There are several coexisting, or comorbid, conditions associated with attention deficit hyperactivity disorder — anxiety and depression among them. But what’s to be said of any possible association between ADHD and eating disorders? Are there any connections? If so, what steps can be taken to manage the challenges?
Roberto Olivardia, a lecturer in department of psychology in Harvard Medical School, who runs a private psychotherapy practice in Lexington, Massachusetts, specializing in ADHD and eating disorders, cites research showing people with ADHD are more likely to “be at risk of having an eating disorder than those without ADHD.” He says there’s a correlation between those with ADHD and their body mass index; the more obese someone is, the likelier he or she is to also have ADHD.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
Overeating, Not Undereating, Is More Common
But why would obesity be more prevalent instead of other eating disorders? Ari Tuckman, a clinical psychologist with a private practice in West Chester, Pennsylvania, who is also a co-chair for Children and Adults with Attention-Deficit/Hyperactivity Disorder national ADHD conference, explains that some of the common ADHD symptoms — impulsivity and an inability to plan well — may play a role. “ADHD might drive obesity in the first place,” he says, emphasizing that healthy eating takes a certain amount of planning, which is “not a strength for many people with ADHD.” He adds that many people with the disorder are also likely not eating consistently throughout the day because they “may become overly absorbed or run out of time.” It’s not unheard of, he says, for people with ADHD to make impulsive food choices, not be able to pick up on the body’s food satiety signals — something Olivardia says is called “poor interoceptive awareness” — or eat once there’s only a few hours left in the day, at which point binge eating may take place.
Understanding the types of eating disorders may help. According to the National Eating Disorders Association, the “feeding and eating disorders described in the American Psychiatric Association’s Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)” are as follows:
— Anorexia nervosa: an “inadequate food intake leading to a weight that is clearly too low.”
— Binge eating disorder: “Frequent episodes of consuming very large amounts of food but without behaviors to prevent weight gain, such as self-induced vomiting.”
— Bulimia nervosa: “Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.”
— Eating disorder not otherwise specified: “A feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.”
While Tuckman says that people with ADHD can go on to develop other eating disorders like anorexia nervosa, he says binge eating is the most common. “Anorexia is negatively associated with ADHD; if someone has ADHD, they’re less likely to have anorexia. Obesity is more positively associated with ADHD.” Olivardia agrees. In those with ADHD, “binge eating disorder and bulimia nervosa is more common,” he says. “I have seen anorexia and ADHD,” but he explains that anorexia is typically associated with compulsive behaviors, whereas binge eating typically deals with impulsive behaviors, which tend to be a struggle for those with ADHD.
[See: 8 Things You Didn’t Know About Counseling.]
Surveys and Research on ADHD and Eating Disorders
Dr. Patricia Quinn, a developmental pediatrician in the District of Columbia and the co-founder of ADDvance.com, a resource site that advocates for girls and women with ADHD, says that ADHD and eating disorders have a lot of symptoms in common. “The impulsivity of ADHD tends to lead women to have disordered eating, low self-esteem and depression.” She points to an informal survey she sent readers of AD/HDvance Magazine, which she published and edited, that found that 92 percent of the women readers under 40 engaged in binge eating, while 78 percent of women over 40 engaged in the same behavior.
Her study isn’t the only attempt to focus on possible associations between ADHD and eating disorders.
In an August 2010 study in the Journal of Abnormal Psychology, the “theoretical rationale as to why ADHD and eating pathology may be linked” was assessed — along with other related questions and concerns.
The study drew conclusions that, compared to girls without ADHD, girls with ADHD-C in childhood were more at risk for experiencing bulimia nervosa behaviors and body image issues during their teenage years. “We contend that BN symptoms and body image dissatisfaction should be incorporated into conceptions of risk and impairment among youth with ADHD,” the study concludes. ADHD-C refers to the combined type of this disorder, which involves both hyperactivity-impulsivity and inattention, while BN refers to bulimia nervosa.
Additionally, assessments of various research and studies presented in the April 2017 Clinical Psychology Review note that “overall, a moderate strength of evidence exists for a positive association between ADHD and disordered eating and with specific types of disordered-eating behaviour, in particular, overeating behaviour.”
Quinn says that women with ADHD who have disordered eating tendencies eat for several unhealthy reasons, including coping with stress and to find stimulation to counter boredom. She’s also observed that many of these women benefit from taking their ADHD stimulant medication. She knew of one woman whose medication wore off in the afternoon. “That’s when she’d start eating and wouldn’t stop,” Quinn says, adding that treating ADHD in this manner may help decrease impulsivity and, in turn, lead to better eating habits. This concept is something she says Dr. Carolyn Dukarm covers in her book, “Pieces of a Puzzle: The Link Between Eating Disorders and ADD,” which Quinn says homes in on ways to decrease self-medication with food.
Stimulant Medication May Help Diminish Urge to Overeat
Olivardia, who serves on CHADD’s professional advisory board and will be presenting at the 2017 annual international conference in November on the topic of ADHD and healthy eating, agrees that ADHD medication may play a role in improving eating disordered tendencies. He says the FDA approved the ADHD stimulant Vyvanse to help treat binge eating disorder in 2015, so it’s something that people may want explore with the guidance of a medical professional. “Stimulants can be helpful in that they can boost executive function [the ability to plan, execute and organize daily tasks] and increase levels of dopamine, so a person is better able to control their impulse to have excessive amounts of food.” Indeed, the Vyvanse “indications and usage” section on the U.S. National Library of Medicine says it’s “indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD)” and “Moderate to Severe Binge Eating Disorder (BED) in adults.”
Managing ADHD and any possible related eating disorders are all the more reason Tuckman urges people to seek treatment. He maintains that “untreated ADHD impacts life in many ways, including weight.” He explains that medication can be a part of the management process, but also encourages people to make other healthy living choices by evaluating sleep, engaging in stress management, eating healthy and considering speaking with a therapist.
[See: Hoarding, ADHD, Narcissism: Inside the Minds of History’s Great Personalities.]
A Healthy Lifestyle, Whether You Have ADHD or Not, Is Essential
Awareness, Tuckman says, is an important first step in acknowledging issues exist, which can pave the way towards improvement. “If you want to function at your best and feel your best, this is a part of it,” he says. “The end goal is not just about managing ADHD, but having a life worth living. That includes a life of taking good care of yourself so you can be around for a long time and do all of the things that make life worth living.” Tuckman says that everyone, not just people with ADHD, should strive to live a healthy lifestyle. “Even if you don’t have weight issues, if you’re not eating right, you’re not functioning at your best.”
More from U.S. News
10 Concerns Parents Have About Their Kids’ Health
8 Things You Didn’t Know About Counseling
Hoarding, ADHD, Narcissism: Inside the Minds of History’s Great Personalities
ADHD and Eating Disorders: What You Should Know originally appeared on usnews.com
