ADHD And Eating Disorders: Are They Connected?
According to research published in 2021, the lifetime prevalence of eating disorders is approximately 1.89% in Western countries. Some people living with eating disorders also experience attention-deficit/hyperactivity disorder (ADHD), which can exacerbate eating disorder symptoms in some cases. It’s thought that the impulsivity associated with ADHD may play a role in behaviors associated with anorexia, bulimia, and binge eating disorder. Therapy is often beneficial for those living with both ADHD and eating disorders, and some individuals who have experienced physical health impacts due to disordered eating may require medical care as well.
What is ADHD, and how does it affect the brain and behavior?
According to the American Psychiatric Association, ADHD tends to be one of the most common mental health disorders among children, who may be diagnosed by a specialist in developmental and behavioral pediatrics. However, this disorder can also affect adults. Individuals may experience the inattentive type, the hyperactive/impulsive type, or a combined presentation.
Inattentive type
With the inattentive type of ADHD, individuals tend to experience difficulty paying attention. They may have difficulty focusing during classes or meetings and experience challenges concentrating during conversations. These symptoms can contribute to personal and professional relationship challenges. Individuals with this type of ADHD may also have trouble staying organized, which may affect their time management skills and ability to manage deadlines.
Hyperactive/impulsive type
Individuals with the hyperactive/impulsive type of ADHD may experience excessive energy and have difficulty sitting still. This may manifest as a tendency to fidget or frequently get up during classes or meetings. Those who experience this type of ADHD may also experience the urge to talk often and take over projects on which others are working.
Combined type
As the name suggests, those with a combined presentation typically have symptoms of both other subtypes of ADHD.
Those with any type of ADHD may experience comorbid mental health disorders, including eating disorders, but these may be more common in people living with the hyperactive/impulsive type of attention-deficit/hyperactivity disorder.
What are eating disorders?
The American Psychiatric Association states that eating disorders “are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.” Some of the most common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder.
Anorexia nervosa
Bulimia nervosa
Bulimia nervosa is usually characterized by binge eating, which generally consists of consuming large quantities of food in a short time, followed by purging behaviors to prevent weight gain. Purging may involve self-induced vomiting or the use of laxatives. Individuals living with bulimia may attempt to hide their behavior out of fear or embarrassment. Their behavior is often motivated by concerns related to weight and body image.
Binge eating disorder
Like bulimia, binge eating disorder typically involves eating large quantities of food quickly. However, individuals with binge eating disorder don’t usually engage in purging behaviors.
How commonly do eating disorders and ADHD co-occur?
Eating disorders and ADHD can co-occur in some cases. The following are a few statistics about the comorbidity of these disorders, taken from a study published in Current Treatment Options in Psychiatry:
- Up to 12% of individuals with ADHD may also have an eating disorder.
- Approximately 5% to 17% of those with eating disorders may also have ADHD.
- It’s possible that bulimia may have a higher comorbidity rate with ADHD than other eating disorders. Around 9% of inpatients with bulimia also have ADHD.
The possible role of impulse control difficulties
In some eating disorders, such as bulimia and binge eating disorder, individuals often experience an impulse to engage in binge eating. Impulsive behavior may also be seen in some people living with ADHD. Some researchers have posited that impulsiveness in those with ADHD may lead to disordered eating behaviors.
According to the study mentioned above, even individuals with ADHD who don’t meet enough criteria to be diagnosed with an eating disorder may experience impulsive eating tendencies.
Does dopamine play a role in ADHD and eating disorders?
Research suggests that dopaminergic signaling likely plays a role in both ADHD and eating disorder behaviors. Dopamine is typically involved in a person’s reward processing system, which may explain, in part, why both addictive eating and substance use disorders can be common comorbidities of ADHD.
Some researchers posit that comorbid disorders in those with ADHD can explain their eating behaviors. More research may shed light on the relationship between ADHD, eating disorders, and other comorbid disorders.
Is there help for ADHD and eating disorders involving impulse control?
Individuals living with eating disorders can receive help regardless of whether they also meet the criteria for ADHD. Treatment often involves a combination of medical care and therapy. Some people may require hospitalization if they experience serious physical symptoms, as eating disorders can affect numerous body systems.
In addition, a doctor may need to monitor recovery to avoid refeeding syndrome, which can occur when a person facing malnourishment begins to eat again. Refeeding syndrome typically results from changes in fluids and electrolytes and can involve symptoms like vomiting, nausea, lethargy, hypotension, and cardiac failure.
