The 10th Annual Veritas Collaborative Symposium on Eating Disorders, co-hosted by The Emily Program, will unite healthcare professionals and eating disorders experts around the theme of “Engaging Science, Unifying Voices, and Transforming Access.” In this article, Roberto Olivardia, PhD, a speaker at this year’s Symposium, examines the complex relationship between ADHD and eating disorders.
Alex*, 35, feels that the only thing that gives him relief from the chaos caused by his ADHD is food. He makes several stops on his way home from work. Along the way and later at home, he might order and eat four hamburgers, four large French fries, a pizza, two bags of potato chips, two gallons of ice cream, and a dozen cupcakes. His numbness after such a binge turns into frustration and disgust. Then he vomits. He swears he will never binge and purge again, something he has told himself for 10 years.
Although eating disorders have been recognized for many years, their association with ADHD is relatively new. ADHD is poorly understood. In a nutshell, it is characterized by attention dysregulation (versus a lack of attention), impulsivity (addictive behaviors, emotional dysregulation, risky actions), and poor executive functioning (disorganization, poor time management, low working memory, impulsive decision making). Some people with ADHD are also hyperactive. ADHD impacts every life domain.
Research has demonstrated that individuals with ADHD have a greater risk for developing binge eating disorder or bulimia nervosa than their peers without ADHD. A 2007 study conducted at Harvard Medical School found that girls with ADHD were almost four times more likely to have an eating disorder than those without ADHD.
Many people with ADHD have poor impulse control and find it hard to regulate their emotions. This combination can set the stage for binge eating. Haley, 28, compares it to a drug problem. “Food is my heroin,” she says. “It sounds dramatic, but it is true. As hard as I try to prevent a binge, it is like driving over the same pothole that blows out your tires every day.”
For people struggling with bulimia, food is self-medication for anxiety, stress, anger, and boredom. Eating is stimulating, so when sufferers feel “empty” emotionally, food fills the gap. People with ADHD who can feel inadequate and incompetent turn to food as a source of comfort. Eating is used as an unhealthy outlet to take control of their lives. Both people experiencing binge eating and people with ADHD have trouble heeding their internal cues of satiety and hunger.
Fernando, 44, who has struggled with bulimia since he was 15, says, “Controlling my weight is my only success. I was constantly procrastinating, being overwhelmed, and getting nothing done. Back then, there was no support or recognition of ADHD. Everyone thought I was either not trying hard enough or was stupid. After hearing that for so long, I started believing it myself.”
There are biological, neurochemical, behavioral, and psychological reasons why people with ADHD are predisposed to develop eating disorders. When a sufferer also has ADHD, seeing treatment through an ADHD lens is essential. Knowing how the eating disorder is affected by ADHD symptoms, and how it, in turn, affects ADHD symptoms, must be central to treatment. Not managing the ADHD usually leads to treatment failure. The presence of unmanaged ADHD will undermine any treatment of a comorbid condition, like an eating disorder. If the eating disorder therapist is not an ADHD expert, it would be helpful to add an ADHD therapist to the team to consult or collaborate in the treatment.
In addition to typical treatments for eating disorders, patients with both ADHD and eating disorders can benefit from psychoeducation about ADHD and executive function training, as well as discussion around adopting a nonjudgmental, non-shaming view of their ADHD. This includes also connecting to the strengths that come along with an ADHD brain. Stimulants are a first-line treatment for ADHD symptoms, but there is hesitation among prescribers to provide stimulants to patients with eating disorders. Research has shown, however, that using stimulants for patients with ADHD and bulimia promotes impulse control that can prevent binge eating, as well as boost executive functions that, in turn, make people’s lives easier. Stimulants also help the patient execute the treatment plan. In fact, Vyvanse, a stimulant and ADHD medication, is the first FDA-approved drug for the treatment of Binge Eating Disorder.
Treating an eating disorder is a process that requires investment, hard work, and the proper resources and support. Having undiagnosed and untreated ADHD can make that process so much harder. However, identified and treated ADHD can significantly help in eating disorder treatment, giving patients the much-needed hope and proper tools to forge a path to recovery.
To explore the relationship between ADHD and eating disorders in greater depth, join us for Dr. Olivardia’s presentation at this year’s Symposium, “The Interesting Relationship Between ADHD, Eating Disorders, and Body Image.” See the full agenda here.
*Names changed to respect patient confidentiality
About the Author
Dr. Roberto Olivardia is a Clinical Psychologist, Lecturer in Psychology in the Department of Psychiatry at Harvard Medical School, and Clinical Associate at McLean Hospital. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specializes in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), and Body Dysmorphic Disorder (BDD), as well as issues that face students with learning disabilities. He is a nationally recognized expert and specialist in eating disorders and body image problems in boys and men.
He is co-author of The Adonis Complex, the first book of its kind detailing male body image issues. He has appeared in publications such as TIME, GQ, and Rolling Stone, and has been featured on Good Morning America, CNN, and VH1. He has spoken on numerous webinars and presents at many talks and conferences across the country. He currently serves on the Professional Advisory Boards for Children and Adults with ADHD (CHADD), The Attention Deficit Disorder Association (ADDA) and ADDitude, as well as a Featured Expert on Understood.org.