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ADHD and Eating Disorders: Understanding Challenges and Solutions

Attention-deficit/hyperactivity disorder (ADHD) is a widely recognized neurodevelopmental condition and one of the most prevalent of its kind. It is a disorder characterised by impulsivity, hyperactivity, and inattention. Recent studies have proven that 20% of children with ADHD also develop eating disorders (EDs), including anorexia nervosa, bulimia nervosa and binge eating disorder. It is defined by inattention and hyperactivity-impulsivity. ADHD often occurs alongside various other conditions, including eating disorders (EDs).In this article, we will discuss ADHD and eating disorders.

Signs and Symptoms of ADHD and Eating Disorders

People suffering from ADHD have symptoms such as sleep disorders, anxiety, depression, and some learning disabilities.

Criteria for ADHD diagnosis are as follows:

  • Five or more symptoms of hyperactivity and impulsivity, inattention, or both, lasting at least six months.
  • Signs of inattention or hyperactive-impulsive behaviour often appear before the age of 12.
  • These symptoms typically show up in multiple settings, such as at home, school, or work, and can significantly impact social, academic, or professional performance.
  • The symptoms do not meet the diagnostic criteria for another mental health condition.

In children who are aged up to 16 years, six or more symptoms of inattention and hyperactivity must be present for at least six months.

Disordered Eating in ADHD: Nutritional Issues

Individuals with ADHD frequently experience a complicated relationship with food. Eating habits of people having ADHD could put them at risk of developing an eating disorder later in life. There are many nutrition issues in people with ADHD, which are the following:

Unusual Schedules

People who have disordered eating patterns are at more risk of developing ADHD. People who consume snacks and sweet foods instead of fruits and vegetables are more likely to develop issues. Eating in this manner is common in people with binge eating disorder (BED). A late-night sugary snack can easily escalate into a binge.

Strict Diets

Some mothers are very restricted in giving their children foods like gluten, eggs, or soy to help ease ADHD symptoms. Children must have knowledge of the ingredients in each item before eating and develop rules about what is good and bad.

Food Sensitivities

Individuals with ADHD are highly sensitive to the taste, smell, and texture of food. These children can categorise foods into good and bad groups.

Sensory Processing

People suffering from ADHD have irregularity with the interoceptive sense, due to which the brain interprets signals and cues from the rest of the body. For example, signals transmitted to the brain about thirst, hunger, or pain may be distorted in a person who struggles with ADHD. A child who are unable to recognise when they are hungry and full may eat abnormally, under-eat or overeat, or develop food aversions in response to a malfunction with their interoceptive signal.

ADHD and Eating Disorder Types

People having ADHD have apparent symptoms such as restlessness, inability to concentrate, or impulsiveness. These symptoms are the cause of eating disorders. Some main eating disorders due to ADHD are the following:

Binge Eating Disorder (BED) and ADHD

People with binge eating disorder (BED) eat large amounts of food but don’t purge those meals. They are often overweight due to this behaviour. Impulsivity is a factor, as individuals with ADHD often struggle to resist tempting foods. However, researchers also say that some people with ADHD have unusual brain responses to food, which makes their meals more rewarding than they are to others. They may eat because it brings them intense pleasure.

Symptoms of BED include:

  • Consuming exceptionally large quantities of food within a short time frame.
  • Eating even when full or not hungry.
  • Eating quickly during binge episodes.
  • Eating until uncomfortably full.
  • Eating alone or in secret to avoid embarrassment.
  • Feeling distressed, ashamed, or guilty about eating.
  • Frequently dieting, possibly without weight loss.

Bulimia Nervosa

Bulimia is characterised by cycles of bingeing in which the person eats a large amount of food. Bingeing and inappropriate compensatory behaviours must occur at least once a week for three months to satisfy a diagnosis. Self-evaluation based on body shape and weight is common. Individuals with bulimia often struggle with a negative perception of their body image.

Symptoms of bulimia include:

  • Consuming excessively large amounts of food within a short timeframe.
  • Experiencing a lack of control during eating episodes.
  • Harmful compensatory behaviours, such as vomiting, excessive exercise, or laxative misuse.
  • Self-criticism of body shape or weight.

Physical signs of bulimia can include:

  • Chronically inflamed and sore throat.
  • Swollen salivary glands in the neck and jaw.
  • Worn tooth enamel and increasingly sensitive, decaying teeth due to stomach acid exposure.
  • Acid reflux disorder and other gastrointestinal problems.
  • Severe dehydration from purging fluids.
  • Electrolyte imbalance meaning excessively high or low levels of sodium, calcium, potassium, and other minerals can lead to stroke or heart attack.

Anorexia Nervosa

Anorexia is an obsessive-compulsive eating disorder defined by restriction of energy intake, leading to significantly low body weight (in the context of what is minimally expected for age, sex, developmental trajectory, and physical health). The disorder is not as prevalent in people with ADHD as the impulsive eating disorders.

With anorexia, there is either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain. Anorexia is accompanied by body image distortion – including disturbances in the way one’s body weight or shape is experienced; body weight or shape influences self-evaluation, or there’s a continuous inability to recognize the severity of their low body weight.

