Eating disorders (EDs) are increasingly recognised among neurodivergent and transgender and gender diverse (TGD) individuals, yet most assessment and treatment models remain grounded in cisnormative and neuronormative assumptions and frameworks. Sensory processing, spanning interoception and exteroception, has been proposed as a potential factor that may help explain observed associations between neurodivergent traits, gender incongruence, and EDs. Empirical evidence, however, remains limited. This study examined whether sensory processing characteristics accounted for variance in observed associations between neurodivergent traits (with a focus on Autism and attention deficit/hyperactivity disorder, ADHD), gender incongruence, and ED symptoms in an adult community sample. Participants (N = 195) completed an online Qualtrics survey involving validated self-report measures of exteroception, interoceptive sensibility, gender congruence, and ED symptoms (for example, Eating Disorder Examination Questionnaire Short, EDE-QS and Nine Item Avoidant or Restrictive Food Intake Disorder Screener, NIAS). Correlation, regression, and effects analyses were used to explore associations among self-reported neurodivergent traits, gender incongruence, sensory processing, and ED symptoms. Gender incongruence and Autistic traits showed positive associations with restrictive and avoidant ED symptoms. ADHD traits showed positive associations with a broader range of ED symptoms, including restrictive, avoidant, and binge eating presentations. Gender incongruence also showed positive associations with sensory processing differences across both exteroceptive and interoceptive domains: namely, elevated visual and auditory sensitivity and reduced body trust. Furthermore, interoceptive sensibility, particularly lower body trust, showed significant statistical relations with ADHD motor traits and EDE-QS scores. Interoceptive sensibility also showed significant statistical relations in models including gender incongruence and EDE-QS scores. Exteroceptive hypersensitivity showed a partial statistical relation in models examining gender incongruence and NIAS scores. To the authors’ knowledge, this study provides the first lived experience-led empirical intersectional investigation linking interoception and exteroception with neurodivergent traits, gender incongruence, and ED symptoms. Results highlight the relevance of intersectional, sensory-informed, and identity-affirming perspectives for future research and the ongoing development of ED assessment and care. We invited adults to complete an anonymous online survey about eating disorder symptoms, how comfortable they felt with their gender, their sensory experiences, and traits linked with Autism or ADHD. A total of 195 people took part between July and September 2025. People who felt less comfortable or less congruent with their physical characteristics in relation to their gender identity reported more eating disorder symptoms. How people make sense of internal bodily cues and trust their bodies (interoceptive sensibility) helped explain these links. Lower trust in bodily signals and lower noticing of internal sensations were associated with more eating problems. Heightened exteroception, particularly sensitivity to sights and sounds, was also linked with gender incongruence and eating disorder symptoms. Autistic traits were mostly related to avoidant or restrictive eating. ADHD traits were related to a wider set of disordered eating behaviours, including restricting and binge eating. These findings suggest that more investigations into the role of sensory processing in disordered eating in the context of neurodivergence and gender diversity might help tailor treatment in order to better meet the support needs of gender diverse and neurodivergent individuals.
Cobbaert et al. (Wed,) studied this question.