Bingeing as an ADHD-related strategy: a qualitative study of experiences of Neurodivergent and potentially Neurodivergent adults with bulimic-spectrum eating disorders

PURPOSE: ADHD and Autism are overrepresented in adults with bulimic-spectrum eating disorders (EDs) and are associated with unique underlying mechanisms and poorer treatment outcomes. This qualitative study explores how Neurodivergent and potentially Neurodivergent individuals with bulimic-spectrum EDs make sense of their (potential) Neurodivergence, its impact on their ED, and their treatment needs. METHODS: Sixteen adults with bulimic-spectrum EDs who either self-reported a diagnosis of ADHD and/or Autism or scored highly on screeners (ASRS-Screener > 3; AQ-10 > 5) were interviewed. Data was analysed using reflexive thematic analysis, with cross-group comparisons between ADHD-only and ADHD + Autism presentations. Reflexivity was strengthened through critical friend discussions, and member reflections. RESULTS: We developed four themes and 12 sub-themes: 1. Difficulty making sense of potential Neurodivergence: participants expressed mixed feelings about identifying as Neurodivergent. While some found the label helpful, others felt uncertain about whether they were Neurodivergent or had concerns around stigma. Participants struggled to distinguish features of Neurodivergence from those of their ED. 2. Bingeing as ADHD self-regulation: bingeing was used to manage emotional overwhelm or under-stimulation linked to ADHD, and often became compulsive over time. 3. Restriction shaped by Autistic traits: restriction was associated with interoceptive and exteroceptive sensory differences, preference for sameness, and social disconnect, particularly among those with co-occurring Autism. 4. Balancing personalised and structured care: participants wanted flexible, personalised care that also provided structure to support recovery. CONCLUSIONS: ADHD and Autistic traits may influence bulimic-spectrum EDs in distinct ways. Helping Neurodivergent individuals and clinicians understand these connections can guide personalised treatment priorities and adaptations, improving treatment engagement and outcomes for Neurodivergent individuals. LEVEL OF EVIDENCE: Level IV, qualitative exploratory study.