ADHD and Eating Disorders
One lesser-known aspect of ADHD is its connection to eating disorders. Research has shown that individuals with ADHD are at a higher risk of developing eating disorders compared to the general population. The most common eating disorders associated with ADHD are Binge Eating Disorder (BED), Bulimia Nervosa (BN), and emotional eating.
Binge Eating Disorder is characterised by recurrent episodes of consuming large quantities of food in a short period, often accompanied by feelings of guilt and shame. There are no compensatory behaviours performed for this bingeing, like vomiting or excessive exercise. The impulsive nature of ADHD may contribute to a lack of self-control when it comes to eating, leading to these binge episodes.
Bulimia Nervosa involves cycles of binge eating followed by compensatory behaviours, such as self-induced vomiting, excessive exercise, or misuse of laxatives, to prevent weight gain. Similar to BED, the impulsivity and difficulty with self-regulation associated with ADHD can play a role in the development of bulimic behaviours.
Emotional eating refers to using food as a way to cope with or escape from negative emotions, such as stress, anxiety, or sadness. Adults with ADHD may be more prone to emotional eating due to difficulties managing their emotions and due to impulsivity.
In general I see many more clients with a form of emotional eating than those who meet the formal diagnostic criteria for an eating disorder, and as with eating disorders in general, women more often show these eating patterns than men.
Several factors may contribute to the development of eating disorders in adults with ADHD:
Impulsivity: Difficulty controlling urges and impulses can lead to overeating, binge eating, or engaging in compensatory behaviours.
Emotional Dysregulation: ADHD can make it challenging to manage emotions, resulting in using food as a coping mechanism.
Executive Functioning Deficits: Planning, organisation, and decision-making skills may be compromised in ADHD, leading to poor eating habits and difficulty adhering to a structured meal plan.
Conventionally, a good treatment for eating disorders that include binge eating is cognitive behavioural therapy. I have used this with good results over the years. However, for those with ADHD, stimulant medications can also help to reduce binge eating. Interestingly, in the US, the amphetamine lisdexamfetamine (Vyvanse) is an approved drug for treatment of binge eating disorder. This drug was first approved for treatment of ADHD, and hopefully one day it will be available in New Zealand for treatment of ADHD, and perhaps binge eating disorder also.
Stimulants help to improve focus, attention, and impulse control, which may contribute to a reduction in binge eating behaviors. I have seen a few clients with ADHD and binge eating significantly reduce or even stop their binge eating after starting stimulants. I have also seen people lose weight due to the change in their eating behaviour and the appetite-suppressing side effects. But, I have also seen people continue to binge eat, particularly in the evening when their medication has worn off, so stimulant medication is not a panacea.
Stimulant treatment for ADHD symptoms may also increase a person's ability to benefit from therapy for eating problems. I see an increased ability to benefit from therapy generally once stimulant medication is started.
Below are some links to more information about eating disorders and ADHD:
ADHD Experts one-hour presentation Diagnosing and Treating Eating Disorders in Children and Adults with ADHD by clinical psychologist Dr Roberto Olivardia