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Currently accepting new professional consultation clients only

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Stacie Fanelli, LCSW

Walking with you, not ahead of you

Collaborative, identity-affirming psychotherapy for eating disorders,

late-discovered neurodivergence & more

Of course my love of categorizing and labeling things drove me to ask this question: Are there TYPES of pattern recognition?? Surely it can't all be lumped together in the way that you're either "good at patterns" or you're not, and some people must excel at some over others, given what we know about spiky profiles.

Okay, maybe I was also inspired in part by a conversation with my partner in which I realized the facial and verbal micro-expressions (abstract patterns) that guide my decisions about when to bring up topics I know will be sensitive because of past experiences (predictive patterns) are not obvious to him. Likewise, when I yelled "plot twist!" at the end of a movie we were watching, he incorrectly assumed I was being sarcastic because it was so predictable to him (associative patterns), this shed more light on the ways in which pattern recognition is a very broad term for a very nuanced thing! I also felt curious about how this shows up as we're establishing and maintaining our relationships with food and our bodies.

#Neurodiversity #PatternRecognition #PatternSeeking #EDRecovery

Of course my love of categorizing and labeling things drove me to ask this question: Are there TYPES of pattern recognition?? Surely it can't all be lumped together in the way that you're either "good at patterns" or you're not, and some people must excel at some over others, given what we know about spiky profiles.

Okay, maybe I was also inspired in part by a conversation with my partner in which I realized the facial and verbal micro-expressions (abstract patterns) that guide my decisions about when to bring up topics I know will be sensitive because of past experiences (predictive patterns) are not obvious to him. Likewise, when I yelled "plot twist!" at the end of a movie we were watching, he incorrectly assumed I was being sarcastic because it was so predictable to him (associative patterns), this shed more light on the ways in which pattern recognition is a very broad term for a very nuanced thing! I also felt curious about how this shows up as we're establishing and maintaining our relationships with food and our bodies.

#Neurodiversity #PatternRecognition #PatternSeeking #EDRecovery

Rather than "just think differently about your situation, and you'll feel better," I am suggesting that if your brain is already wired this way anyway, why not make it work for you?

Let this post be the best-case-scenario, my hope for us all, with the caveat that those cons will often outweigh the pros, that when a feeling is present it may seem like it's always going to be present, and that other aspects of being neurodivergent may make override the benefits discussed here. There's nothing foolproof to this, it's not a "hack," and this isn't toxic positivity. It's just an opportunity to feel good about one of the few ways ADHDers may actually be at an advantage in recovery...when you're a neurominority used to working harder to get to the same place as the majority, that's worth celebrating.

#Neurodiversity #EDRecovery #ObjectPermanence #ADHD

Rather than "just think differently about your situation, and you'll feel better," I am suggesting that if your brain is already wired this way anyway, why not make it work for you?

Let this post be the best-case-scenario, my hope for us all, with the caveat that those cons will often outweigh the pros, that when a feeling is present it may seem like it's always going to be present, and that other aspects of being neurodivergent may make override the benefits discussed here. There's nothing foolproof to this, it's not a "hack," and this isn't toxic positivity. It's just an opportunity to feel good about one of the few ways ADHDers may actually be at an advantage in recovery...when you're a neurominority used to working harder to get to the same place as the majority, that's worth celebrating.

#Neurodiversity #EDRecovery #ObjectPermanence #ADHD

An invitation to look critically at our language and remember that what one person finds supportive another may not. This is not a call to stop using affirmations that feel helpful but rather to reconsider them as axioms.

What if instead of it being "okay" and "fine" to eat ~insert societally demonized convenience and/or preferred food here~ it was celebrated? What if instead of my evening routine of pack of Gushers before bed being forgivable since I'm autistic and you understand that autistic people find routine regulating, it was more akin to the value you find in another person's chamomile tea before bed? Neutral to positive.

I hear a lot of very well-meaning and neurodiversity-affirming providers call for diet culture to go easy on the neurodivergent ones. That is, "if all they can manage to eat for lunch is an Uncrustable, that's better than nothing!" It's a step up from being shamed, for sure, but given that the triple venn diagram of people with eating disorders, ADHDers and autistic folks, and perfectionists is nearly a circle (for all kinds of trauma and masking-related reasons as well as an inherent predisposition for some), the drive to do better than just "good enough" is STRONG, the shame when we can't is high, and the willingness to push through pain (e.g. endure sensory distress) to get there is a major risk to our wellbeing. Think of it like the phrase "Your anxiety about eating will hurt you more than pizza will." The implication is that pizza will in fact hurt you. Why get hurt a little when you could avoid getting hurt at all? A perfectionist is not reassured by this; a perfectionist sees a challenge - the kind that can trigger and exacerbate eating disorders.

This line of thinking was inspired by Oliver Burkeman's "The Imperfectionist" newsletter on doing 70% instead of 100%. Shoutout to the person who share it with me!

An invitation to look critically at our language and remember that what one person finds supportive another may not. This is not a call to stop using affirmations that feel helpful but rather to reconsider them as axioms.

What if instead of it being "okay" and "fine" to eat ~insert societally demonized convenience and/or preferred food here~ it was celebrated? What if instead of my evening routine of pack of Gushers before bed being forgivable since I'm autistic and you understand that autistic people find routine regulating, it was more akin to the value you find in another person's chamomile tea before bed? Neutral to positive.

I hear a lot of very well-meaning and neurodiversity-affirming providers call for diet culture to go easy on the neurodivergent ones. That is, "if all they can manage to eat for lunch is an Uncrustable, that's better than nothing!" It's a step up from being shamed, for sure, but given that the triple venn diagram of people with eating disorders, ADHDers and autistic folks, and perfectionists is nearly a circle (for all kinds of trauma and masking-related reasons as well as an inherent predisposition for some), the drive to do better than just "good enough" is STRONG, the shame when we can't is high, and the willingness to push through pain (e.g. endure sensory distress) to get there is a major risk to our wellbeing. Think of it like the phrase "Your anxiety about eating will hurt you more than pizza will." The implication is that pizza will in fact hurt you. Why get hurt a little when you could avoid getting hurt at all? A perfectionist is not reassured by this; a perfectionist sees a challenge - the kind that can trigger and exacerbate eating disorders.

This line of thinking was inspired by Oliver Burkeman's "The Imperfectionist" newsletter on doing 70% instead of 100%. Shoutout to the person who share it with me!

***FINAL UPDATE*** We have expanded the format of the group to have no cap and will section it into two halves - one large group discussion space and the second for small breakout groups for specific case consultations - the time selected by popular vote is 2/11 10-11:15am Pacific! Registrations accepted up to the day before with follow-up email sent out within 2 days.

**UPDATE: Whew, there’s been way more interest than anticipated, which is wonderful to see! We’ll be in touch with those who have registered or are still registering ASAP about scheduling and may not be able to get everyone interested in, though rather than cap attendees, we may open up a set number of consult slots. We both see professional clients for 1:1 consultation in between groups, so feel free to reach out in the meantime.**

Calling all eating disorder providers who work with autistic and ADHD adult and adolescent clients in any capacity! Regardless of whether you specialize in this niche, have a current case you're seeking support on, or just want to learn and/or brainstorm ideas about how ED care can be more affirming for all neurotypes, you're invited to the free consult group we are hosting next month.

Registration will be capped at the first 8 sign-ups to ensure space for all to share. Open to all disciplines in any location.

https://autonomousmindstherapy.com/consultation-group

***FINAL UPDATE*** We have expanded the format of the group to have no cap and will section it into two halves - one large group discussion space and the second for small breakout groups for specific case consultations - the time selected by popular vote is 2/11 10-11:15am Pacific! Registrations accepted up to the day before with follow-up email sent out within 2 days.

**UPDATE: Whew, there’s been way more interest than anticipated, which is wonderful to see! We’ll be in touch with those who have registered or are still registering ASAP about scheduling and may not be able to get everyone interested in, though rather than cap attendees, we may open up a set number of consult slots. We both see professional clients for 1:1 consultation in between groups, so feel free to reach out in the meantime.**

Calling all eating disorder providers who work with autistic and ADHD adult and adolescent clients in any capacity! Regardless of whether you specialize in this niche, have a current case you're seeking support on, or just want to learn and/or brainstorm ideas about how ED care can be more affirming for all neurotypes, you're invited to the free consult group we are hosting next month.

