ADHD and Eating Disorders: Research, Diagnosis & Treatment Guidelines
Individuals with ADHD face a heightened risk for eating disorders, maximum particularly bulimia nervosa and binge eating dysfunction, in line with a rising body of research. What’s extra, eating disorders appear to develop in severity along ADHD signs.
Several factors – biological, cognitive, behavioral, and emotional – might provide an explanation for why ADHD predisposes folks to eating disorders and demanding situations. Understanding those components, together with the connection between a affected person’s ADHD and eating disorder, is very important when devising an acceptable and efficient treatment plan.
Types of Eating Disorders
Roughy 30 million other people in the U.S. (20 million women and 10 million males) be afflicted by eating disorders1. Eating disorders are considered led to by means of a complex interplay of genetic, organic, behavioral, social, and psychological components.
Binge Eating Disorder
Binge eating disorder (BED) and bulimia nervosa (beneath) are each impulsive eating disorders prevalent in individuals with ADHD.
BED is outlined via recurrent episodes of binge eating, characterized by both of the following:
- Eating, in a discrete time period (e.g., inside of any two-hour period), an amount of food this is definitely larger than most of the people would consume all the way through a an identical time period and underneath an identical circumstances.
- A way of loss of keep an eye on over eating all through the episode (e.g., a sense that you cannot forestall eating or keep an eye on what or how much you might be eating).
In addition, the episodes are associated with at least three of the next to merit a diagnosis:
- Eating a lot more abruptly than commonplace
- Eating till feeling uncomfortably full
- Eating massive amounts of food when now not feeling physically hungry
- Eating on my own because of feeling embarrassed via how a lot you might be eating
- Feeling disgusted with yourself, depressed, or in charge later on
Marked misery referring to binge eating must even be provide for a diagnosis. Episodes must also happen, on reasonable, at least one time every week for 3 months.
Bulimia is characterised by recurrent episodes of binge eating (as described above) as well as recurrent, irrelevant, compensatory behaviors exercised to forestall weight achieve from binging. These behaviors can include self-induced vomiting, laxative misuse, fasting, or over the top exercise.
Binging and irrelevant compensatory behaviors will have to happen, on moderate, once or more per week for 3 months to satisfy a diagnosis. Self-evaluation could also be unduly influenced through frame shape and weight; regularly, people with bulimia be afflicted by detrimental frame image.
Anorexia is an obsessive-compulsive eating disorder defined by means of restriction of power intake resulting in a considerably low frame weight (in context of what is minimally expected for age, intercourse, developmental trajectory, and physical health). The dysfunction is not as prevalent in folks with ADHD as are the impulsive eating disorders.
With anorexia, there may be both an intense fear of gaining weight or of changing into fats, or persistent behavior that interferes with weight gain. Anorexia is accompanied through frame symbol distortion – including disturbances in the way in which one’s body weight or form is experienced; body weight or form influence self-evaluation, or there’s a continual lack of recognition of the seriousness of the low body weight.
Clinicians also specify whether a patient is of the restricting sort (no binging; weight loss accomplished through weight-reduction plan, fasting, and/or over the top workout) or binge-eating/purging sort (i.e. self-induced vomiting, laxative misuse, diuretics, enemas).
Other Eating Disorders
- Avoidant/Restrictive Food Intake Disorder (ARFID): An eating or feeding disturbance manifested through power failure to satisfy appropriate nutritional and/or power needs. It’s continuously associated with important weight reduction, nutritional deficiency, dependence on enteral feeding or oral dietary dietary supplements, and marked interference in psychosocial functioning. Absent in this diagnosis is unfavourable frame symbol.
- Other Specific Feeding or Eating Disorder (OSFED): Includes extraordinary anorexia nervosa (all criteria for anorexia met, however affected person’s weight is inside or above the normal vary); bulimia nervosa of low frequency; BED of low frequency; purging disorder; Night Eating Syndrome; and Chewing and Spitting disorder (chewing however no longer swallowing meals).
- Orthorexia: While not in the DSM-5, orthorexia is characterized by an obsession over healthy, clean eating. It can seem like anorexia, but people with orthorexia are not motivated by means of thinness or aesthetic.
Eating Disorders: Medical Consequences
Eating disorders are related to opposed health penalties together with the following:
- Dental problems
- Hair loss
- Dysregulated metabolism
- Sleep issues
- Acute ADHD symptoms (for people with existing ADHD)
- Temperature dysregulation
- Problems with concentration
- Cardiovascular issues
- Gastrointestinal problems
- Neurological issues
- Endocrine problems
- Kidney failure
Given those adverse health consequences, eating disorders have prime mortality rates2. It is estimated that only 10% to 15% of women with eating disorders seek treatment, and an excellent smaller percentage of men search treatment.
