coping strategies that make mealtimes easier, even if they differ from usual practice. This may include reading, watching a TV show, listening to music, doing schoolwork or work, or using self-soothing items such as a teddy bear, fidget spinner, or ear defenders.
For some individuals, sitting and making small talk during meals can be extremely anxiety-provoking. These adjustments can help reduce distress and increase engagement.
- Recognising that practices such as locking patients out of their rooms all day may be particularly stressful for someone who already finds social interaction overwhelming. Being forced into prolonged social situations can negatively affect recovery.
- Understanding that some eating behaviours may be unrelated to the eating disorder itself. Attempting to forcibly change these behaviours can have harmful consequences.
It is important to speak with family members and those who knew the individual before the eating disorder developed in order to understand which behaviours and characteristics predated the illness. These should then be considered within the care plan.
For example, I always ate the crusts of sandwiches and pizza first. I would scrape the toppings off pizza and eat them first because I preferred the texture of the softer base afterwards. I also ate the filling of pies before the pastry because I liked the pastry most and wanted to save it for last.
My family all do this, and we jokingly call it the “bombouche,” after something my grandmother used to say. However, in hospital, these behaviours were interpreted as “anorexic behaviours,” and I was repeatedly told off for them.
I am sure there are many other reasonable adjustments that can be made for people going through eating disorder treatment because everyone is unique and functions differently.
I would recommend speaking directly with individuals to understand what may make treatment feel easier, safer, and more accessible for them. Doing so can help them become more receptive to treatment and give them the best possible chance at recovery.”