Registration will be capped at the first 8 sign-ups to ensure space for all to share. Open to all disciplines in any location.

https://autonomousmindstherapy.com/consultation-group

*REPOST WITH HIGHER CONTRAST* Sorry for the accessibility oversight!

*****
If you’ve ever been taken aback by the leisurely, unhurried pace of the staff at a restaurant that values quality of the experience over turning around tables, you might be someone who a) has adapted to capitalism and b) has come to value getting the most “bang for your buck,” so to speak.

Most of the late-discovered ADHD and autistic folks I work with have some level of insecurity about the speed at which they get things done. It makes sense, given inherent traits that create barriers to the efficiency that is so culturally prized: delayed processing, attention regulation challenges, monotropic interests, bottom-up cognition that requires us to have all the info to get to a conclusion, and executive functioning differences that usually go unaccommodated in workplaces, lest it cut into a company’s bottom line, and in the educational settings where we grow up, lest someone get a “leg up” who doesn’t actually need it (tone: sarcastic, annoyed). Additionally, the pursuit of thinness in service to taking up as little space as possible to "compensate" for barriers to efficiency we simply can't do anything about, can serve as a mask. That is, "I am taking up too much space here, but I make up for it over here."

This is not to say that an individual only comes to appreciate efficiency as a result of ableism and adversity! There is certainly something pleasing about the puzzle that is trying to fit the most amount of things into the least amount of space. Neurodivergent brains often thrive on challenges like this, and the dopamine hit from solving a problem can keep us coming back for more by implementing similar strategies into our routines and making a lifestyle out of optimization. While this is positively reinforced by society at large in the way that weight loss is praised even if it’s harmful to an individual, it’s not fair to swing the pendulum to the other side and dismiss it as a symptom of a mental illness, either. If you’re someone who appreciates efficiency and optimization, how do you balance this with the abundance and slowness that is sometimes a necessary part of self-care?

*REPOST WITH HIGHER CONTRAST* Sorry for the accessibility oversight!

*****
If you’ve ever been taken aback by the leisurely, unhurried pace of the staff at a restaurant that values quality of the experience over turning around tables, you might be someone who a) has adapted to capitalism and b) has come to value getting the most “bang for your buck,” so to speak.

Most of the late-discovered ADHD and autistic folks I work with have some level of insecurity about the speed at which they get things done. It makes sense, given inherent traits that create barriers to the efficiency that is so culturally prized: delayed processing, attention regulation challenges, monotropic interests, bottom-up cognition that requires us to have all the info to get to a conclusion, and executive functioning differences that usually go unaccommodated in workplaces, lest it cut into a company’s bottom line, and in the educational settings where we grow up, lest someone get a “leg up” who doesn’t actually need it (tone: sarcastic, annoyed). Additionally, the pursuit of thinness in service to taking up as little space as possible to "compensate" for barriers to efficiency we simply can't do anything about, can serve as a mask. That is, "I am taking up too much space here, but I make up for it over here."

This is not to say that an individual only comes to appreciate efficiency as a result of ableism and adversity! There is certainly something pleasing about the puzzle that is trying to fit the most amount of things into the least amount of space. Neurodivergent brains often thrive on challenges like this, and the dopamine hit from solving a problem can keep us coming back for more by implementing similar strategies into our routines and making a lifestyle out of optimization. While this is positively reinforced by society at large in the way that weight loss is praised even if it’s harmful to an individual, it’s not fair to swing the pendulum to the other side and dismiss it as a symptom of a mental illness, either. If you’re someone who appreciates efficiency and optimization, how do you balance this with the abundance and slowness that is sometimes a necessary part of self-care?

A few weeks ago I went to a vegan food festival I’d been excited for for a long time - I love fake meat, and the expense, labor, and availability are barriers to enjoying it often. Therefore, I went in knowing the stakes were high for me to choose the exact right thing (in contrast to an eating disorder mindset, in which the stakes might be high because I am only “allowing” this food for a special occasion that will eventually end). I spent about a half hour going from booth to booth looking at all the options and processing them through my mental algorithm, considering the bang for my buck, my texture and temperature preferences, and what’s available at other times, with the intention of choosing the meal that would make this infrequent experience most memorable (I enjoyed this process - there was some decision anxiety, but in an eating disorder headspace, it might have overwhelmed me without any benefits). I settled on a sandwich that was my favorite in college and I haven’t seen since. When I took a bite, my heart sank, and I felt devastated by the difference between what I was expecting and what I got. It was just okay. “Devastation” may seem extreme, perhaps even disordered, to someone who hasn’t had a similar experience. But it’s not for me. And yet, if given a do-over, I would not change anything about the expectations I set or my process of preparing because they brought me joy and excitement, regardless of my lack of control over the outcome. The sandwich was tolerable, though not my favorite, so I finished it, and had it not been tolerable, I would’ve planned on eating a preferred food when I got home and felt more regulated. In my eating disorder, though, I might’ve responded by throwing it out and deciding that this experience was the universe telling me I wasn’t meant to eat, and I would’ve let my emotions dictate how I showed up for my body.

I have encountered both of these experiences many times as both client and clinician. When I worked in a treatment center, I was tasked with facilitating exposure work around what was assumed to be food perfectionism by enforcing rules on grocery shopping outings...(SEE CAPTION CONTINUED IN COMMENTS)

A few weeks ago I went to a vegan food festival I’d been excited for for a long time - I love fake meat, and the expense, labor, and availability are barriers to enjoying it often. Therefore, I went in knowing the stakes were high for me to choose the exact right thing (in contrast to an eating disorder mindset, in which the stakes might be high because I am only “allowing” this food for a special occasion that will eventually end). I spent about a half hour going from booth to booth looking at all the options and processing them through my mental algorithm, considering the bang for my buck, my texture and temperature preferences, and what’s available at other times, with the intention of choosing the meal that would make this infrequent experience most memorable (I enjoyed this process - there was some decision anxiety, but in an eating disorder headspace, it might have overwhelmed me without any benefits). I settled on a sandwich that was my favorite in college and I haven’t seen since. When I took a bite, my heart sank, and I felt devastated by the difference between what I was expecting and what I got. It was just okay. “Devastation” may seem extreme, perhaps even disordered, to someone who hasn’t had a similar experience. But it’s not for me. And yet, if given a do-over, I would not change anything about the expectations I set or my process of preparing because they brought me joy and excitement, regardless of my lack of control over the outcome. The sandwich was tolerable, though not my favorite, so I finished it, and had it not been tolerable, I would’ve planned on eating a preferred food when I got home and felt more regulated. In my eating disorder, though, I might’ve responded by throwing it out and deciding that this experience was the universe telling me I wasn’t meant to eat, and I would’ve let my emotions dictate how I showed up for my body.

I have encountered both of these experiences many times as both client and clinician. When I worked in a treatment center, I was tasked with facilitating exposure work around what was assumed to be food perfectionism by enforcing rules on grocery shopping outings...(SEE CAPTION CONTINUED IN COMMENTS)

ADHD boredom is often misunderstood and stigmatized as the lower-intensity emotion those with typical dopamine reserves expect it to be and one that children eventually grow out of. In fact, it's not uncommon for one's ability to endure boredom to be perceived as virtuous and for the things we do to cope with boredom to be assigned negative moral value. Remember when that trend of people staring at the seat in front of them on long flights was hailed as a demonstration of "self-control" earlier this year? Are those of us who pack a minimum of one activity per hour on a flight are "out of control" then? EDs promise control.

Boredom isn't experienced equally for everyone, and while life hacks, systems, and structure can make it more tolerable for those who struggle with understimulation on a wide-open plans-free day, when we experience this chronically and at a high intensity without support or effective coping mechanisms, zooming out and considering where we're going in life and why we do the things we do might leave us feeling empty and frustrated. The inspiration for this post came from my experience forgetting to take my stimulant meds on a Sunday recently and turning down dozens of suggestions for things to do because they all sounded unfulfilling, followed by panic that nothing would ever feel stimulating enough again. "Wow," I thought, when reflecting on the experience the next day, back on my meds. "That was a lot like how food feels sometimes." It wasn't a lack of interest or motivation, and it couldn't be overcome with logic. It wasn't mild discomfort; it was desperation without reprieve. And I started to wonder why, amongst all the emotion wheels and socioemotional education, the only coping skill I've ever heard for boredom is "find something to do" or "sit with it" (to paraphrase an adage from childhood: "If you're bored, you're boring"). No wonder we ADHDers, ever creative, learn to use food and conflict and risk-taking and art and animals and sports and other adrenaline-pumping activities to match the energy of the urgency we feel, at times even becoming dependent on the activity and then tending to our dependence.

