Mast cells (MC) are ubiquitous in the body, and they are critical for not only in allergic diseases but also in immunity and inflammation, including having potential involvement in the pathophysiology of dysautonomias and neuroinflammatory disorders.  MC are located perivascularly close to nerve endings and sites such as the carotid bodies, heart, hypothalamus, the pineal gland, and the adrenal gland that would allow them not only to regulate but also to be affected by the autonomic nervous system (ANS).  MC are stimulated not only by allergens but also many other triggers including some from the ANS that can affect MC release of neurosensitizing, proinflammatory, and vasoactive mediators.  Hence, MC may be able to regulate homeostatic functions that seem to be dysfunctional in many conditions, such as postural orthostatic tachycardia syndrome, autism spectrum disorder, myalgic encephalomyelitis/chronic fatigue syndrome, and Long-COVID syndrome.  The evidence indicates that there is a possible association between these conditions and diseases associated with MC activation.  There is no effective treatment for any form of these conditions other than minimizing symptoms.  Given the many ways MC could be activated and the numerous mediators released, it would be important to develop ways to inhibit stimulation of MC and the release of ANS-relevant mediators.

Autistic people and those with attention deficit hyperactivity disorder are at a high risk of developing an eating disorder.  While there is limited evidence on the relationship between other forms of neurodivergence and eating disorders, research suggests associations between giftedness, intellectual disability, Tourette’s syndrome, and disordered eating.  Factors underlying disordered eating and/or eating disorder risk for neurodivergent people are multifaceted and complex, encompassing a wide range of intertwined psychosocial, environmental, and biological processes.  Moreover, research shows that neurodivergent individuals experience poorer treatment outcomes compared to neurotypical individuals.  However, there is a paucity of research in this area overall.  More specifically, lived experience-led research remains rare, despite its critical role for improving individualised eating disorder care, as well as mental healthcare more broadly.  Indeed, the importance of eating disorder care individuation is increasingly being recognised, particularly within the context of neurodivergence, given the heterogeneous experiences and support needs of neurodivergent people affected by disordered eating and/or eating disorders.  Furthermore, despite documented overlaps between various forms of neurodivergence (e.g., co-occurring autism and attention deficit hyperactivity disorder), research looking at eating disorders in the context of neurodivergence through a transdiagnostic perspective is scarce.  This lived experience-led narrative review aims to shed light on the intersectional factors underlying high disordered eating and/or eating disorder risk for neurodivergent individuals.  First, an overview of prevalence data is provided, followed by a thematic framework identifying factors underlying disordered eating and/or eating disorder risk in relation to neurodivergence.  A critical appraisal of current eating disorder research and care is then offered before suggestions for neurodiversity-affirming eating disorder care are made. In this view, this paper offers a foundation for future empirical work in this nascent field of inquiry by providing a lived experience-led, transdiagnostic, and intersectional account of eating disorders in the context of neurodivergence.

Autistic people may be distinguishable from non-autistic individuals in the content and modality of their thoughts. Such differences potentially underlie both psychological vulnerability and strengths, motivating the need to better understand autistic thought patterns. In non-clinical undergraduates, a recent study found that autistic traits were associated with thinking more in words than images. However, it is unclear whether such differences in thought are present in clinically diagnosed autistic individuals. The current study applied the same methods (multidimensional experience sampling during an N-back task) to examine ongoing thought in autistic and non-autistic adults. We found that autistic individuals showed less variability in the modality of their thoughts between easy and difficult task contexts. While both non-autistic and autistic participants tended to report thinking more in words during the difficult task context, the difference between conditions was significantly smaller for the autistic group. In addition, autistic individuals showed a weaker coupling between task performance and off-task social thinking, a finding that may be related to differences in social processing during the off-task state. Overall, our results provide a clinical replication and extension of previous work, highlighting the differential effects of changing external context on internal mental states in autism.

While exteroceptive sensory processing is a hallmark of autism spectrum disorder, how interoceptive processing may impact and contribute to symptomatology remains unclear.  In this comprehensive narrative review on interoception in autism, we discuss:  1) difficulties with assessing interoception;  2) potential interoceptive differences;  3) interactions between neural systems for interoception, attention, sensorimotor processing, and cognition; and  4) potential differences in neural circuits involved in interoception.  In general, there are mixed findings on potential interoception differences in autism.  Nevertheless, some data indicate differences in integration of interoceptive and exteroceptive information may contribute to autism symptomatology.  Neurologically, interoceptive processing in autism may be impacted by potential differences in the development, morphometry, and connectivity of key interoceptive hubs (vagal processing, brainstem, thalamus, insula), though much work is needed on this topic.