In addition to medical care, people living with eating disorders typically receive talk therapy. Cognitive behavioral therapy, in particular, may help people identify and replace negative or inaccurate thoughts they have about themselves, which may lead to improved behaviors.
CBT can also be helpful for those who have ADHD. This type of therapy may help them challenge unhelpful thought patterns that may be exacerbating ADHD symptoms. For example, some people may practice negative self-talk that leads them to believe they can’t do things correctly at work or school. A therapist may be able to help these individuals identify and replace inaccurate thoughts with more constructive ones, often resulting in more positive emotions and improved behavioral outcomes.
Online therapy for anorexia nervosa, binge eating disorder, and ADHD symptoms
Individuals living with eating disorders may be hesitant to participate in traditional in-person therapy. Those who experience eating disorders may experience a sense of shame and low self-esteem, which may make it difficult to talk about their thoughts, feelings, and symptoms. In cases like these, online therapy may be a more viable option.
With online therapy, individuals can be matched with a mental health professional who has experience treating eating disorders and ADHD. They can communicate with their therapist in a way that’s comfortable for them, such as audio, video, or live chat. Individuals can also reach out to their therapist at any time through in-app messaging, and the therapist will generally respond as soon as they can. This may be helpful if clients have questions about emotions or eating habits in between sessions.
Is online therapy effective for impulse control and eating disorder symptoms?
In recent years, research has demonstrated the effectiveness of online therapy for numerous mental illnesses. One study published in 2020 found that online therapy can effectively treat eating disorders, as well as anxiety, depression, and substance use disorders, and additional research supports the use of online therapy for ADHD treatment.
While online therapy can often be helpful for those with ADHD and eating disorders, some individuals with severe physical health impacts resulting from eating disorder symptoms may require in-person medical care.
Takeaway
Is there a connection between ADHD and food?
Although there is no definitive proof that certain foods cause ADHD symptoms—there are clinical implications to suggest a complex interaction between the two. For example, magnesium, iron, and zinc deficiencies have been linked to ADHD symptoms in children. Similarly, lower levels of omega-3 fatty acids can contribute to ADHD symptoms such as impulsivity and attention.
Certain artificial colorings and preservatives (like those found in hyper-processed foods) might worsen hyperactivity and impulsivity in some children, especially those already diagnosed with ADHD. While sugar itself doesn’t cause ADHD, systematic reviews and meta-analyses investigating the relationship between sugar and sugar-sweetened beverage (SSB) consumption reveal a modest but significant association between more sweetened beverage intake and ADHD symptoms.
The results of these studies provide insight into possible links between ADHD and food—but future research is required to establish how they impact one another and to explore the potential of nutrition as a complement to ADHD treatments. Individuals considering using supplements or making dietary changes for ADHD management should speak with a doctor or nutritionist for guidance.
How might brain function affect ADHD and eating disorders?
According to criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ADHD and eating disorders share some symptom characteristics, partially because of the role that brain function plays in the two conditions. Several studies featured in the Archives of General Psychiatry (arch gen psychiatry) show that they share some neurological and psychological mechanisms associated with a few key areas:
Dopamine regulation
Research reveals a significant association between ADHD and binge eating disorder (BED), potentially caused by dopamine deficiency. For some, lower dopamine levels may lead to impulsive, pleasure-seeking behavior, difficulty focusing, and a heightened need for stimulation. Recurrent binge eating episodes or overeating—critical characteristics of eating disorders—might serve as a way to boost low dopamine levels and provide temporary “relief” from ADHD symptoms.
Executive functioning
People with ADHD often experience deficits in the prefrontal cortex, the area responsible for planning, organization, memory, goal-setting, and other executive functions. This can impact one’s ability to maintain regular meal schedules or follow dietary guidelines, potentially leading to disordered eating patterns. Additionally, executive dysfunction in ADHD can make it difficult to stop or interrupt binge-eating episodes.
Impulsivity
Areas of the prefrontal cortex are also responsible for impulse control and self-regulation. People with dysfunction in these areas, like those with ADHD, may have trouble regulating behaviors associated with eating, resulting in disruptive patterns like binge eating episodes and chronic overeating.