#AdultADHD #neurodiversity

ADHD boredom is often misunderstood and stigmatized as the lower-intensity emotion those with typical dopamine reserves expect it to be and one that children eventually grow out of. In fact, it's not uncommon for one's ability to endure boredom to be perceived as virtuous and for the things we do to cope with boredom to be assigned negative moral value. Remember when that trend of people staring at the seat in front of them on long flights was hailed as a demonstration of "self-control" earlier this year? Are those of us who pack a minimum of one activity per hour on a flight are "out of control" then? EDs promise control.

Boredom isn't experienced equally for everyone, and while life hacks, systems, and structure can make it more tolerable for those who struggle with understimulation on a wide-open plans-free day, when we experience this chronically and at a high intensity without support or effective coping mechanisms, zooming out and considering where we're going in life and why we do the things we do might leave us feeling empty and frustrated. The inspiration for this post came from my experience forgetting to take my stimulant meds on a Sunday recently and turning down dozens of suggestions for things to do because they all sounded unfulfilling, followed by panic that nothing would ever feel stimulating enough again. "Wow," I thought, when reflecting on the experience the next day, back on my meds. "That was a lot like how food feels sometimes." It wasn't a lack of interest or motivation, and it couldn't be overcome with logic. It wasn't mild discomfort; it was desperation without reprieve. And I started to wonder why, amongst all the emotion wheels and socioemotional education, the only coping skill I've ever heard for boredom is "find something to do" or "sit with it" (to paraphrase an adage from childhood: "If you're bored, you're boring"). No wonder we ADHDers, ever creative, learn to use food and conflict and risk-taking and art and animals and sports and other adrenaline-pumping activities to match the energy of the urgency we feel, at times even becoming dependent on the activity and then tending to our dependence.

#AdultADHD #neurodiversity

You may be surprised to see a post that includes the words “tough love” coming from two liberation-oriented relational therapists, but we have increasingly felt that nuance is missing from conversations about the changing landscape of ED care, so please read through these slides not as a retraction of all we’ve spoken on previously but an addendum. We do not believe abolition and outsourcing your decision-making are mutually exclusive.

Fellow providers: centering our clients’ needs, wants, capacity, and vision for recovery is not at odds from providing direction. Whether our client would benefit from us drafting a road map or just a gentle reminder to turn right at the light is something that can only be ascertained from ongoing conversations with them in the weeds and the mess of their most vulnerable thoughts that we must earn access to through rapport and trust-building. Sometimes that looks like spending time learning and observing before jumping in to add recommendations or “hard truths.” But it always looks like obtaining consent to share these things first and having conversations about how they land. For example, “Would it be helpful if I email you on Wednesday about that snack you want to challenge yourself to if you don’t text me a picture of it first?” “Can I tell you about what I’ve seen happen in my clinical experience to others who have cut out carbs to the extent you have?” There is a huge difference between these questions and either a) lecturing and scolding or b) “I’ll help you however you want me to, but you have to tell me what that looks like.”

You may be surprised to see a post that includes the words “tough love” coming from two liberation-oriented relational therapists, but we have increasingly felt that nuance is missing from conversations about the changing landscape of ED care, so please read through these slides not as a retraction of all we’ve spoken on previously but an addendum. We do not believe abolition and outsourcing your decision-making are mutually exclusive.

Fellow providers: centering our clients’ needs, wants, capacity, and vision for recovery is not at odds from providing direction. Whether our client would benefit from us drafting a road map or just a gentle reminder to turn right at the light is something that can only be ascertained from ongoing conversations with them in the weeds and the mess of their most vulnerable thoughts that we must earn access to through rapport and trust-building. Sometimes that looks like spending time learning and observing before jumping in to add recommendations or “hard truths.” But it always looks like obtaining consent to share these things first and having conversations about how they land. For example, “Would it be helpful if I email you on Wednesday about that snack you want to challenge yourself to if you don’t text me a picture of it first?” “Can I tell you about what I’ve seen happen in my clinical experience to others who have cut out carbs to the extent you have?” There is a huge difference between these questions and either a) lecturing and scolding or b) “I’ll help you however you want me to, but you have to tell me what that looks like.”

What I am NOT saying is that “everyone’s a little autistic.” And I choose autism as an example because this microaggression is the one I see most commonly clapped back against - I am very much not saying neurodivergent identity is confined to autism (or ADHD or even a diagnosis, as that would be counter to the points I’ve made about the medical model in this post) - see @livedexperienceeducator’s Smorgasbord and Umbrella models for more on how ND is defined.

What I am NOT saying is that if you identify with a few TikToks about traits of a personality disorder, you should just take that at face value and start identifying with this label immediately if you want to find peace.

What I am NOT saying is that misdiagnosis can’t harm people, just as missed diagnosis can. Or hey, even accurate diagnosis, depending on how it’s utilized.

But a study published last month in Autism in Adulthood by Brown et al found that “autistic traits predicted elevated ED risk overall,” but “the effect was substantially lower in women with a formal autism diagnosis.” So knowing about your neurodivergence DOES matter. Do the pros outweigh the cons, or vice versa? Well, that’s something everyone must figure out for themselves. That’s part of why this is so damn hard.

What I AM saying is that if you are curious whether you might be neurodivergent and are beginning to explore that, there is a high likelihood that you will never feel one hundred percent sure that you are one hundred percent of the time. This is an invitation to ask “What if that’s okay?” What if you could do the self-discovery and the re-conceptualization of your memories and narratives and forgiveness and grief and all the other emotions enveloped in the whirlwind that is a late diagnosis without that certainty? What’s holding you back? What are you waiting for? If your answer to “Will there ever be enough validation to start doing this work?” is “I don’t know” then consider just starting and seeing what you find. You are not a fraud. You are not watering down other people’s experiences. You are curious. (Caption continued in the comments)

What I am NOT saying is that “everyone’s a little autistic.” And I choose autism as an example because this microaggression is the one I see most commonly clapped back against - I am very much not saying neurodivergent identity is confined to autism (or ADHD or even a diagnosis, as that would be counter to the points I’ve made about the medical model in this post) - see @livedexperienceeducator’s Smorgasbord and Umbrella models for more on how ND is defined.

What I am NOT saying is that if you identify with a few TikToks about traits of a personality disorder, you should just take that at face value and start identifying with this label immediately if you want to find peace.

What I am NOT saying is that misdiagnosis can’t harm people, just as missed diagnosis can. Or hey, even accurate diagnosis, depending on how it’s utilized.

But a study published last month in Autism in Adulthood by Brown et al found that “autistic traits predicted elevated ED risk overall,” but “the effect was substantially lower in women with a formal autism diagnosis.” So knowing about your neurodivergence DOES matter. Do the pros outweigh the cons, or vice versa? Well, that’s something everyone must figure out for themselves. That’s part of why this is so damn hard.

What I AM saying is that if you are curious whether you might be neurodivergent and are beginning to explore that, there is a high likelihood that you will never feel one hundred percent sure that you are one hundred percent of the time. This is an invitation to ask “What if that’s okay?” What if you could do the self-discovery and the re-conceptualization of your memories and narratives and forgiveness and grief and all the other emotions enveloped in the whirlwind that is a late diagnosis without that certainty? What’s holding you back? What are you waiting for? If your answer to “Will there ever be enough validation to start doing this work?” is “I don’t know” then consider just starting and seeing what you find. You are not a fraud. You are not watering down other people’s experiences. You are curious. (Caption continued in the comments)

There's a lot happening underneath the iceberg that providers don't see. This is an invitation to get curious and dig deeper than "they're just not motivated" or are "treatment resistant." If you resonate with some of these barriers, what's been helpful for you in either troubleshooting OR finding an alternative to meal planning and food logging altogether?

#ADHD #EDRecovery #TimeAgnosia #EDTreatment #ExecutiveFunctioning

There's a lot happening underneath the iceberg that providers don't see. This is an invitation to get curious and dig deeper than "they're just not motivated" or are "treatment resistant." If you resonate with some of these barriers, what's been helpful for you in either troubleshooting OR finding an alternative to meal planning and food logging altogether?

