Sensory Processing and Functional Assessment of Eating Disorders

Sensory processing, or the manner in which information from senses and the environment is received, organized, and interpreted by the brain to form an adaptative response, plays a significant role in people’s ability to participate in everyday life. Sensory processing and sensory preferences vary and are unique to everyone. However, in some instances, the way in which sensory stimuli are processed can be atypical, interfering with the ability to function effectively in different environments. When sensory processing is compromised, people can experience a combination of over- or under-responsiveness to sensory input or have difficulty detecting, discriminating, and responding to sensory stimuli leading to difficulty regulating emotions and maladaptive compensatory behaviors. Understanding sensory preferences and how they influence responses to sensory stimuli as well as developing intervention strategies that align with a person’s sensory needs and preferences contributes to increased participation in daily activities, effective adaptative responses to environmental changes, sustained positive social interactions, and regulation of emotional responses. Interest in sensory processing, and more specifically the related concepts of sensory sensitivity and interoception, has been growing in the field of eating disorders. Studies including people with eating disorders have described sensory responses and sensory processing difficulties, their potential impact on eating disorder behaviors and symptomatology, and the assessment of sensory processing. Meanwhile, functional impairment and functional health status have also been explored in the existing literature across health conditions. At times, functional health status and functional impairment have been used interchangeably while more recent literature suggests these be considered as different concepts. Functional health status, whether it focuses on function or functional impairment, is multifaceted, unique to everyone, and influenced by the environments in which people live, making it complex to assess. Historically, functional health status has been assessed using a combination of clinical judgement, nonstandardized and standardized tools, and clinical observations. Adding to the complexity of such assessment, function and functional impairment seem to be mostly associated with physical capabilities where independence or dependence is either based on use of assistive technology, the ability to complete different tasks, organs and body parts function, or participation in social roles. While eating disorders can be associated with limited physical capabilities, the functional health status of someone with an eating disorder includes and goes beyond these capabilities. In this context, this chapter will start with describing sensory processing with a focus on sensory sensitivity and interoception and their presentation in the context of eating disorders. The concept of neurological threshold and its potential use with people with eating disorders will be discussed. Sensory processing assessment tools will be presented. Then, functional impairment and functional health status will be defined and discussed. Lastly, functional assessments and their relevance for people with an eating disorder will be introduced.