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"You're not the exception"(but what if you are?)

Writer's picture: Stacie FanelliStacie Fanelli

If you didn't grow up hearing that you were the exception to the norm directly from caregivers, teachers, and peers, my best guess is that you either:

a) witnessed it implicitly rather than hearing it explicitly, or

b) have neurotypical privilege.


"Exceptionality" itself is a neutral concept, and its positive or negative connotations only enter into the picture when we add the context of why one falls outside a bell curve. For example, if you were identified as "gifted" academically, it's because you scored higher than the average child your age on standardized testing or because you demonstrated behavior in the classroom that was remarkable enough to catch the attention of an educator whose experience taught them to expect a different set of behavior from some kids, whether that's in the realm of focus, memory, problem-solving, or another ability category. Generally, when a child's parents are told they are "gifted," they are praised and the ability or behavior that was first identified is reinforced and may become a part of their identity. As a society, we like this kind of exceptionality.


On the flip side, exceptionality deemed "problem behavior" is that which interferes in social norms. It might be look like misconduct or disobedience, for example, on the tip of the iceberg, underneath which is actually an exceptional amount of dysregulation stemming from any number of possible sources. A child identified as exceptional in this way will, at best, receive an intervention that singles them out from their peers (even something supportive, like being pulled out of class for a sensory break), and at worst, be punished. Alternatively, a neurodivergent child who has high capacity for masking and lack of safety to unmask may not be identified as exceptional at all even though they feel like an outsider when it comes time to participate in the dominant group. They may hang out on the sidelines watching the kids who are clear exceptions in either a good or a bad way and either emulating or avoiding those behaviors, respectively.


By the time we are adults, we have had ample opportunity to develop and deeply internalize the belief that "I am the exception," alongside ideas about what it means to be exceptional, whether it's safe for others to know this, and what the consequences might be if we visibly fall out of the box we were put in. Unless we have had nothing but positive and sustainable experiences with that exceptionality (a superhuman feat - no one is immune to burnout), we're bound to try to change it in one direction or another!


Eating disorders and exceptionality


Eating disorders are very fluid, multi-purpose tools that can serve two opposite purposes simultaneously:

1) Dialing down our exceptionality if it's not working in our favor: pursuit of thinness gives us a common interest with neurotypical peers (thanks, diet culture) that we can lean on in lieu of special interests and hyper-fixations that may have previously made us feel singled out, judged, and hyper-visible. Thinness itself can increase our capacity to camouflage because it is considered the default body - "nothing to see here, just another small person." Taking up as little space as possible makes sense when you're tired of performing to meet unreasonably high expectations. If people have fewer visible talking points when they perceive us, perhaps they'll leave us alone, and we can finally blend in.

2) Dialing up our exceptionality either overall (if we've previously felt invisible and unremarkable), or from negative to positive (if we've been harshly critiqued). Engaging in restrictive or obsessive diet and exercise culture isn't itself anything abnormal in the ocean we're swimming in, but "succeeding" is. When we consider that 95% of diets fail to produce sustained weight loss, the promise of being the exception and finally being acknowledged for our efforts is tempting. Unfortunately, though, since we have control over the mechanism but not necessarily how it's received by others, we might experience the eating disorder, the thing we developed as a means of control, as contributing to a paradoxical decrease in control.


Eating disorder treatment and exceptionality


Now imagine entering eating disorder treatment and hearing a starkly different message: “You’re not special. Stop trying to be the exception.” This shift can feel unsettling on a spectrum of disorienting to deeply invalidating. Let’s unpack why generic treatment plans for eating disorders in which the assumption,"This person is trying to be unique" is made often fall short of affirming neurodivergent individuals' actual experience.


Eating disorder treatment may be the first time an person's belief that they are different is ever explicitly named and addressed. This has such potential to be a helpful, transformative experience. Just think - a lifetime of loneliness, pressure, masking, etc. associated with your differences - and you finally get to collaboratively troubleshoot the problems your exceptionality has caused.


Unfortunately, my experience both working in higher levels of care and talking to clients in therapy who recently attended a program has shown me that this opportunity is usually missed in favor of taking them down a peg, due to the misperception that ego or entitlement are at play. In fact, feeling like the exception may actually be heightened in treatment at the same time as it's pathologized and labeled a cognitive distortion because of the ways neurodivergent traits intersect with the eating disorder. Think about sensory sensitivities around food, fixation on calorie counting, and "inflexibility" with routines, things that may appear "standard" from the outside looking in but are not experienced internally in the same ways as they are by neurotypical people with eating disorders. These are just a few manifestations of an eating disorder likely to be oversimplified by providers. The commonplace attitude that clients' objections to one-size-fits-all treatment approaches they don't feel fit their needs are simply how the eating disorder doubles down and responds to being challenged leads clinicians to justify dismissing truly ineffective (at best; harmful at worst) interventions in the name of "fighting the eating disorder." This dismissal echos the familiar message that got us here in the first place: "Your needs don't matter."


Tossing out generic treatment for neurodivergent-friendly treatment


There's a saying in autistic spaces - "If you've met one autistic person, you've met one autistic person" - that eating disorder clinicians would do well to adopt. If you've met one individual with an eating disorder, you've met one individual with an eating disorder. I know we generally agree that "individualized treatment" is important, given that this phrase is plastered all over treatment centers' websites, but what does that actually look like? There is no exhaustive list of qualities of individualized treatment; by definition, there can't be.


That's why being an affirming provider has to look like ongoing consultation with each client, the people they trust (e.g. outpatient team members, family, friends), and your own colleagues who specialize in the unique concerns the client brings to the table. It has to look like trusting them to tell you something isn't working without having to prove it. It has to look like adapting policies and protocols your agency has created to cater to most people to cater to this one. Whether that's making a meal plan more flexible, throwing it out altogether, learning about alternative modalities, extending the time limits of your sessions or referring to someone who can, actualizing a sensory profile by holding therapy in a closet...there are infinite ways that you can affirm an neurodivergent client's genuine exceptionality once you drop your fear that doing so will enable their eating disorder.


Recovery is not about erasing a person's uniqueness but about finding a path that honors who they are while supporting their health and well-being. For neurodivergent individuals, that path will look different than it will for neurotypical individuals — and that’s not just okay; it’s essential.

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