#ADHD #EDRecovery #TimeAgnosia #EDTreatment #ExecutiveFunctioning

I’ve had some super interesting conversations lately about the protective nature of “black and white” or “all or nothing” thinking, including the simplification of decision-making and expediting of complex, lengthy processing mechanisms for bottom-up thinkers.

At many points in my own eating disorder, I felt like a “fraud” or that I was doing the ED “wrong” because I was able to make the choice to eat things I was normally scared of without much emotional fallout because it was a special occasion or sometimes even just because I decided I wanted to and was tired enough of the limits the ED placed on me. I’d cycle in and out of these periods of “on” and “off” while providers would use this as evidence to suggest that I was more capable of ~recovery~ than I thought I was when the light switch was back “on”: “You ate that thing last time and it went fine, so you can do it again.” Yes, but that was when the light switch was “off.”

This is the sort of mindset that gets labeled as a cognitive distortion, rigidity, inflexibility…call it what you want, but it’s not irrational, it’s not unreasonable, it’s a divergence from an expected way of thinking, and if it works, it works. My biggest regret knowing what I know now is that when my light switch would turn off, I spent so much time wondering if I was lying about having an ED to begin with that I couldn’t just enjoy the reprieve from anxiety and thought loops.

Of course, not having any “yellow flags” that the ED is re-emerging leading up to it precludes us from “coping ahead” or doing any prevention work, and that’s terrifying - the sense of loss of control is fear come to fruition - but it is made worse when those around us question the validity of the ED, question whether we simply made a choice or worse, are being “manipulative,” as affirmations like the one above are only afforded to those whose ED presents in a slower, gradual and predictable, thus more sympathetic, manner.

Additionally we don’t have to “wait for the other shoe to drop” just because it has before (easier said than done, for sure).

I’ve had some super interesting conversations lately about the protective nature of “black and white” or “all or nothing” thinking, including the simplification of decision-making and expediting of complex, lengthy processing mechanisms for bottom-up thinkers.

At many points in my own eating disorder, I felt like a “fraud” or that I was doing the ED “wrong” because I was able to make the choice to eat things I was normally scared of without much emotional fallout because it was a special occasion or sometimes even just because I decided I wanted to and was tired enough of the limits the ED placed on me. I’d cycle in and out of these periods of “on” and “off” while providers would use this as evidence to suggest that I was more capable of ~recovery~ than I thought I was when the light switch was back “on”: “You ate that thing last time and it went fine, so you can do it again.” Yes, but that was when the light switch was “off.”

This is the sort of mindset that gets labeled as a cognitive distortion, rigidity, inflexibility…call it what you want, but it’s not irrational, it’s not unreasonable, it’s a divergence from an expected way of thinking, and if it works, it works. My biggest regret knowing what I know now is that when my light switch would turn off, I spent so much time wondering if I was lying about having an ED to begin with that I couldn’t just enjoy the reprieve from anxiety and thought loops.

Of course, not having any “yellow flags” that the ED is re-emerging leading up to it precludes us from “coping ahead” or doing any prevention work, and that’s terrifying - the sense of loss of control is fear come to fruition - but it is made worse when those around us question the validity of the ED, question whether we simply made a choice or worse, are being “manipulative,” as affirmations like the one above are only afforded to those whose ED presents in a slower, gradual and predictable, thus more sympathetic, manner.

Additionally we don’t have to “wait for the other shoe to drop” just because it has before (easier said than done, for sure).

I am a person who tends to run under-stimulated…until suddenly I don’t anymore. Part of my unmasking work has been to notice and interrupt my constant self-monitoring of my innately narrow window of ideal stimulation to ensure I don’t fall “out of range” and instead trust myself to up- or down-regulate when I need to. The only time this fails me is the rare occasion on which I over-shoot my input in an attempt to stave off intolerable boredom (thanks, ADHD) and wind up over-stimulated. It’s a lot harder to come down from a meltdown or shutdown than it is to come up from task paralysis, mostly because of the social implications of the former and the “explaining” I have to do, whereas I can mask under-stimulation pretty well.

All this to say, there is privilege in leaning toward stimulation-seeking more than stimulation-avoiding, and I am also increasingly susceptible to internalized narratives from the world around me about my need to “be careful” about how I up-regulate, lest it be to the detriment of myself or the inconvenience of others.

In my eating disorder, I’ve harbored the “secret” that despite a prescribed meal plan and nutrition education up the wazoo, I felt I would never be truly satisfied - a bottomless pit - and that every amount of “allowed” food felt restrictive. This contributed to shame about nothing “working” and doing recovery “wrong.”

Hot take: while ADHDers are more likely to meet clinical criteria for binge eating disorder for this reason, I believe eating to stim is not inherently disordered and only looks like BED from the outside in (parallel to ARFID looking like anorexia if we don’t ask the right questions). Binge eating is, similarly, tied to trying to meet an unmet emotional need via food. However, stimulation is not emotional alone - many neurodivergent brains have a physiological NEED to stim that we can’t out-think (I’m looking at you, CBT) - and what meets that need is as unique as our fingerprints. Prescribing stretching or TikTok or hanging out with friends to someone whose gustatory sensory system is hypo-sensitive to prevent them from “bingeing” is akin to recommending (caption continued in comments!)

I am a person who tends to run under-stimulated…until suddenly I don’t anymore. Part of my unmasking work has been to notice and interrupt my constant self-monitoring of my innately narrow window of ideal stimulation to ensure I don’t fall “out of range” and instead trust myself to up- or down-regulate when I need to. The only time this fails me is the rare occasion on which I over-shoot my input in an attempt to stave off intolerable boredom (thanks, ADHD) and wind up over-stimulated. It’s a lot harder to come down from a meltdown or shutdown than it is to come up from task paralysis, mostly because of the social implications of the former and the “explaining” I have to do, whereas I can mask under-stimulation pretty well.

All this to say, there is privilege in leaning toward stimulation-seeking more than stimulation-avoiding, and I am also increasingly susceptible to internalized narratives from the world around me about my need to “be careful” about how I up-regulate, lest it be to the detriment of myself or the inconvenience of others.

In my eating disorder, I’ve harbored the “secret” that despite a prescribed meal plan and nutrition education up the wazoo, I felt I would never be truly satisfied - a bottomless pit - and that every amount of “allowed” food felt restrictive. This contributed to shame about nothing “working” and doing recovery “wrong.”

Hot take: while ADHDers are more likely to meet clinical criteria for binge eating disorder for this reason, I believe eating to stim is not inherently disordered and only looks like BED from the outside in (parallel to ARFID looking like anorexia if we don’t ask the right questions). Binge eating is, similarly, tied to trying to meet an unmet emotional need via food. However, stimulation is not emotional alone - many neurodivergent brains have a physiological NEED to stim that we can’t out-think (I’m looking at you, CBT) - and what meets that need is as unique as our fingerprints. Prescribing stretching or TikTok or hanging out with friends to someone whose gustatory sensory system is hypo-sensitive to prevent them from “bingeing” is akin to recommending (caption continued in comments!)

As more and more treatment centers cling to the demand for neurodiversity-affirming eating disorder care and claim to be autism-affirming, the talk seems to be a whole lot of “headphones at the table” and “emphasizing strengths over deficits” (good things, for sure!), while I’ve yet to hear any talk about how they conceptualize and support their autistic clients through the less palatable experiences of autism, the ones that have historically traumatized, deflated, and shaken our worth because of how those in our lives have responded over the course of a lifetime (or, because of the impact of having suppressed or masked them for the sake of safety, if we had that privilege). How are treatment centers educating their staff and ensuring old relational patterns are not re-enacted, that clients aren’t getting further validation that even in a supposedly safe space, they are “too much”, bad, wrong, etc.? I want to hear about providers going beyond “autism is a superpower.” I want to hear that you are prepared to be inconvenienced, that you aren’t going to blame or abandon or incarcerate the person in an incredibly vulnerable moment, that you are going to give them the benefit of the doubt, that you are going to support their support people in making a plan for when these meltdowns or shutdowns continue at home rather than setting the unrealistic goal of eradicating them or telling them that once they’re more nourished it won’t be a problem anymore. I want to know where I can send clients with all kinds of support needs, with fluctuating support needs, with support needs that will always be there who don’t have an interest and/or ability in needing less support but still deserve to work toward eating disorder recovery.