Eating Habits and ADHD
What Do We Know About ADHD and Eating?
- Studies show that people with ADHD can be somewhat impulsive with their eating conduct. In one study involving a simulated kitchen, children with ADHD fed on extra meals than children without ADHD. Consumption, furthermore, was not influenced by means of their mood state, stage of starvation, or even their liking of the meals3. This means that even for meals the ADHD crew didn’t like, they tended to consume more of it just because it used to be there.
- Studies additionally display that individuals with ADHD have a tendency to have disruptive eating habits.4 In one study, youngsters with ADHD skipped meals more frequently than did youngsters within the keep an eye on team, ate fewer fruits and vegetables, and drank more sweetened beverages.3
ADHD and Obesity
These factors may explain why research have found a high prevalence of ADHD in obese populations.5 In a find out about of 215 bariatric patients, 27% of them had ADD, and the prevalence was very best in sufferers with extreme obesity (43%).6 The similar learn about additionally found that in any respect ranges, patients with ADHD were much less successful at dropping pounds than their non-ADHD friends. The researchers concluded that, in treatment for weight problems and ADHD, outcomes were more closely tied to ADHD signs than to level of weight problems.
While it is frequently assumed that people with predominantly hyperactive sort ADHD are all the time “at the move” and thus probably not to expand weight problems or eating problems, this is not the case. One learn about that tested about 100 male patients with ADHD-hyperactive type found that they have been significantly extra obese in comparison to a reference population.7
ADHD and Eating Disorders
Research on eating disorders and ADHD has basically concerned with bulimia nervosa and BED. Studies have found that bulimia is more common in adolescent girls with ADHD than it is of their non-ADHD peers10, and that women with ADHD are 3.6 times more likely to have bulimia nervosa or BED in comparison to their peers.11 In a learn about of sufferers being handled for bulimia, 1 / 4 of topics had ADHD.12
Few studies have excited by men with eating disorders, however in my clinical practice, the place I specialize within the treatment of boys and men with eating disorders, I’ve treated many men with bulimia and binge eating disorder with comorbid ADHD.
ADHD Risk Factors for Eating Disorders
How can having ADHD predispose someone to expand an eating disorder?
Biological and Genetic Factors
- Reward deficiency syndrome. The ADHD mind produces inadequate dopamine, a neurochemical implicated in praise, which may reason individuals to hunt pride via food.
- GABA deficit. ADHD brains have lower levels of GABA, a neurochemical implicated in inhibition.
- Purging can be a euphoric, almost addictive type of stimulation that increases dopamine ranges.
- Restrictive behaviors can building up praise sensitivity – people might purposely prohibit food in order that once they do eat, it's much more rewarding to them.
- Dopamine receptors may overlap with obesity, binge eating, and ADHD.
- ADHD brains take longer to absorb glucose than non-ADHD brains, which could result in higher sugar and easy carb consumption.
- Executive function deficits can impact all facets of eating and getting ready meals. Individuals with ADHD, like the ones with eating disorders, have deficient interoceptive awareness, which affects the ability to grasp hunger and satiety cues. Planning and decision-making round meals may also be tough, which can contribute to impulsive eating and even restriction to steer clear of the manager process of making ready food.
- Poor impulse regulate can lead to overeating
- Poor sleep habits can dysregulate metabolism
- Irregular eating schedule may end up in overeating
- Poor self-regulators make it obscure the volume of meals eaten
Emotional Factors and Self-Esteem
ADHD and Eating Disorders: Treatment
Guiding Principles for Clinicians
- Treat both ADHD and the eating disorder in combination and don’t bargain the relevance of ADHD signs in driving the eating disorder. ADHD has to be treated with the intention to free up effective ED treatment.
- Understand the affected person’s ADHD-ED link, or how the affected person’s ADHD signs impact and are impacted via the eating disorder.
- Destigmatize ADHD, particularly for women and ladies, as many remain undiagnosed.
- Destigmatize eating disorders, particularly for boys and males.
Treatment for an eating dysfunction is multimodal, steadily involving a staff of psychiatrists, psychologists, nutritionists, and family therapists. While relatively few people with eating disorders seek treatment, patients who do search treatment must know that restoration is conceivable. For patients with ADHD, approaches should be tailored to symptoms and should suit their strengths:
- Executive function abilities coaching can cope with the cognitive components that contribute to ED
- Cognitive behavioral therapy (CBT) can assist undo negative concept patterns and build vanity in addition to sure body image
- Dialectical behavior treatment (DBT), which makes a speciality of mindfulness, emotional legislation talents, interpersonal effectiveness skills, and distress tolerance is very helpful for patients with ADHD and eating dysfunction
- Acceptance and Commitment Therapy (ACT) seems to be at a affected person’s worth device and is helping line up suitable behaviors to it
- Nutritional remedy is very important for patients with eating disorders
- Group therapy
- Parent training
Stimulant treatment is helping control eating in patients with ADHD and an eating dysfunction.
