Eating Disorders and Sensory Processing Through the Lens of Lived Experience: An Intersectional Investigation from Gender Diversity to Neurodivergence

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Abstract

Eating disorders (EDs) are shaped by interacting genetic, biological, psychological, and sociocultural factors, yet sensory processing, neurodivergence, and gender diversity have received limited attention in dominant ED models. This thesis examines sensory processing, encompassing interoception and exteroception, in relation to ED symptoms, and explores whether sensory characteristics help to contextualise associations involving neurodivergent traits, gender incongruence, and disordered eating. Across six chapters, the thesis integrates a systematic review and meta-analysis, three empirical studies using adult community samples, and a lived experience-led narrative review. Chapter 2 presents a systematic review and meta-analysis of self-reported interoception and exteroception across ED diagnoses, identifying transdiagnostic sensory processing alterations. Chapters 3 and 4 report empirical studies examining exteroception and interoception, respectively, in relation to ED symptoms. Both studies demonstrate associations between sensory processing alterations and a range of ED symptom dimensions, with the strongest associations observed for restrictive and avoidant eating. Sociodemographic factors, including sex assigned at birth, sexual orientation, and racial background, were associated with variation in sensory processing scores and partially moderated associations with ED symptoms. Chapter 5 uses correlation and regression analyses to examine the role of sensory processing in associations involving neurodivergent traits, gender incongruence, and ED symptoms. Autistic traits and gender incongruence were associated with restrictive and avoidant eating, while ADHD traits were associated with restrictive, avoidant, and binge eating symptoms. Gender incongruence was also associated with reduced interoceptive body trust and heightened exteroceptive sensitivity. Sensory processing partially accounted for associations between neurodivergent traits, gender incongruence, and ED symptoms. Chapter 6 provides a lived experience-led narrative review situating these findings within broader biopsychosocial contexts, including executive functioning, minority stress, and systemic discrimination. The chapter proposes a sensory-informed, neurodiversity- and gender-affirming conceptual framework. Overall, the thesis identifies sensory processing as an under-recognised but important dimension of EDs that intersects with neurodivergent traits and gender incongruence.

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