#NeurodiversityAffirming #EatingDisorderTreatment #EatingDisorderRecovery #AutismAcceptance #Meltdowns #shutdowns

As more and more treatment centers cling to the demand for neurodiversity-affirming eating disorder care and claim to be autism-affirming, the talk seems to be a whole lot of “headphones at the table” and “emphasizing strengths over deficits” (good things, for sure!), while I’ve yet to hear any talk about how they conceptualize and support their autistic clients through the less palatable experiences of autism, the ones that have historically traumatized, deflated, and shaken our worth because of how those in our lives have responded over the course of a lifetime (or, because of the impact of having suppressed or masked them for the sake of safety, if we had that privilege). How are treatment centers educating their staff and ensuring old relational patterns are not re-enacted, that clients aren’t getting further validation that even in a supposedly safe space, they are “too much”, bad, wrong, etc.? I want to hear about providers going beyond “autism is a superpower.” I want to hear that you are prepared to be inconvenienced, that you aren’t going to blame or abandon or incarcerate the person in an incredibly vulnerable moment, that you are going to give them the benefit of the doubt, that you are going to support their support people in making a plan for when these meltdowns or shutdowns continue at home rather than setting the unrealistic goal of eradicating them or telling them that once they’re more nourished it won’t be a problem anymore. I want to know where I can send clients with all kinds of support needs, with fluctuating support needs, with support needs that will always be there who don’t have an interest and/or ability in needing less support but still deserve to work toward eating disorder recovery.

#NeurodiversityAffirming #EatingDisorderTreatment #EatingDisorderRecovery #AutismAcceptance #Meltdowns #shutdowns

On Liberation Lunch (Taylor’s Version), we unpacked themes of carcerality, religious trauma, and white feminism in The Tortured Poets Department, not to mention the notable absence of queer themes and cat references 🤔 and asked the question “Is a billionaire with a big platform ethically obligated to show up a certain way for the public?” (not unlike previous conversations of managed care’s ethical obligations to consumers, though we did not get into that today). We also discussed externalization of eating disorders in music (whether any breakup song is ED-recovery-coded). Pictured: $5 squeezy brain from Five Below.

On Liberation Lunch (Taylor’s Version), we unpacked themes of carcerality, religious trauma, and white feminism in The Tortured Poets Department, not to mention the notable absence of queer themes and cat references 🤔 and asked the question “Is a billionaire with a big platform ethically obligated to show up a certain way for the public?” (not unlike previous conversations of managed care’s ethical obligations to consumers, though we did not get into that today). We also discussed externalization of eating disorders in music (whether any breakup song is ED-recovery-coded). Pictured: $5 squeezy brain from Five Below.

Join two AuDHD therapists for an unpacking of The Tortured Poets Department through an anti-oppressive lens (disclaimer: we are not Taylor apologists, harm will be named, you can come for us it’s fine), but also probably some discussion of things that actually matter re: EDs - you decide, show up in the comments, get your meal support, and engage with like-minded comrades.

Join two AuDHD therapists for an unpacking of The Tortured Poets Department through an anti-oppressive lens (disclaimer: we are not Taylor apologists, harm will be named, you can come for us it’s fine), but also probably some discussion of things that actually matter re: EDs - you decide, show up in the comments, get your meal support, and engage with like-minded comrades.

As Taylor Swift says, “I have this thing where I get older but just never wiser.” ADHDers will more often than not relate, in my experience. We know the years are passing, technically, logically, but the content filling those years is challenging to assess as adequate, above or below expectations (ours and others’). We may never quite know where we stand in time. This is a major piece of why I find depth psychology and existential approaches to be so fulfilling for many of my ADHD clients. Those of us who experience time non-linearly and as a construct in a world that requires us to function opposite of this, we must grieve.

Additionally, the linear experience of time can be devastating to the ADHD brain in that it is infinite. There will never be enough stimulation to fill it. Anything can happen within it. It’s outside our control. Not a fan. Eating disorders may interact with this reality by creating structure for us via rules like how many hours we must go between meals or that we must try to go for as long as possible without eating to gain a sense of power over the limitlessness of time. Conversely, they may take a more nihilistic approach, a la “None of it matters, I’ll never fill it up completely, there isn’t enough structure in the world, but eating makes it pass faster.”

Most of the discourse I see around ADHD and time is in regards to “managing” it, not perceiving it. The two go hand-in-hand, they’re not separate. How we perceive time impacts our ability to use it the way we’d like to or others would like us to. And the shame that pops up when we cannot do so can be coped with via an ED, too.

#EatingDisorderRecovery #ADHD #AdultADHD #Neurodiversity #NeurodivergentAffirming #Neuronormativity

As Taylor Swift says, “I have this thing where I get older but just never wiser.” ADHDers will more often than not relate, in my experience. We know the years are passing, technically, logically, but the content filling those years is challenging to assess as adequate, above or below expectations (ours and others’). We may never quite know where we stand in time. This is a major piece of why I find depth psychology and existential approaches to be so fulfilling for many of my ADHD clients. Those of us who experience time non-linearly and as a construct in a world that requires us to function opposite of this, we must grieve.

Additionally, the linear experience of time can be devastating to the ADHD brain in that it is infinite. There will never be enough stimulation to fill it. Anything can happen within it. It’s outside our control. Not a fan. Eating disorders may interact with this reality by creating structure for us via rules like how many hours we must go between meals or that we must try to go for as long as possible without eating to gain a sense of power over the limitlessness of time. Conversely, they may take a more nihilistic approach, a la “None of it matters, I’ll never fill it up completely, there isn’t enough structure in the world, but eating makes it pass faster.”

Most of the discourse I see around ADHD and time is in regards to “managing” it, not perceiving it. The two go hand-in-hand, they’re not separate. How we perceive time impacts our ability to use it the way we’d like to or others would like us to. And the shame that pops up when we cannot do so can be coped with via an ED, too.

#EatingDisorderRecovery #ADHD #AdultADHD #Neurodiversity #NeurodivergentAffirming #Neuronormativity

If you know me, you know I am not a platitudes person. When someone says something idealistic, I tend to ask for proof. So I offer these pieces of reassurance I've sincerely offered to others recently after years of pushing them away for myself as a gift on world autism day - take what feels like it's for you. Affirmations don't have to promise sunshine and rainbows will come; they can just be a pause button or a dimmer switch on your internal assholery :P

If you know me, you know I am not a platitudes person. When someone says something idealistic, I tend to ask for proof. So I offer these pieces of reassurance I've sincerely offered to others recently after years of pushing them away for myself as a gift on world autism day - take what feels like it's for you. Affirmations don't have to promise sunshine and rainbows will come; they can just be a pause button or a dimmer switch on your internal assholery :P

When considering what participation in eating disorder awareness week would be most meaningful, we decided it would be values-aligned to sidestep statistics and fundraising that already exists in abundance to instead talk about an area of ED care that often goes overlooked and misconceived in neurodivergent folks. In bringing ~awareness~ to affirming ways to support those with hyper- and hypo-sensitivity to their internal cues, we hope to reach clinicians who feel stuck and folks who have long thought their bodies were the problem.

When considering what participation in eating disorder awareness week would be most meaningful, we decided it would be values-aligned to sidestep statistics and fundraising that already exists in abundance to instead talk about an area of ED care that often goes overlooked and misconceived in neurodivergent folks. In bringing ~awareness~ to affirming ways to support those with hyper- and hypo-sensitivity to their internal cues, we hope to reach clinicians who feel stuck and folks who have long thought their bodies were the problem.

I have hosted a handful of iterations of this support group over the past couple of years - paid vs. free vs. exclusive to Patreon, weekly vs. biweekly vs. monthly, all neurodivergent vs. only autistic participants, drop-in vs. closed and time-limited, therapy-style facilitation vs. peer support. And what I've learned is that needs fluctuate. What people want in a supportive hour with community will be different from month to month, as will their capacity to engage and my own.

I have juggled the desire to make the group accessible by not requiring RSVPs that can feel like a demand with the difficulty of holding space for just a couple people at a time, especially those who expected there to be more people so they wouldn't have to be as perceived. So I'm at a point now where holding the group space still feels incredibly important, and I'm out of spoons to invest in structured facilitation. When a lived experience therapist offers support with their peer hat on, it gets tricky because folks know I'm a therapist, so there is an implicit power dynamic as much as I can say I don't want there to be, no matter how much disclosure and stepping back I try to do.