- Vyvanse is the primary FDA-approved medicine for BED, and is only the second medicine accredited for ED
- SSRIs are FDA-approved drugs for bulimia nervosa
- Stimulant medicine can help sufferers with ADHD and bulimia, consistent with analysis13
- There are not any permitted medicines for anorexia (partly on account of the trouble for the starved frame to metabolize anything)
Eating Disorders: Next Steps
The content material for this text used to be derived from the ADDitude Expert Webinar Diagnosing and Treating Eating Disorders in Children and Adults with ADHD [podcast episode #358] with Roberto Olivardia, Ph.D., which was once broadcast survive June 8, 2021.
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1 Wade, T. D., Keski-Rahkonen A., & Hudson J. (2011).Epidemiology of eating disorders. In M. Tsuang and M. Tohen (Eds.), Textbook inPsychiatric Epidemiology (third ed.) (pp. 343-360). New York: Wiley.
2 Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724–731. doi:10.1001/archgenpsychiatry.2011.74
3 Hartmann, A. S., Rief, W., & Hilbert, A. (2012). Laboratory snack meals consumption, damaging temper, and impulsivity in youth with ADHD signs and episodes of loss of keep watch over eating. Where is the lacking hyperlink?. Appetite, 58(2), 672–678. https://doi.org/10.1016/j.appet.2012.01.006
4 Ptacek, R., Kuzelova, H., Stefano, G. B., Raboch, J., Sadkova, T., Goetz, M., & Kream, R. M. (2014). Disruptive patterns of eating behaviors and related life in males with ADHD. Medical science observe : world scientific journal of experimental and clinical research, 20, 608–613. https://doi.org/10.12659/MSM.890495
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6 Altfas J. R. (2002). Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment. BMC psychiatry, 2, 9. https://doi.org/10.1186/1471-244x-2-9
7 Holtkamp, Ok., Konrad, Ok., Müller, B., Heussen, N., Herpertz, S., Herpertz-Dahlmann, B., & Hebebrand, J. (2004). Overweight and obesity in children with Attention-Deficit/Hyperactivity Disorder. International magazine of obesity and related metabolic disorders : magazine of the International Association for the Study of Obesity, 28(5), 685–689. https://doi.org/10.1038/sj.ijo.0802623
8 Nazar, B. P., Bernardes, C., Peachey, G., Sergeant, J., Mattos, P., & Treasure, J. (2016). The possibility of eating disorders comorbid with attention-deficit/hyperactivity dysfunction: A systematic overview and meta-analysis. The International magazine of eating disorders, 49(12), 1045–1057. https://doi.org/10.1002/eat.22643
9 Curtin, C. , Pagoto, S. and Mick, E. (2013) The affiliation between ADHD and eating disorders/pathology in youth: A scientific evaluation. Open Journal of Epidemiology, 3, 193-202. doi: 10.4236/ojepi.2013.34028.
10 Mikami, A. Y., Hinshaw, S. P., Patterson, Okay. A., & Lee, J. C. (2008). Eating pathology among adolescent ladies with attention-deficit/hyperactivity disorder. Journal of strange psychology, 117(1), 225–235. https://doi.org/10.1037/0021-843X.117.1.225
11 Biederman, J., Ball, S. W., Monuteaux, M. C., Surman, C. B., Johnson, J. L., & Zeitlin, S. (2007). Are women with ADHD in danger for eating disorders? Results from a managed, five-year prospective learn about. Journal of developmental and behavioral pediatrics : JDBP, 28(4), 302–307. https://doi.org/10.1097/DBP.0b013e3180327917
12 Seitz, J., Kahraman-Lanzerath, B., Legenbauer, T., Sarrar, L., Herpertz, S., Salbach-Andrae, H., Konrad, K., & Herpertz-Dahlmann, B. (2013). The position of impulsivity, inattention and comorbid ADHD in sufferers with bulimia nervosa. PloS one, 8(5), e63891. https://doi.org/10.1371/journal.pone.0063891
13 Guerdjikova, A. I., & McElroy, S. L. (2013). Adjunctive Methylphenidate within the Treatment of Bulimia Nervosa Co-occurring with Bipolar Disorder and Substance Dependence. Innovations in clinical neuroscience, 10(2), 30–33.