Mike (not his real name) is a 27-year-old male with a 13-year history of binge eating disorder. He has been to various eating disorder specialists, and nothing seemed to help. His weight was dangerously increasing and self-esteem was plummeting. His last therapist said he was “treatment resistant” and probably did not want to get better.
When I first met Mike, I saw a man who desperately wanted to be free of this eating disorder. Upon further inquiry, I discovered some important details about Mike and his treatment history. He reported that he could not get himself to the appointments on time. He would often sleep through them. He had every intention of filling out a food log, but would lose it or simply forget to do it. “I always say I will follow through, but I just can’t.” He often skipped meals because he would be working through lunch, unable to transition out of a task. Then he was hit with hunger at dinner and ended up “pigging out.” After much assessment, history taking and a comprehensive clinical interview, it was clear that Mike had undiagnosed ADHD. It was only when the treatment for his eating disorder was through the lens of his ADHD, Mike made significant progress for the first time in his 13-year battle with food.
There is a growing scientific literature regarding ADHD and eating disorders, weight, and obesity. Studies have found that individuals with ADHD are 3-4 times more likely than those without ADHD to suffer from an eating disorder, often bulimia nervosa or binge eating disorder. The problem is that ADHD is a widely misunderstood condition, especially when it comes to adults. Myths include the idea that people with ADHD cannot focus that they all do poorly at school or outgrow it. And the biggest myth of all – that ADHD just impacts academic functioning. That could not be farther from the truth.
ADHD affects every life domain and area of functioning, and healthy and regulated eating is one of them. There is a myriad of cognitive, biological, emotional, genetic, behavioral, and psychological reasons that having ADHD can predispose someone to developing an eating disorder.
Clinicians too quickly dismiss ADHD as an important factor in their patients’ eating disorder and it comes at a cost. The more understanding and education eating disorder clinicians have about ADHD, the better they can recognize this condition in their patients with eating disorders and therefore can adequately treat their patients. The encouraging news is that these issues can be successfully treated, provided that the relationship between the ADHD and the eating disorder is fully understood.
People who have either an eating disorder or ADHD struggle with feelings of shame, ineffectiveness and being perceived by others as being lazy or lacking “willpower”. These negative feelings are exponentially increased when people struggle with both ADHD and an eating disorder.
ADHD is not a curse. In fact, it can be a gift or asset to many, if it is navigated properly.
Roberto Olivardia, Ph.D. is a Clinical Psychologist and Clinical Instructor in the Department of Psychiatry at Harvard Medical School in Boston, Massachusetts. He is co-author of “The Adonis Complex”, a book about body image and eating disorders in boys and men. He has a private therapy practice where he specializes in the treatment of ADHD, eating disorders, obsessive-compulsive disorder, and body dysmorphic disorder in Lexington, MA.