All this said, I'd LOVE to have more folks pop in even just once to see how it feels. Please know the following:

-I will be eating, so if you need a space to body double with food this is it, and if being in a space with people eating is hard but you still want to attend, you can try turning your screen away and participating via audio only.

-I will continue to do whatever I can to make accommodations not just available but a norm. But I won't always get it right.

-The focus is on community discussion and/or just having a space to vent, so I will respond empathetically as a fellow human but I won't challenge you or reflect patterns as a therapist might. It might feel awkward. There will be silence sometimes. It's ok :)

-You never know how many or how few people will show up, but you're not responsible for staying in the group if you're uncomfortable with the numbers just to keep it going.

-You can review the guidelines/structure ahead at staciefanelli.com/support group

I have hosted a handful of iterations of this support group over the past couple of years - paid vs. free vs. exclusive to Patreon, weekly vs. biweekly vs. monthly, all neurodivergent vs. only autistic participants, drop-in vs. closed and time-limited, therapy-style facilitation vs. peer support. And what I've learned is that needs fluctuate. What people want in a supportive hour with community will be different from month to month, as will their capacity to engage and my own.

I have juggled the desire to make the group accessible by not requiring RSVPs that can feel like a demand with the difficulty of holding space for just a couple people at a time, especially those who expected there to be more people so they wouldn't have to be as perceived. So I'm at a point now where holding the group space still feels incredibly important, and I'm out of spoons to invest in structured facilitation. When a lived experience therapist offers support with their peer hat on, it gets tricky because folks know I'm a therapist, so there is an implicit power dynamic as much as I can say I don't want there to be, no matter how much disclosure and stepping back I try to do.

All this said, I'd LOVE to have more folks pop in even just once to see how it feels. Please know the following:

-I will be eating, so if you need a space to body double with food this is it, and if being in a space with people eating is hard but you still want to attend, you can try turning your screen away and participating via audio only.

-I will continue to do whatever I can to make accommodations not just available but a norm. But I won't always get it right.

-The focus is on community discussion and/or just having a space to vent, so I will respond empathetically as a fellow human but I won't challenge you or reflect patterns as a therapist might. It might feel awkward. There will be silence sometimes. It's ok :)

-You never know how many or how few people will show up, but you're not responsible for staying in the group if you're uncomfortable with the numbers just to keep it going.

-You can review the guidelines/structure ahead at staciefanelli.com/support group

We are not exempt from the same underlying issues as anyone else, AND our experiences with ableism (external and internalized), ND-specific trauma, perception of the world, etc. must be factored into clinical conceptualization of treatment. Neurodivergent-affirming providers use an intersectional lens, which means sometimes it's the same stuff anyone else in front of you asking for support is going to need, and sometimes it's not. Exploring all possibilities is crucial. For example, if I'm using an eating disorder to numb intense emotions and my provider assumes that because I'm autistic, the target of our work should be meltdown prevention, what other useful tools might I be missing out on that they'd use for anyone else? This is one way virtue signaling with the ND-affirming label impedes effective care. If my ED helps me trust myself because the world has taught me I'm not trustworthy as a result of my ADHD traits, then challenging ableism will enter into the conversations had in therapy, self-acceptance will be a piece of the work, but what do we do for folks without ADHD who struggle to trust themselves? And what other reasons might I have internalized that I'm not trustworthy? I want those conversations TOO. Let's not be so quick to pin the eating disorder on the neurotype entirely. Instead, offering equitable treatment is truly affirming. #AuDHD #EatingDisorderTreatment #EatingDisorderRecovery #Neurodivergent #ActuallyAutistic

We are not exempt from the same underlying issues as anyone else, AND our experiences with ableism (external and internalized), ND-specific trauma, perception of the world, etc. must be factored into clinical conceptualization of treatment. Neurodivergent-affirming providers use an intersectional lens, which means sometimes it's the same stuff anyone else in front of you asking for support is going to need, and sometimes it's not. Exploring all possibilities is crucial. For example, if I'm using an eating disorder to numb intense emotions and my provider assumes that because I'm autistic, the target of our work should be meltdown prevention, what other useful tools might I be missing out on that they'd use for anyone else? This is one way virtue signaling with the ND-affirming label impedes effective care. If my ED helps me trust myself because the world has taught me I'm not trustworthy as a result of my ADHD traits, then challenging ableism will enter into the conversations had in therapy, self-acceptance will be a piece of the work, but what do we do for folks without ADHD who struggle to trust themselves? And what other reasons might I have internalized that I'm not trustworthy? I want those conversations TOO. Let's not be so quick to pin the eating disorder on the neurotype entirely. Instead, offering equitable treatment is truly affirming. #AuDHD #EatingDisorderTreatment #EatingDisorderRecovery #Neurodivergent #ActuallyAutistic

Loved hanging out with @em.does.therapy for Liberation Lunch! We talked relational therapy, collaboration, self-disclosure, pros and cons of diagnosis, and Diet Coke. Thanks to everyone who showed up in the comments, I love this community 🥰

Loved hanging out with @em.does.therapy for Liberation Lunch! We talked relational therapy, collaboration, self-disclosure, pros and cons of diagnosis, and Diet Coke. Thanks to everyone who showed up in the comments, I love this community 🥰

There is a lot more psychology involved in a full understanding of why ADHDers are prone to worse body image. We can’t boil it down to the reasons we are more susceptible to eating disorders as a whole (e.g. compensation, masking, self-esteem issues, etc.) and just throw in “and EDs come with body image concerns.” Yes, sometimes it’s the chicken first, sometimes it’s the egg. It turns out that object impermanence, low visual memory span, and the resulting difficulty we have perceiving our bodies accurately set us up to have more anxiety and uncertainty about our appearance and thus the holistic Self. We turn to objective measures like the scale and risk spiraling into obsession; we may use ED behaviors “just in case” we’re wrong because we learn we can’t trust our perception. What does recovery look like when neurological differences mean that it’s NOT “just the eating disorder talking”?

Journal article cited on slide 5 re: visuospatial memory and body image: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338767/

There is a lot more psychology involved in a full understanding of why ADHDers are prone to worse body image. We can’t boil it down to the reasons we are more susceptible to eating disorders as a whole (e.g. compensation, masking, self-esteem issues, etc.) and just throw in “and EDs come with body image concerns.” Yes, sometimes it’s the chicken first, sometimes it’s the egg. It turns out that object impermanence, low visual memory span, and the resulting difficulty we have perceiving our bodies accurately set us up to have more anxiety and uncertainty about our appearance and thus the holistic Self. We turn to objective measures like the scale and risk spiraling into obsession; we may use ED behaviors “just in case” we’re wrong because we learn we can’t trust our perception. What does recovery look like when neurological differences mean that it’s NOT “just the eating disorder talking”?

Journal article cited on slide 5 re: visuospatial memory and body image: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338767/

I’m in the market for a new therapist. After a consultation call last week in which I explained that somatic modalities are inaccessible to me, the therapist suggested I try CBT (a la “change your thoughts, change your life”). I have in fact seen CBT absolutely rock some first-time therapy attendees’ worlds. But it is not exhaustive, it often doesn’t hit the root of the issue - a band-aid at best - and many neurodivergent folks in particular report that CBT feels very invalidating and exacerbates their problem.

“Talk therapy” has gotten a bad rap in recent years as “bottom-up” body-based modalities like EMDR, somatic experiencing, sensorimotor, mindfulness-based stress reduction, and more have boomed, promising to take you further than “traditional” therapy could ever. And there’s validity to that for many people. And not all. For instance, those of us who have always been alexithymic due to our neurotype cannot connect to emotions supposedly stored in our bodies in the same way others can. But because trauma can be a catalyst to alexithymia, there’s a big push to “restore” this ability deemed a birthright by some clinicians, a promise that adhering to the fidelity of a model will earn us the reward of accessing unchartered (or previously chartered) emotions that we can then release from our bodies, facilitating healing. Maybe. And you can’t really know for sure if that’s you ’til you try. But continuing to try and blaming yourself when it doesn’t work is NOT benign. If you Google “top-down therapies” most of the results are about how bottom-up is the only way to address trauma effectively. Reading this feels similarly to reading the pitying commentary of religious proselytizers who feel they know something you don’t that would save you if only you would open your heart.