Emotional regulation
Studies involving young adults reveal that difficulty regulating emotions is a common shared symptom of ADHD and eating disorders. In some cases, individuals turn to eating as a coping mechanism for overwhelming emotions, and disordered eating behaviors such as bingeing and overeating might provide temporary relief or a sense of control during moments of emotional distress.
Does ADHD cause eating issues?
There is sufficient scientific evidence to suggest that ADHD can lead to eating issues in several contexts. Here are a few studies that may shed light on the link:
- In the study "Laboratory snack food intake, negative mood, and impulsivity in youth with ADHD symptoms and episodes of loss of control (LOC) eating," researchers explored the link between ADHD, LOC eating, impulsivity, and mood in children and adolescents. The children were separated into a control group and an ADHD group. Results showed that young people in the ADHD group consumed more snack foods than those in the control group (though food intake was not strongly influenced by mood or impulsivity). The findings suggest that higher snack consumption in ADHD may contribute to the risk of obesity; however, further research on how mood impacts LOC eating is needed.
- Another paper published in the Journal of Abnormal Psychology examined the relationship between ADHD and eating pathology in adolescent girls, particularly within the context of how symptoms might be associated with eating disturbances and restrictive behaviors related to food, as well as broader eating and body image concerns. The researchers found that ADHD girls are at a higher risk of developing eating disorders or showing disordered eating behaviors than their non-ADHD peers. This includes a heightened prevalence of binge eating and restrictive eating patterns.
- A study published in the journal “Appetite” examined how sensory processing differences commonly seen in children with neurodevelopmental disorders (NDDs) such as attention deficit disorder might influence their eating behaviors—
particularly “food fussiness” and specific food preferences. Researchers found that children with such clinical characteristics are more prone to food fussiness, particularly due to adverse reactions to certain textures, tastes, or food smells.
They also tend to show stronger preferences for certain foods while rejecting others, partly due to sensory processing issues.
A study titled “Disruptive patterns of eating behaviors and associated lifestyles in males with ADHD” found that children with ADHD showed notable differences in eating habits than those without. For example, the study’s ADHD group tended to skip meals, particularly breakfast and dinner, more often than the control group—yet tended to eat more than five times a day. They also consumed fewer fruits and vegetables and drank more sweetened beverages. ADHD children in the same study engaged in sports activities for an average of two hours less per day than the control. These results support statistics indicating that children and individuals in early adolescence with ADHD tend to be more overweight compared to their non-ADHD counterparts—underscoring the need for child and adolescent health initiatives targeting those with ADHD.
What percentage of people with eating disorders have ADHD?
The National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports between 6 and 17% of eating disorder patients also have ADHD. Studies on childhood ADHD reveal as much as 20 % of children with ADHD also develop eating disorders such as BED, bulimia, and anorexia nervosa.
What medication is used for ADHD and eating disorder?
Vyvanse (lisdexamfetamine dimesylate) is the first FDA-approved drug for treating co-occurring ADHD and binge eating disorder (BED). Certain stimulants are prescribed for ADHD, but might also help treat BED and other commonly co-occurring disorders. For example, research on adjunctive methylphenidate (a stimulant used primarily for treating ADHD) shows the drug can be effective for some in relieving symptoms of bulimia nervosa and comorbid ADHD, substance dependence, and bipolar disorder.
While there isn’t a non-stimulant FDA-approved drug for eating disorders related to ADHD, some can potentially help manage impulsive eating behaviors by enhancing self-regulation and decreasing impulsivity. Antidepressants, particularly SSRIs (Selective Serotonin Reuptake Inhibitors), are commonly prescribed for anxiety disorders, mood disorders, and some other mental disorders that co-occur with ADHD and eating disorders.
Though not FDA-approved specifically for ADHD or BED, bupropion targets dopamine and norepinephrine, making it useful for ADHD. Its effect on dopamine can help improve focus and reduce impulsivity. This medication is also sometimes used off-label for BED or to help with obesity treatment. Some anticonvulsants, such as topiramate, may also be used off-label for impulse control, binge eating, and weight management.
Do people with ADHD not like certain foods?
While this isn't the case for everyone, some people with ADHD may have specific food aversions due to a combination of several factors. These might include:
Issues with sensory sensitivity
Some people with ADHD, particularly children, have heightened sensitivity to food textures, flavors, and smells. For example, foods with softer textures (like mashed potatoes or oatmeal) or strong smells might be off-putting. They might also dislike mixing certain food textures (like crunchy and soft), which can limit their willingness to eat certain foods.