Other Eating Disorders

  • Avoidant/Restrictive Food Intake Disorder (ARFID): If you have an eating or feeding disturbance as a result of which your body fails to fulfil nutritional and/or energy needs, this can lead to weight loss and nutritional deficiencies. People who are suffering from ARFID may need enteral feeding or oral nutritional supplements to meet their body’s needs.
  • Other Specific Feeding or Eating Disorder (OSFED): There are many other disorders such as anorexia nervosa; bulimia nervosa of low frequency; BED of low frequency; purging disorder; Night Eating Syndrome; and Chewing and Spitting Disorder, where food is chewed but not swallowed.

Various studies have shown that individuals with ADHD are three to six times more likely to develop eating disorders compared to non-ADHD individuals. Research has shown that bulimia is more prevalent among adolescent girls with ADHD than their non-ADHD counterparts, with girls with ADHD being 3.6 times more likely to develop bulimia nervosa or BED.

ADHD and Eating Disorders: Medical Issues

If you have eating disorders, you may experience the following health issues:

  • Hair loss
  • Dysregulated metabolism
  • Sleep problems
  • Acute ADHD symptoms (for individuals with existing ADHD)
  • Temperature dysregulation
  • Problems with concentration
  • Cardiovascular problems
  • Gastrointestinal problems
  • Neurological problems
  • Endocrine problems
  • Kidney failure
  • Dental problems

ADHD and Eating Disorders: Risk Factors

There are many types of ADHD risk factors for eating disorders. Some main risk factors are as follows:

Biological and Genetic Factors

  • Reward deficiency syndrome: The ADHD brain generates inadequate levels of dopamine, a neurotransmitter involved in the brain's reward system.Insufficient amounts of dopamine cause individuals to seek satisfaction through food.
  • GABA deficit: ADHD brains exhibit reduced levels of GABA, a neurotransmitter responsible for regulating inhibition.
  • Purging: Purging can be a euphoric, almost addictive form of stimulation that increases dopamine levels.
  • Restrictive behaviours: Restrictive behaviours can build up reward sensitivity – individuals may purposely restrict food so that when they do eat, it is much more rewarding to them.
  • Dopamine receptors: These could overlap with obesity, binge eating, and ADHD.
  • Glucose absorption: ADHD brains take longer to absorb glucose than non-ADHD brains, which could lead to higher sugar and simple carbohydrate consumption.

Cognitive Factors

  • Executive function deficits: These can impact all aspects of eating and preparing foods. People with ADHD, similar to those with eating disorders, often struggle with poor interoceptive awareness, making it difficult to recognize hunger and fullness cues. This challenge, combined with difficulties in planning and decision-making around food, can lead to impulsive eating or even food restriction to avoid the effort of meal preparation.

Behavioural Factors

  • Poor impulse control can lead to overeating.
  • Poor sleep habits can dysregulate metabolism.
  • Irregular eating schedules can lead to overeating.
  • Poor self-regulation makes it difficult to understand the quantity of food consumed.

Emotional Factors and Self-Esteem

  • Boredom: This could be a major predisposing factor to binge eating.
  • Food as relief: Food can be a relief from anger, sadness, anxiety, and other difficult emotions.

Treatment: ADHD and Eating Disorders

Treatment for an eating disorder is multimodal. It includes a team of psychiatrists, psychologists, nutritionists, and family therapists. For individuals with ADHD, treatment approaches should be tailored to their specific symptoms and leverage their unique strengths.

  • Executive function skills training: This can address the cognitive factors that contribute to ED.
  • Cognitive Behavioural Therapy (CBT): This can help undo negative thought patterns and build self-esteem as well as positive body image.
  • Dialectical Behaviour Therapy (DBT): This focuses on mindfulness, emotional regulation skills, interpersonal effectiveness skills, and distress tolerance, and is very helpful for patients with ADHD and eating disorders.
  • Acceptance and Commitment Therapy (ACT): This therapy examines a patient’s value system and helps align appropriate behaviours with it.
  • Nutritional therapy: This is essential for patients with eating disorders.
  • Group therapy.
  • Parent coaching.

How CBT Can Help:

Managing ADHD isn’t easy, especially when it comes to impulsive behaviours that often spill into eating habits. That’s where Cognitive Behavioural Therapy (CBT) steps in. It’s a practical, hands-on approach that helps people understand and manage their thought patterns. For adults with ADHD, CBT can make a world of difference not just in controlling impulsivity, but also in building better habits around food, emotions, and daily decision-making. It’s like giving your brain the tools it needs to work smarter, not harder. Learn more about how CBT supports adults with ADHD here.

Psychopharmacological Treatments

Stimulant treatment can help manage eating behaviours in individuals with ADHD and an eating disorder.

  • Vyvanse: The first FDA-approved medication for BED and the second approved for ED.
  • SSRIs: These are FDA-approved medications for bulimia nervosa.
  • Stimulant medication: This can help patients with ADHD and bulimia.
  • No approved medications for anorexia: This is partly because the starved body struggles to metabolise medication.

Conclusion

Studies have shown that there is a link between ADHD and eating disorders, such as bulimia and BED. ADHD does not seem to be linked with anorexia, likely because overeating is impulsive in nature, whereas undereating involves restrictive behaviours. In addition to talk therapy, the medication lisdexamfetamine dimesylate can be effective in treating ADHD and BED. If a person has symptoms of ADHD or an eating disorder, they should contact a doctor.

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