What about those of us for whom this is simply NOT true? It’s parallel to telling someone if they keep following their meal plan, they will inevitably feel hunger cues their eating disorder has stolen from them. Okay, but what about the harm caused by this messaging to those for whom this isn’t the case? Those whose brains are just wired differently? (Caption continued in comments)

I’m in the market for a new therapist. After a consultation call last week in which I explained that somatic modalities are inaccessible to me, the therapist suggested I try CBT (a la “change your thoughts, change your life”). I have in fact seen CBT absolutely rock some first-time therapy attendees’ worlds. But it is not exhaustive, it often doesn’t hit the root of the issue - a band-aid at best - and many neurodivergent folks in particular report that CBT feels very invalidating and exacerbates their problem.

“Talk therapy” has gotten a bad rap in recent years as “bottom-up” body-based modalities like EMDR, somatic experiencing, sensorimotor, mindfulness-based stress reduction, and more have boomed, promising to take you further than “traditional” therapy could ever. And there’s validity to that for many people. And not all. For instance, those of us who have always been alexithymic due to our neurotype cannot connect to emotions supposedly stored in our bodies in the same way others can. But because trauma can be a catalyst to alexithymia, there’s a big push to “restore” this ability deemed a birthright by some clinicians, a promise that adhering to the fidelity of a model will earn us the reward of accessing unchartered (or previously chartered) emotions that we can then release from our bodies, facilitating healing. Maybe. And you can’t really know for sure if that’s you ’til you try. But continuing to try and blaming yourself when it doesn’t work is NOT benign. If you Google “top-down therapies” most of the results are about how bottom-up is the only way to address trauma effectively. Reading this feels similarly to reading the pitying commentary of religious proselytizers who feel they know something you don’t that would save you if only you would open your heart.

What about those of us for whom this is simply NOT true? It’s parallel to telling someone if they keep following their meal plan, they will inevitably feel hunger cues their eating disorder has stolen from them. Okay, but what about the harm caused by this messaging to those for whom this isn’t the case? Those whose brains are just wired differently? (Caption continued in comments)

If I never hear another parent of an autistic or ADHD child or young adult insist they go to therapy because they spend all their time in their room staring at a screen and don’t come say hi to the family or leave to hang out with friends, etc, I will be THRILLED. I understand it can be scary to see a loved one interact with others in a way that strikes you as potentially "unhealthy" - especially if you yourself are fulfilled by social interactions and struggle to wrap your head around happiness being found alone. It makes sense to compassionately and collaboratively assess: is this what they want or is there fear? If all needs were met (including access to communication like AAC), would this still be their choice? ARE all needs met, including safety? If there's no problem, there's no problem. Sometimes the problem is that we exist in an ableist world and folks have been traumatized by previous interactions, so safety IS isolation for the time being until something external changes.

Remember, you don’t have to understand it to accept it. I am a dog person who doesn’t like cats, but I don’t think cat people need to work on their love of cats with a professional; they don’t even need to get more exposure to dogs. Social preferences are just preferences, not illnesses. Beyond preferences, for many ND folks, we're talking about social NEEDS. And lest we forget, autistic brains do not habituate the same way to exposure as allistic brains do, so if we’re forcing someone to engage socially who doesn’t want to do so in a way that seems “healthy” to the majority over and over, they’re just repeatedly miserable at best (albeit perhaps masking), traumatized at worst. If and when a person wants more social opportunities, when they express loneliness, if they indicate their quality of life is impaired by isolation but they’re too fearful to make a change, then we can help figure out how to support on their terms. Furthermore, there’s a lot of generalizations in eating disorder recovery about the role being social plays - a la “You can’t recover alone” and “Isolation is a yellow flag.” Let’s start truly individualizing care. Social needs are a part of neuroDIVERSITY.

If I never hear another parent of an autistic or ADHD child or young adult insist they go to therapy because they spend all their time in their room staring at a screen and don’t come say hi to the family or leave to hang out with friends, etc, I will be THRILLED. I understand it can be scary to see a loved one interact with others in a way that strikes you as potentially "unhealthy" - especially if you yourself are fulfilled by social interactions and struggle to wrap your head around happiness being found alone. It makes sense to compassionately and collaboratively assess: is this what they want or is there fear? If all needs were met (including access to communication like AAC), would this still be their choice? ARE all needs met, including safety? If there's no problem, there's no problem. Sometimes the problem is that we exist in an ableist world and folks have been traumatized by previous interactions, so safety IS isolation for the time being until something external changes.

Remember, you don’t have to understand it to accept it. I am a dog person who doesn’t like cats, but I don’t think cat people need to work on their love of cats with a professional; they don’t even need to get more exposure to dogs. Social preferences are just preferences, not illnesses. Beyond preferences, for many ND folks, we're talking about social NEEDS. And lest we forget, autistic brains do not habituate the same way to exposure as allistic brains do, so if we’re forcing someone to engage socially who doesn’t want to do so in a way that seems “healthy” to the majority over and over, they’re just repeatedly miserable at best (albeit perhaps masking), traumatized at worst. If and when a person wants more social opportunities, when they express loneliness, if they indicate their quality of life is impaired by isolation but they’re too fearful to make a change, then we can help figure out how to support on their terms. Furthermore, there’s a lot of generalizations in eating disorder recovery about the role being social plays - a la “You can’t recover alone” and “Isolation is a yellow flag.” Let’s start truly individualizing care. Social needs are a part of neuroDIVERSITY.

A dietitian in college picked up on my pattern of bingeing only when I “should” be studying, writing a paper, doing laundry, attending a dreaded meeting, etc. It would start out with the thought “I can’t do that til I eat because I’m recovering from an eating disorder, and eating always has to come first,” but after I ate, I didn’t want to do the task any more than when I first had the thought…but since that was the only thing that felt like a valid reason to keep putting it off, I would keep going. “Not done eating yet…I’ll do the paper after.” Therapists’ voices from ED treatment rang in my head: “Who cares about school if you’re dying from an eating disorder?” To be clear, I’m not talking about using recovery as an “excuse.” I’m talking about not NEEDING an excuse. Because it’s true - food is at the base of our hierarchy of needs; without it, we can’t fuel everything else in life. And ALSO, if food is our entire life, if the actions that support recovery are the entirety of how we define recovery, what are we recovering TO? We need both. What if compassion for our ADHD tendency to put off undesirable things was no-strings-attached? What if we accommodated by adjusting expectations or strategies to make the task less difficult, more desirable, or to get through it less painfully? What if we separated food from productivity entirely?

#ADHD #ExecutiveFunctioning #Procastination #EatingDisorderRecovery #Neurodiversity

A dietitian in college picked up on my pattern of bingeing only when I “should” be studying, writing a paper, doing laundry, attending a dreaded meeting, etc. It would start out with the thought “I can’t do that til I eat because I’m recovering from an eating disorder, and eating always has to come first,” but after I ate, I didn’t want to do the task any more than when I first had the thought…but since that was the only thing that felt like a valid reason to keep putting it off, I would keep going. “Not done eating yet…I’ll do the paper after.” Therapists’ voices from ED treatment rang in my head: “Who cares about school if you’re dying from an eating disorder?” To be clear, I’m not talking about using recovery as an “excuse.” I’m talking about not NEEDING an excuse. Because it’s true - food is at the base of our hierarchy of needs; without it, we can’t fuel everything else in life. And ALSO, if food is our entire life, if the actions that support recovery are the entirety of how we define recovery, what are we recovering TO? We need both. What if compassion for our ADHD tendency to put off undesirable things was no-strings-attached? What if we accommodated by adjusting expectations or strategies to make the task less difficult, more desirable, or to get through it less painfully? What if we separated food from productivity entirely?

#ADHD #ExecutiveFunctioning #Procastination #EatingDisorderRecovery #Neurodiversity

Does neurodiversity-affirming care exist? Absolutely, it must. Does a singular neurodiversity-affirming way of practicing exist? I’m not so sure anymore. The reason I like Naureen’s (@rds_for_neurodiversity) Neurodiversity-Affirming Model is that it’s a blueprint meant to guide the discovery of what is affirming for a given neurodivergent client, but it doesn’t define a specific set of tangible steps to “become” neurodiversity-affirming. It doesn’t claim there’s a destination we arrive at. And how could there be, when no brains need the same exact things, according to the neurodiversity paradigm itself? But for the sake of teaching and learning, we who educate on neurodiversity must speak broadly. And I think broad statements get taken out of context and applied as a one-size-fits-all to-do list sometimes, ironically the antithesis of the neurodiversity model.