A desire for immediate satisfaction
Some with ADHD might favor foods they can get quickly and provide immediate gratification over foods requiring more involved preparation. For example, processed snacks, sugary foods, and fast food often require less time and effort to prepare—but studies show they also contain ingredients that tap directly into the brain’s reward pathways, delivering a quick dopamine rush. On the other hand, healthier foods that require preparation and lack the chemicals that produce that immediate dopamine rush might be less appealing because they don’t provide the same immediate satisfaction.
Challenges with routine and meal planning
ADHD can make it challenging to stick with a structured meal plan or a nutritious diet. As a result, people with ADHD might choose a more limited selection of more convenient, familiar foods over others. This may mean repeatedly eating the same preferred foods while avoiding foods requiring more planning, preparation, or regular grocery shopping.
ADHD medication’s effects on appetite
Stimulant medications are commonly prescribed for ADHD, among the side effects of which is reduced appetite. This might make certain foods less appealing or create an aversion to food altogether.
Why is eating so hard with ADHD?
Not all people with ADHD have challenges with eating; some might experience difficulties due to its symptoms and biomechanisms. For example, challenges with inattention or hyperfocus can cause inconsistent eating patterns or forgetting to eat entirely. This irregular eating schedule can lead to skipping meals, overeating, or relying on whatever food is immediately available. Some people with ADHD are hypersensitive to specific tastes, textures, or smells, making certain foods or entire food groups unappealing. This might lead to food aversions or "picky" eating.
ADHD is often associated with lower levels of dopamine in the brain, causing a tendency towards impulsive, reward-seeking behaviors that deliver a quick dopamine boost. This can lead to overeating or intense cravings for ultra-processed, high-sugar, or high-fat foods—making it harder to stick to a nutritious diet or make more thoughtful food choices.
Emotional dysregulation, another ADHD symptom, might lead to similar eating tendencies when individuals use food as a coping mechanism. Finally, stimulants often prescribed for ADHD can cause a reduction in appetite, making it challenging to maintain regular eating habits.
Do people with ADHD eat differently?
Yes, some people with ADHD have different eating habits compared to those without. The causes for these behaviors are typically associated with ADHD symptoms like inattention, hyperfocus, impulsivity, emotional dysregulation, sensory issues, and reward-seeking behaviors.
Which ADHD med is best for weight loss?
Some people taking certain ADHD medications might find themselves losing weight, but there are no ADHD medications officially approved for weight loss or to treat extreme obesity. However, there are some ADHD medications (typically stimulants) more frequently used to help control eating and facilitate significant weight loss. For example, Adderall (amphetamine and dextroamphetamine) and Vyvanse (lisdexamfetamine dimesylate) are commonly prescribed stimulants for ADHD. Ritalin (methylphenidate) and Concerta also fall under the stimulant/appetite suppressant category.
Some experts caution against misusing ADHD medications for weight loss for several reasons, the most common being physical health risks such as cardiovascular issues. However, ADHD-specific stimulant misuse can also have profound effects on one’s mood, anxiety, and stress levels. In some cases, individuals experiencing low self-esteem and body image issues might misuse ADHD stimulant medications along with excessive exercise to lose weight and maintain a particular body shape.
What makes ADHD worse?
Research is ongoing, and some of their results require more investigation, but some studies indicate certain factors might worsen ADHD symptoms. These include:
- Poor sleep quality
- Chronic stress
- Chaotic or disorganized environments
- Diets high in sugars, fats, and processed foods
- Excessive screen time
- Alcohol and caffeine consumption
- Overwhelm and task overload
- Lack of physical activity
- Negative thought patterns or low self-esteem
- Hormonal changes
- Substance abuse
There is also evidence to suggest that other mental health conditions might worsen symptoms of ADHD. For example, the study “Associations between ADHD and eating disorders in relation to comorbid psychiatric disorders in a nationally representative sample” investigated the relationship between ADHD, eating disorders (EDs), and the impact of additional comorbid psychiatric disorders on their symptoms. The researchers found that psychiatric comorbidities, such as anxiety, depression, and substance use disorders, may further intensify the association between ADHD and EDs and exacerbate the severity of symptoms—highlighting the importance of providing support to those who seek treatment for mental health concerns.
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