Rebecca Jaspan, MPH, RD, CDN, CDCES
Attention deficit/hyperactivity disorder or ADHD is a disorder characterized by impulsivity, hyperactivity, and inattention, which typically begins in children under 12 years old. ADHD has two subtypes, inattentive and hyperactive/impulsive and is often accompanied by anxiety or depression. The prevalence is estimated to be 5% of children in the United States.1 Although eating disorders have been recognized for many years, their association with ADHD is relatively new. Research has demonstrated that individuals with ADHD have a greater risk for developing an eating disorder than their peers without ADHD.2 In fact, the prevalence of eating disorders in ADHD have been reported up to 12%.3
Specifically, individuals with ADHD are at greater risk for developing binge eating disorder or bulimia nervosa due to a number of similar characteristics. Many individuals with ADHD have poor impulse control and find it difficult to regulate their emotions. Additionally, food can be a form of self-soothing for anxiety, stress, anger, and boredom. People with ADHD may turn to food as a source of comfort or use eating as an unhealthy outlet to take control of their lives.
According to experts, ADHD is caused by an imbalance in brain chemistry. The brains of those with ADHD are low in neurotransmitters norepinephrine and dopamine. Dopamine is essential for controlling impulses. It is also an essential part of the body’s reward circuit. People whose brains are low in dopamine often self-medicate with food because of its ability to temporarily activate dopamine in the reward pathway. A deficiency in both norepinephrine and dopamine can lead to a number of behaviors related to eating including poor awareness of internal hunger and fullness, inability to follow a meal plan, inability to judge portion size accurately, inability to stop bingeing or purging, distraction by thoughts of food, weight, and body shape, increased desire to overeat, and poor self-esteem due to repeated failures of self-control.4
Further, people with ADHD may forget to eat because they are on medications that blunt their appetite. Waiting too long to eat can set you up for a binge later. Commonly used medications for ADHD include Adderall, Vyvanse, and Concerta, which have an appetite-suppressing affect. Other reasons you may not eat during the day on medications include hyperfocusing, forgetting to eat, feeling too overwhelmed to decide what to eat, or not having enough time. Whether restriction during the day is intentional or not, it makes it more likely to overeat or binge at night. Continuing this cycle increases the likelihood that someone will develop an eating disorder.
So, how do you prevent this cycle from starting or break free from bingeing if it does occur? Make sure you are consuming adequate nutrition regularly throughout the day prior to starting medication. When you do begin medication, know that the stimulants may change your appetite and have a plan in place to ensure you are eating regularly throughout the day. You may not be able to rely on your natural hunger and fullness cues, but there are other signs of hunger you can learn to pay attention to including fatigue, mood changes, headache, overwhelm, and trouble making decisions.5 Work with an eating disorder dietitian who is also familiar with the needs of an individual with ADHD. They can help you structure your meals, provide you with simple and low effort meal and snack options, and help you learn to listen to your body’s cues of hunger and fullness.
- Reinblatt SP. Are Eating Disorders Related to Attention Deficit/Hyperactivity Disorder? Curr Treat Options Psychiatry. 2015 Dec;2(4):402-412. doi: 10.1007/s40501-015-0060-7. Epub 2015 Oct 9. PMID: 26949595; PMCID: PMC4777329.
- Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL, Zeitlin S. Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J Dev Behav Pediatr. 2007;28(4):302-307. doi:10.1097/DBP.0b013e3180327917
- Surman CB, Randall ET, Biederman J. Association between attention-deficit/hyperactivity disorder and bulimia nervosa: analysis of 4 case-control studies. J Clin Psychiatry. 2006;67(3):351–4