In neurodiversity education, it’s important to keep reminding generalists that neurodivergent =/= ADHD and autism, that there’s a massive umbrella. But it’s also not enough. Just recognizing someone’s neurodivergence and understanding what that means for your work is not enough, crucial as it is…we have to also collaborate with them and adapt. It makes me think of the boatload of trainings I’ve attended that have essentially been a primer on what neurodiversity is, what to look for, how to assess, etc. without follow-up on implications - what now?
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Does neurodiversity-affirming care exist? Absolutely, it must. Does a singular neurodiversity-affirming way of practicing exist? I’m not so sure anymore. The reason I like Naureen’s (@rds_for_neurodiversity) Neurodiversity-Affirming Model is that it’s a blueprint meant to guide the discovery of what is affirming for a given neurodivergent client, but it doesn’t define a specific set of tangible steps to “become” neurodiversity-affirming. It doesn’t claim there’s a destination we arrive at. And how could there be, when no brains need the same exact things, according to the neurodiversity paradigm itself? But for the sake of teaching and learning, we who educate on neurodiversity must speak broadly. And I think broad statements get taken out of context and applied as a one-size-fits-all to-do list sometimes, ironically the antithesis of the neurodiversity model.

In neurodiversity education, it’s important to keep reminding generalists that neurodivergent =/= ADHD and autism, that there’s a massive umbrella. But it’s also not enough. Just recognizing someone’s neurodivergence and understanding what that means for your work is not enough, crucial as it is…we have to also collaborate with them and adapt. It makes me think of the boatload of trainings I’ve attended that have essentially been a primer on what neurodiversity is, what to look for, how to assess, etc. without follow-up on implications - what now?
Caption continued in comments…

"Their eating disorder is manipulating you. Be careful giving them what they want; you'll enable them." Fellow clinicians, does this sound familiar?

Despite a swelling movement to de-carcerate the eating disorder field, the cages that exist in treatment are pronounced. A prime example is the way in which clinicians have excessive concern about "enabling" clients and their eating disorders. As we articulate here, the notion of enabling inherently implies a hierarchy and represents an imposition of relational carcerality.

In order to provide truly agentic and client led care, we must abolish the systems of hierarchy (which are informed by structural oppression) and invest in relational, feminist, and liberation focused care. This requires a radical shift in the field and we must all be dedicated to this for our clients and for ourselves in the process of collective healing.

#EatingDisorderTreatment #AntiCarceral #AgenticCare #Abolition #Liberation #RadicalMentalHealth

"Their eating disorder is manipulating you. Be careful giving them what they want; you'll enable them." Fellow clinicians, does this sound familiar?

Despite a swelling movement to de-carcerate the eating disorder field, the cages that exist in treatment are pronounced. A prime example is the way in which clinicians have excessive concern about "enabling" clients and their eating disorders. As we articulate here, the notion of enabling inherently implies a hierarchy and represents an imposition of relational carcerality.

In order to provide truly agentic and client led care, we must abolish the systems of hierarchy (which are informed by structural oppression) and invest in relational, feminist, and liberation focused care. This requires a radical shift in the field and we must all be dedicated to this for our clients and for ourselves in the process of collective healing.

#EatingDisorderTreatment #AntiCarceral #AgenticCare #Abolition #Liberation #RadicalMentalHealth

I’d love to hear ideas for other terms that more fully capture the experience of being the ND child of ND parents impacted by their executive functioning challenges around food. I’m certainly not a mission to coin a term here and definitely ruminated on what made the most sense but couldn’t think of anything more fitting (and also catchy). “Back of the pantry” refers to getting creative by turning whatever expired or forgotten about food happened to be left in the pantry into a meal. But there’s so much more to it, and while we may be resilient AF, most of us also struggle with our own EF differences…and being resilient isn’t free; it contributes to neurodivergent burnout. I want to be clear that I am not blaming or shaming parents here. Because I am not a parent, I can only imagine the internal challenges that come with trying to prevent harm, and I don’t have the answers. But I can say with certainty that acknowledging the difficulty and collaborating with your kids to problem-solve on their terms goes a long, long way, even if the limitations remain. It is possible to have good intentions and still have a negative impact, and those intentions DO matter. This post is for the former kids looking for greater understanding of how their relationship with food got to be what it is and where to go next. #ActuallyAutistic #ADHD #EatingDisorderRecovery #ExecutiveDysfunction #NeurodivergentAffirming

I’d love to hear ideas for other terms that more fully capture the experience of being the ND child of ND parents impacted by their executive functioning challenges around food. I’m certainly not a mission to coin a term here and definitely ruminated on what made the most sense but couldn’t think of anything more fitting (and also catchy). “Back of the pantry” refers to getting creative by turning whatever expired or forgotten about food happened to be left in the pantry into a meal. But there’s so much more to it, and while we may be resilient AF, most of us also struggle with our own EF differences…and being resilient isn’t free; it contributes to neurodivergent burnout. I want to be clear that I am not blaming or shaming parents here. Because I am not a parent, I can only imagine the internal challenges that come with trying to prevent harm, and I don’t have the answers. But I can say with certainty that acknowledging the difficulty and collaborating with your kids to problem-solve on their terms goes a long, long way, even if the limitations remain. It is possible to have good intentions and still have a negative impact, and those intentions DO matter. This post is for the former kids looking for greater understanding of how their relationship with food got to be what it is and where to go next. #ActuallyAutistic #ADHD #EatingDisorderRecovery #ExecutiveDysfunction #NeurodivergentAffirming

Calling all eating disorder providers!

I am so excited to step in to co-facilitate the upcoming second round of the ED Provider Process and Support Group while Dr. Jennie Wang-Hall (@dr.jenniewh) is out on maternity leave alongside the wonderful Stacy Rae Godoy, LMFT (@_bolognasandwich_). This group aims to start an open dialogue about the harms that providers have experienced themselves as well as the harms that they have committed, and support each other in our collective healing journey.

*This is for new attendees* If you previously joined the group, please check your email for that specific offering.

Group Details:
- Dates: Friday, August 18th from 1-2pm PST
- Limited to approximately 10-12 attendees per session
- Register via Calendly *link in bio*
- Recommended $20 donation
via Venmo: StacyGodoyLMFT

Together, let's create a supportive community and make a positive impact.
We cannot wait to connect with you!

#eatingdisorderrecovery #eatingdisorderprofessionals #supportgroup #eatingdisorderharmreduction

Calling all eating disorder providers!

I am so excited to step in to co-facilitate the upcoming second round of the ED Provider Process and Support Group while Dr. Jennie Wang-Hall (@dr.jenniewh) is out on maternity leave alongside the wonderful Stacy Rae Godoy, LMFT (@_bolognasandwich_). This group aims to start an open dialogue about the harms that providers have experienced themselves as well as the harms that they have committed, and support each other in our collective healing journey.

*This is for new attendees* If you previously joined the group, please check your email for that specific offering.

Group Details:
- Dates: Friday, August 18th from 1-2pm PST
- Limited to approximately 10-12 attendees per session
- Register via Calendly *link in bio*
- Recommended $20 donation
via Venmo: StacyGodoyLMFT

Together, let's create a supportive community and make a positive impact.
We cannot wait to connect with you!

#eatingdisorderrecovery #eatingdisorderprofessionals #supportgroup #eatingdisorderharmreduction

Thank you to the wonderful neurodivergent followers who contributed to our collective brainstorm about what does and doesn't help in meal support. Reminder that even if "traditional" meal support structures are helpful to you, it doesn't make you less neurodivergent, just privileged to have access to an additional resource more easily. We hope to see the expansion of more accessible meal support in the near future, ideally led by folks with lived experience. Perhaps a silver lining of the often frustrating buzzwordification of neurodiversity? Keep the ideas coming in the comments!

Thank you to the wonderful neurodivergent followers who contributed to our collective brainstorm about what does and doesn't help in meal support. Reminder that even if "traditional" meal support structures are helpful to you, it doesn't make you less neurodivergent, just privileged to have access to an additional resource more easily. We hope to see the expansion of more accessible meal support in the near future, ideally led by folks with lived experience. Perhaps a silver lining of the often frustrating buzzwordification of neurodiversity? Keep the ideas coming in the comments!

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