Eating Disorders & ADHD
What is ADHD?
Attention Deficit/Hyperactivity Disorder is a mental health condition in which individuals struggle with inattention, impulsiveness, and/or hyperactivity. Symptoms may include challenges with emotional regulation, executive function, impulse control, or sensory processing. These difficulties often begin to impact a person in early childhood and overflow into many different areas of life.¹ Diagnosis can be complicated and may require several comprehensive assessments. Many individuals may be unable to afford the cost of diagnostic evaluations and may struggle to find help. Those who are able to receive a diagnosis may be offered treatment modalities such as medication, behavior skill acquisition, and one-on-one counseling and support.¹
By: Kendra Kaczmarski
Reviewed By: Chloe Pinchasick
Studies have shown that individuals with Attention Deficit/Hyperactivity Disorder are at a higher risk for developing clinical eating disorders.²,³ Current estimates state that individuals with ADHD have four times the risk of developing an eating disorder compared to peers without the condition. On the other hand, those with clinical eating disorders are estimated to have a 2.6 times higher risk of having concurrent ADHD.¹ Interestingly, males are more likely to be diagnosed with ADHD, while females are more likely to be diagnosed with eating disorders. This may be attributed to the presentation of the conditions- men more often present with disruptive/hyperactive symptoms of ADHD, while women typically present with the inattentive subtype characterized by a more internal struggle. This internalization of suffering is more likely to be identified while screening for eating disorders.³
While research shows that these two conditions tend to occur together, the relationship between them is still unclear. Scientists estimate that eating disorders often occur as a means for meeting an unmet need or in response to ADHD behavior patterns such as impulsivity. Further research is needed to understand whether one condition tends to cause the other or whether another factor such as environment places an individual at increased risk for both conditions.
What do ADHD and Eating Disorders Have in Common?
Research has shown that dopamine production is dysregulated in both ADHD and binge eating disorder. Dopamine is a chemical messenger in the brain that has an impact on a person’s impulses and “feel good” chemical rewards for their behavior. Scientists speculate that in people with ADHD and binge eating disorder, the dopamine receptors in the brain are unable to reliably detect the chemical. This leads individuals to react by increasing their risky behaviors in order to receive those “feel good” chemical rewards. Studies have shown that binge eating may activate this reward system in a similar way, offering sufferers a source of stimulation or comfort.³
While binge eating is commonly reported on in ADHD research, it is important to note that binge eating is often as a result of restriction-related ADHD symptoms such as hyperfocus and procrastination or stimulant medications. These behaviors and medications may cause ADHDers to forget to eat or avoid making meals and result in extreme hunger later in the day.¹ ADHD and anorexia nervosa also tend to occur together when individuals become overwhelmed by the tasks needed to accomplish meal preparation. Instead of moving forward with preparing a meal, those suffering from AN and ADHD tend to opt out, feeding into the restrictive behaviors of the eating disorder.⁴
Bulimia Nervosa, ARFID, and other eating disorder behaviors hold connections to ADHD as well. For example, individuals that struggle with emotional dysregulation may use binge/purge behaviors to manage frustration, and those with high sensitivity may react poorly to particular textures or flavors.¹
ADHD and Eating Disorder Behaviors
There are many different symptoms related to an ADHD diagnosis. Each patient will present with a different variety of symptoms and their own unique challenges. ADHD symptoms and a few of the difficulties that those with eating disorders may experience are as follows:¹
Inattention
-Dissociation while eating
-Inability to tune in to hunger and fullness cues
-Difficulties with meal planning & shopping
-Forgetting to eat consistently throughout the day
-Challenges with judging portions sizes correctly
Disorganization
-Aversion to meal planning/cooking
-Forgetting to clean up
-Overwhelm with finding recipes
Impulsivity
-Increased risk for binge eating/purging behaviors
-Giving up on meal preparation
-Overspending on groceries
Emotional Dysregulation
-Emotional soothing with food
-Avoiding cooking/eating when mood is low
-Meal prep overwhelm
Hyperactivity
-Impatience waiting for food at a restaurant
-Impatience with the food preparation process
-Increased energy needs
Sensory Processing Dysregulation
-Interference with hunger/thirst/fullness cues
-Specific food and texture aversions
-Increased risk of restricting behaviors
-Eating-related phobias such as emetophobia
-Easily distracted/irritated by sounds
Time Blindness
-Rushing meals
-Underestimating need for time
-Avoiding preparation
-Skipping meals
Perfectionism
-All-or-nothing thinking: “I forgot to eat breakfast, so why even try?”
-Decision fatigue
-Perfect meal mentality
Procrastination
-Putting off eating
-Avoiding clean up
-Avoiding cleaning out the refrigerator
Treatment Options & How the Dietitian Can Help
It is important that individuals suffering from ADHD and an eating disorder establish a strong treatment team consisting of a registered dietitian, a doctor, and a therapist. Other professionals, such as a family therapist or psychiatrist may be helpful. Treatment may include interventions such as CBT, meal structuring and support, emotional regulation, coping skills, and medications. Clinicians may recommend that patients hold off on medications at least initially while stabilizing the eating disorder, since many ADHD medications are stimulants which may impact appetite regulation.⁴
Dietitians can help patients to approach the eating disorder in a stepwise manner that the ADHD brain can manage. Steps in the treatment process may include regulating meal intake, achieving adequacy, improving food variety, learning which foods bring you satisfaction, and implementing gentle nutrition.¹ While approaching the treatment of both ADHD and an eating disorder together may seem daunting, an educated team can work together with the patient to establish clear next steps and ease the process.
At BALANCE eating disorder treatment center™, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. In addition to our full-time Day Treatment Program and Weeknight Intensive Outpatient Program, we offer high-quality programming, nutrition counseling with a licensed dietitian, meal supports, and various other groups and resources to help those seeking help for food concerns.
Our admissions team would be happy to answer any questions you may have about our programs and services. Book a free consultation call with our admissions team below, or read more about our philosophy here.
This post was written by BALANCE Dietetic Intern, Kendra Kaczmarski.
Kendra is a graduate student in nutrition & dietetics at NYC's Hunter College. She is Vice-President of the Anti-Diet Dietetic Students organization and a member of the Association of Size Diversity And Health. Kendra recently completed her Intuitive Eating Counselor Certification and will be wrapping up her graduate program in the spring of 2022. When she has time to relax, she loves to explore the outdoors with her husband, try new restaurants, and cuddle with her dachshund, Simon. Kendra desires to work in the field as a non-diet dietitian helping patients to recover from chronic dieting and disordered eating.
This post was reviewed by Chloe Pinchasick.
Chloe is a graduate student at New York University completing her master’s degree in nutrition and dietetics. Throughout her studies, Chloe has become passionate about the treatment and awareness of eating disorders. After she graduates, Chloe hopes to specialize in eating disorders so she can promote body neutrality and help people in need of eating disorder counseling. In her free time, Chloe loves to cook, travel, and spend time with her husband and 7-month-old Jules.
References
1. Storch, A. Eating Disorders And ADHD. Lecture presented at: EDRD Pro, March 2, 2021; Online.
2. The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample | SpringerLink. Accessed March 10, 2022. https://link.springer.com/article/10.1007/s11414-014-9422-y
3. Levin RL, Rawana JS. Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature. Clinical Psychology Review. 2016;50:22-36. doi:10.1016/j.cpr.2016.09.010
4. ADHD as a Co-Occurring Disorder with Eating Disorders. Eating Disorder Hope. Accessed March 14, 2022. https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/ocd-obsessive-compulsive-disorder/adhd-as-a-co-occurring-disorder-with-eating-disorders