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Comorbidities: ADHD and Eating Disorders

Millions of men and women across the globe suffer from a significant eating disorder at some point in their lives. Although eating disorders like anorexia, bulimia, and binge eating have been recognized for years, their association with ADHD is relatively new. Attention Deficit Hyperactivity Disorder (ADHD) and eating disorders are two distinct conditions that can profoundly impact a person's life. This blog will discuss the significant overlap between these two disorders and how crucial it is to understand this comorbidity for effective diagnosis and treatment.

Identifying Eating Disorders

There are several types of eating disorders, but the most common ones are:


Binge Eating Disorder (BED)

Recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort. Feelings of loss of control, shame, and guilt typically accompany this behavior. Unlike Bulimia, BED does not involve purging. Symptoms can include:

  • Eating quicker than usual

  • Eating until feeling too full

  • Eating a lot despite not being hungry

  • Eating alone because of embarrassment about the amount of food

  • Eating and feeling disgusted, depressed, or guilty afterward


Bulimia Nervosa (BN)

Binge eating large amounts of food in short periods and then compensating for it by exercising aggressively or purging by vomiting or using laxatives.


Anorexia Nervosa (AN)

Severely restricting food intake, relying only on a limited number of foods considered "safe." Individuals with this disorder are fearful of gaining weight, especially in the form of body fat, so they resort to starvation to cope.


The Intersection of ADHD and Eating Disorders

One of the core symptoms of ADHD is impulsivity, which can extend to different aspects of life, including eating behaviors. Another aspect of ADHD that affects eating behavior is emotional dysregulation. The combination of these two symptoms can lead to impulsive eating as a coping mechanism for stress, boredom, or negative emotions.


In addition, ADHD also comes with other executive function deficits, such as planning and decision-making. These deficits can contribute to the development of eating disorders, as individuals may struggle to control their eating habits and make healthy food choices.


Both ADHD and Binge Eating Disorder are associated with dopamine dysregulation, which plays a role in reward and pleasure. This dysregulation can lead to an increased craving for high-calorie, rewarding foods, further perpetuating binge eating behaviors. People with both BED and ADHD have trouble identifying and/or listening to their internal cues of satiety and hunger, so they may continue to eat despite discomfort from overeating.


For those with Bulimia Nervosa, food acts as self-medication for anxiety, stress, anger, and boredom. Since eating is a stimulating and rewarding activity, food helps to fill that dopamine gap. Feelings of inadequacy and incompetence can disguise food as a source of comfort, but it becomes an unhealthy outlet for taking control of life.


The risk factors for Anorexia Nervosa are also more significant for people with ADHD. The amount and variety of information available about food, healthy options, and proper portions can be overwhelming for these individuals. ADHD often involves all-or-nothing thinking, which affects decision-making. Even though those with AN may not eat much, they tend to obsessively hyperfocus on food, scrolling through Pinterest boards and watching YouTube videos or food shows. Ironically, this behavior simplifies their thinking on the topic.


Starvation has also been identified as a way for adolescents to cope with the fear of taking on the responsibilities that come with approaching adulthood. Due to deficiencies in executive function related to ADHD, managing careers, budgets, relationships, and independent living feels significantly more difficult. Starving the body to keep maturity at bay has been widely reported as an unconscious expression of the wish to delay "adulting."


Recognizing the Signs and Treatment Approaches

The relationship between psychiatric disorders and disordered eating is complicated. ADHD is often a missed diagnosis when it comes to issues with food and appetite. It is recommended that adults or adolescents seeking treatment for an eating disorder also be screened for ADHD. This ensures that patients receive effective treatment for both ADHD and disordered eating.


Treating comorbid ADHD and eating disorders requires an integrated therapy approach that addresses both conditions simultaneously. Cognitive-behavioral therapy (CBT) has been effective in helping develop healthier eating patterns and coping mechanisms. For ADHD, behavioral therapy and medication are commonly used to manage symptoms.


Stimulant medications, commonly prescribed for ADHD, have shown some effectiveness in reducing binge eating behaviors. However, working with a healthcare provider to find the right medication and dosage is essential.


Healthy Lifestyle Modifications can help manage symptoms of both ADHD and eating disorders. Regular physical activity, a balanced diet, and mindfulness practices can improve well-being and reduce impulsive behaviors.

 

In summary, through therapy, coaching, and possibly the right combination of medication, the urge to self-medicate through binging or starvation can subside when ADHD impulsivity is treated. Patients can better tune into their body's signals, control cravings, and improve impulse control.


Although this comorbidity presents unique challenges, understanding the signs and links between these conditions is essential for effective treatment strategies. By addressing the underlying causes and providing comprehensive care, individuals can improve their quality of life and achieve better outcomes.


If you or someone you know is struggling with symptoms of ADHD and/or an eating disorder, seeking professional help is a critical step toward recovery. Early intervention and a supportive treatment plan can make a significant, positive difference.


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