The aim of this study was to define neurodiversity in a scientific manner so it can be researched in further studies without involving disorders defined by psychiatry or popular beliefs about neurodiversity in the autistic community.  Neurodiversity was defined as the primary factor output by factor analysis of a data set of human behaviors which contains evenly distributed traits of all sorts that cover all of human diversity. Neurotypical function was defined as the second factor.  The study used many different traits and a large sample to find the full extent of neurodiversity, and to provide evenly distributed traits.  The result was a test with 145 scoring items and 5 control items that could give participants a neurodiverse and a neurotypical score, and an indication that the participant was neurodiverse, neurotypical, or mixed.  It was found that the neurodiversity score was independent of gender and age, and that the prevalence appears to have remained unchanged.  There were possible differences in racial prevalence that need further research.  The results correlated to many disorders defined by psychiatry, and also with several factors in personality tests. People who had been diagnosed with these disorders had considerably higher neurodiversity scores.  The idea that neurodiversity was at the extreme end of a normal distribution was not supported, rather it was found that neurodiversity had its own normal distribution overlapping typical traits.

Camouflaging (using (un)conscious strategies to appear as non‐autistic) is thought to be an important reason for late autism diagnoses and mental health difficulties.  However, it is unclear whether only autistic people camouflage or whether people with other neurodevelopmental or mental health conditions also use similar camouflaging strategies.  Therefore, in this preregistered study (AsPredicted: #41811) study, we investigated if adults with attention‐deficit/hyperactivity‐disorder (ADHD) also camouflage.  Adults aged 30–90 years filled in the Dutch Camouflaging Autistic Traits Questionnaire (CAT‐Q‐NL), the ADHD Self‐Report (ADHD‐SR) and the Autism Spectrum Quotient (AQ).  We investigated differences in camouflaging between adults with ADHD, autism, and a comparison group in an age and sex‐matched subsample (N = 105 per group).  We explored if autism and ADHD traits explained camouflaging levels in adults with an autism and/or ADHD diagnosis (N = 477).  Adults with ADHD scored higher on total camouflaging and assimilation subscale compared to the comparison group.  However, adults with ADHD scored lower on total camouflaging, and subscales compensation and assimilation than autistic adults.  Autism traits, but not ADHD traits, were a significant predictor of camouflaging, independent of diagnosis.  Thus, camouflaging does not seem to be unique to autistic adults, since adults with ADHD also show camouflaging behavior, even though not as much as autistic adults.  However, as the CAT‐Q‐NL specifically measures camouflaging of autistic traits it is important to develop more general measures of camouflaging, to compare camouflaging more reliably in people with different mental health conditions.  Furthermore, focusing on camouflaging in adults with ADHD, including potential consequences for late diagnoses and mental health seems a promising future research avenue. In the present study, we investigated whether only autistic people use strategies to hide one's autistic traits (also referred to as camouflaging) or whether people with ADHD use similar strategies.  We found that people with ADHD reported more camouflaging behavior compared to a neurotypical comparison group, but less than autistic people.  Thus, these results indicate that camouflaging is not unique for autism and it is important to be aware of camouflaging strategies in people with ADHD.

By addressing ableism through social media and other digital outlets, feminist disability activists share stories on what it means to be human from an intersectional perspective, and their storying is a way of understanding and theorising the world.  However, the possibilities of digital disability activism to story ableism within broader feminist debates are underexplored.  Storying as an anti-hegemonic approach to theorising ableism further from an intersectional perspective, implemented through an activist-academic working alliance, contributes to speaking otherwise about disability and draws attention to disability perspectives in feminist theory. In this article, I propose a feminist intersectional approach to storying ableism that exposes manifestations of ableism in its intersections with classism, racism and sexism at structural, identity and representational levels.  I then argue for digital disability activism as a means of storying ableism, provide examples of such storying and describe the potentials and principles of digital activist storying.  While the creation of further theory is central to the proposed approach, the connection of intersectionality theory with ableism and feminist disability theory serves as its foundation.  I discuss how linking ableism with intersectionality strengthens the uncovering of ableism at different levels, why studies of ableism should be extended to fields beyond Disability Studies but remain closely connected to disability activism and how feminist disability theory has thus far shaped debates on the dis/ability binary in relation to the gendered body.

