"I'm autistic and my eating disorder is my special interest. Now what?"

For those of us who are autistic and have an interest-driven nervous system, "special interests" (SpIns) are not just hobbies—they’re integral to our identity, offering comfort, focus, and a sense of mastery. An eating disorder may become a SpIn in and of itself or it may arise tangentially through other SpIns that either necessitate heightened awareness of one's body, eating, and movement habits, or are just muddied by the messaging of diet culture and involve a body ideal, such as fitness, fashion, health and wellness, or cooking. Check out this quick guide to differentiating between some of these interests as part of an ED or more neurodivergence-related:

When an eating disorder becomes a special interest, the intersection of these two aspects can complicate traditional approaches to treatment. This is where harm reduction, a compassionate and pragmatic strategy, can make a profound difference. By respecting and working with the individual’s unique relationship to their special interest, harm reduction provides a way to address eating disorders and whatever version of "recovery" a person does or does not want while honoring their neurodivergent traits.

Embracing the Special Interest as a Key Component

Autistic special interests often play a significant role in daily life, providing structure and enjoyment. When an eating disorder aligns with these interests—whether through specific dietary rituals, calorie counting, or restrictive eating habits—it can become deeply ingrained in their routine. Understanding this helps in crafting a supportive approach that integrates their interests rather than attempting to replace or eliminate them.

What Harm Reduction Looks Like

Harm reduction focuses on reducing the negative impacts of a behavior without demanding complete cessation. It’s about meeting people where they are and supporting them in making safer choices. As harm reduction has entered the popular vernacular amongst ED providers, however, one of the most common misconceptions I see is that providers get to be the ones defining "safer" for their patients. That is, if an individual's lab values indicate they are at high risk for osteoporosis and a doctor has the medical knowledge to confidently assert that increasing weight to bring back their menstrual cycle will significantly reduce that risk, a harm reduction approach would necessitate deferring to the patient's disinterest in weight gain and brainstorming alternative strategies for reducing the risk, even if they're less effective, and educating them on managing osteoporosis not to fear-monger or convince them to consider weight gain but to prepare them to care for themselves if and when it does occur on their own terms. Here’s how harm reduction might be adapted to eating disorders intertwined with SpIns:

1. Honor and Respect Special Interests

Instead of seeing SpIns as obstacles, acknowledge them as a significant and valuable part of the person’s life. Engage with their interests in a positive way. This might involve finding safe ways to incorporate their eating-related interests into a healthier framework. For example, if calorie counting is part of their routine, you might work together to explore balanced nutrition and flexible eating patterns in a way that still respects their interest in tracking. Maybe there is a distressing piece of the routine, even though the pros feel as if they outweigh the cons, such as opening up a tracking app and comparing what they ate to what they could've eaten instead, so you collaboratively determine, through trial and error, that using a calculator to track cuts down on that distress.

2. Collaboratively Set Personal Goals

Work with the individual to establish realistic and personalized goals that reduce harm without requiring an immediate or complete overhaul. Small, achievable changes can be more effective and less anxiety-provoking. If the person follows strict food rules, introduce the ideas for adjustments without insisting on them and use an "experiment" framework, reminding the individual that they can always return to the way they've been doing things if the change doesn't ultimately feel useful. Any changes that are made are in service of shifting the pro-con balance in favor of pros, as defined by the individual, not the provider. Any "sitting with discomfort" that's supported is done with consent and only for the sake of waiting long enough to collect adequate data to say, "Yes, this is a change I want to keep" or "No, I don't think this is for me."

3. Promote Informed Choices

Support regular medical check-ups and share nutrition information when it is requested. That is, before providing education, ask for consent to do so and never take on the "expert" role unless requested. This approach can make changes feel less like a threat and more like an enhancement to existing interests.

4. Create an Affirming and Supportive Environment

Build a support network that understands and values neurodiversity. Engage professionals who are familiar with autism and who respect SpIns as part of the neurotype, without exceptions. A supportive environment means having open conversations where the individual feels heard and valued, and where their SpIns are incorporated into their care plan.

5. Explore and Integrate New Interests

While respecting the individual’s current special interest, offer exploration of new activities or interests. This doesn’t mean replacing their existing interests but offering additional avenues for engagement that might provide balance and fulfillment. New interests can complement and enhance their existing ones, supporting a broader range of experiences. The caveat here is that an autistic individual doesn't necessarily choose their special interest; it often chooses them. So trying to shift to something new may just not hit the same. And monotropism is a part of autism; it can be soothing and grounding to stick to what we know, so don't take it personally if your offer falls flat, and don't push a person to feign an interest that isn't there for your benefit. Masking or "fawning" in this way has detrimental consequences that can exacerbate the functionality of an ED.