The general aim of this ex post facto study was to investigate the emotional component of theory of mind (eToM) in a sample of 97 female patients with eating disorders (ED), considering all the diagnostic subtypes. Empirical research on this matter in ED is limited, specially focused on anorexia nervosa (AN), and results have been contradictory. The Reading the Mind in the Eyes test was administered to the patients and to 39 healthy controls. The emotional valence of the items was also examined. Patients with bulimia nervosa (BN) and ED-not otherwise specified (EDNOS) showed a poorer eToM ability compared to controls, especially in relation to positive emotions and non-emotional cognitive states. AN patients showed no differences in relation to controls. These results suggest that BN and EDNOS may show a specific pattern of difficulties inferring complex emotions, while AN patients would have no relevant difficulties in this regard. These deficits may need to be targeted in psychological treatment.

Gender identities that differ from biological sex (non-cisgender identities) appear to be more common in autism and neurodiversity.  The study found that part of the non-cisgender identities could be related to having behavioral preferences of the opposite sex, but this failed to explain the higher prevalence in neurodiversity.  Non-cisgender identities in neurodiversity could better be explained by having neurodiverse relationship preferences or lacking typical relationship preferences.  Being part of the LGBT (Lesbian Gay Bi Transgender) community biased answers to questions about gender identity.  Neurodiverse non-cisgender people, just like neurodiverse asexual people, might be better off with new communities that focus on the more relevant relationship preference differences rather than on narrow and indirect gender and sexual issues.

Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world.  Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce.  We therefore undertook a study to test whether imprecise processing of proprioceptive error signals may underlie the connection between neurodivergence and emotional dysregulation.  In a cohort of people with complex chronic conditions, including chronic pain/fatigue, and complex trauma, and in a comparison group, we assessed presence of neurodivergence, variant connective tissue manifested through joint hypermobility, and emotional dysregulation.  We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals.  We suggest that future research in this area may have important clinical implications for the interaction of mental and physical wellbeing in neurodivergent people.  This article is part of the theme issue ‘Sensing and feeling: an integrative approach to sensory processing and emotional experience’.

Interoception refers to the perception of the physiological condition of the body, including hunger, temperature, and heart rate.  There is a growing appreciation that interoception is integral to higher-order cognition. Indeed, existing research indicates an association between low interoceptive sensitivity and alexithymia (a difficulty identifying one’s own emotion), underscoring the link between bodily and emotional awareness.  Despite this appreciation, the developmental trajectory of interoception across the lifespan remains under-researched, with clear gaps in our understanding.  This qualitative review and opinion paper provides a brief overview of interoception, discussing its relevance for developmental psychopathology, and highlighting measurement issues, before surveying the available work on interoception across four stages of development: infancy, childhood, adolescence and late adulthood.  Where gaps in the literature addressing the development of interoception exist, we draw upon the association between alexithymia and interoception, using alexithymia as a possible marker of atypical interoception.  Evidence indicates that interoceptive ability varies across development, and that this variance correlates with established age-related changes in cognition and with risk periods for the development of psychopathology.  We suggest a theory within which atypical interoception underlies the onset of psychopathology and risky behaviour in adolescence, and the decreased socio-emotional competence observed in late adulthood.

Background:  Although autistic adults often discuss experiencing "autistic burnout" and attribute serious negative outcomes to it, the concept is almost completely absent from the academic and clinical literature.  Methods:  We used a community-based participatory research approach to conduct a thematic analysis of 19 interviews and 19 public Internet sources to understand and characterize autistic burnout.  Interview participants were autistic adults who identified as having been professionally diagnosed with an autism spectrum condition.  We conducted a thematic analysis, using a hybrid inductive-deductive approach, at semantic and latent levels, through a critical paradigm.  We addressed trustworthiness through multiple coders, peer debriefing, and examination of contradictions.  Results:  Autistic adults described the primary characteristics of autistic burnout as chronic exhaustion, loss of skills, and reduced tolerance to stimulus.  They described burnout as happening because of life stressors that added to the cumulative load they experienced, and barriers to support that created an inability to obtain relief from the load.  These pressures caused expectations to outweigh abilities resulting in autistic burnout. Autistic adults described negative impacts on their health, capacity for independent living, and quality of life, including suicidal behavior.  They also discussed a lack of empathy from neurotypical people and described acceptance and social support, time off/reduced expectations, and doing things in an autistic way/unmasking as associated in their experiences with recovery from autistic burnout.  Conclusions:  Autistic burnout appears to be a phenomenon distinct from occupational burnout or clinical depression.  Better understanding autistic burnout could lead to ways to recognize, relieve, or prevent it, including highlighting the potential dangers of teaching autistic people to mask or camouflage their autistic traits, and including burnout education in suicide prevention programs.  These findings highlight the need to reduce discrimination and stigma related to autism and disability.