There does appear to be a connection between ADHD and eating disorders. While one condition does not inherently cause the other, growing evidence shows the relationship between these two include restrictive tendencies, binge eating, and compensatory behaviors. Evidence also suggests that being overweight, having bulimia, or engaging in binge-eating behaviors are common for those with ADHD.1
What Is Attention-Deficit/Hyperactivity Disorder (ADHD)?
ADHD is a neurodevelopmental disorder typically diagnosed in childhood. People with ADHD often have difficulty concentrating and paying attention. This condition can present in three different ways. Someone with a predominantly inattentive presentation struggles to stay on task, pay attention to details, and follow instructions. They tend to be forgetful and distractible. On the other hand, those with a predominantly hyperactive presentation typically act impulsively and restlessly. They often interrupt others and struggle with waiting or taking their turn. Others experience a combined presentation of ADHD, displaying symptoms from both types.2
ADHD symptoms can fluctuate throughout someone’s life. They may be more apparent in childhood and less intrusive during adulthood. However, the intensity and severity of symptoms vary dramatically from person to person.
Common symptoms of ADHD include:
- Difficulty paying attention
- Inability to sit still
- Speaking at inappropriate times
- Constant fidgeting and moving
- Frequent and intense forgetfulness
What Are Eating Disorders?
Eating disorders are mental health conditions that refer to disturbed and chronic eating patterns. The symptoms of an eating disorder vary based on the specific type and the individual, but chronic dieting, body checking, low self-esteem, self-loathing, and preoccupation with perfectionism and control are typical. Binge eating disorder, anorexia, and bulimia are most commonly associated with ADHD.
Common symptoms of an eating disorder include:
- Patterns of binge eating
- Purging behavior (including vomiting, excessive exercise, or laxative abuse)
- Severe dehydration
- Dental problems
Binge eating disorder:
- Patterns of binge eating
- Fears of losing control while eating
- Feelings of guilt or shame about eating habits
- Gastrointestinal distress
- Rapid weight gain
- Patterns of restrictive eating or fasting
- Brittle hair and nails
- Abnormally low body weight
- Intense fear of gaining weight
6 Links Between ADHD & Eating Disorders
There is a common clinical co-occurrence between ADHD and various eating disorders. However, the strongest correlation seems to occur in those with ADHD and binge eating-related symptoms (associated with bulimia or binge-eating disorder). One Swedish study found that 35-37% of participants with bulimia and anorexia binge eating/purging subtype also experienced symptoms of ADHD. Furthermore, other research speculates specific genetic associations may contribute to both conditions.3
Below are six connections between ADHD and eating disorders:
1. Poor Impulse Control
Impulsivity is a core feature of both ADHD and eating disorders. Impulsivity refers to acting in a way that disregards behavioral consequences. Even people with high insight into their mental health conditions can still engage in impulsive behavior. For example, someone with ADHD may realize how poor money management affects their well-being, but they still impulsively buy a new jacket. In that same vein, they may overeat sugary food, because doing so temporarily makes them experience pleasure.
2. Neurotransmitter Disturbances
Research shows that both ADHD and eating disorders may coincide with brain reward dysfunction, especially within the dopamine system.4 Dopamine is a brain chemical closely linked to pleasure, reward, and motivation. Eating is pleasurable, and patterns of overeating and binge eating highly-palatable foods trigger the brain to release dopamine. Over time, this behavior becomes reinforced.5
3. All-or-Nothing Thinking
All-or-nothing thinking is a cognitive distortion that refers to perceiving situations in extremes. For instance, if something isn’t “perfect,” they are a “failure.” Or, if they can’t do all of something in one day, they may as well do none of it. People with comorbid ADHD and eating disorders often struggle with this distorted thinking pattern. Subsequently, they may have trouble practicing flexibility and moderation in everyday life. Someone with food rules may believe that if they eat something they deem “bad,” then their entire day is destroyed.
ADHD hyperfixation occurs when one entirely immerses themselves into a specific interest, hobby, or activity. Occasional hyperfixation isn’t inherently bad (as it can motivate you to get things done). However, it can become problematic if the pattern interferes with other areas of functioning or causes psychological distress. Hyperfixation can also be a feature of eating disorder behaviors, especially in anorexia, ARFID (avoidant restrictive food intake disorder), and orthorexia (severe hyperfixation on healthy eating). For example, someone might only eat certain food groups or obsess about certain numbers regarding weight, macronutrients, or calories.
5. Executive Dysfunction
Executive dysfunction is difficulty carrying out important tasks and relating interpersonally to others. Someone with executive dysfunction often struggles with critical thinking and acting in prosocial ways. For example, those with ADHD may struggle with sustained attention, organization, and goal-directed behavior. Likewise, someone with an eating disorder may also display these symptoms–along with poor emotional control and reduced cognitive flexibility.
6. Low Self-Esteem
People with ADHD and eating disorders often struggle with immense shame, guilt, and loneliness. These feelings can contribute to low self-esteem. The individual may believe something is fundamentally wrong with them, or that they’re inferior to others. Unfortunately, low self-esteem can reinforce and exacerbate ADHD and eating disorder symptoms.
Risk Factors for Eating Disorders & ADHD
There is no single cause for any mental illness, including eating disorders and ADHD. Instead, researchers often examine clusters of certain biological and environmental factors. Several risk factors may increase someone’s likelihood of developing either or both conditions. However, it is unclear if the presence of more risk factors makes this likelihood more significant.
Risk factors for ADHD and eating disorders include:
- Family history of either condition: Research shows that people with first-degree relatives of any mental illness are more likely to also have that mental illness.
- Childhood trauma: Trauma impacts brain regions associated with impulsivity and inattention. Experiencing early stressful life events such as childhood trauma may increase one’s likelihood of developing ADHD and eating disorders.
- Brain injury: Some research shows links between traumatic brain injuries and ADHD and eating disorder symptoms.
- Environmental toxins: Although studies are limited, some research suggests that exposure to environmental toxins may increase the likelihood of developing a mental illness.
- Brain differences: ADHD is considered a neurodivergent condition, meaning people with ADHD process and use information differently (not better or worse) than neurotypical people. Brain differences may also be a contributing factor to eating disorder prevalence.
How Are Comorbid Eating Disorders & ADHD Treated?
If you are struggling with your mental health, reach out to a healthcare provider. You don’t need to hit a certain rock bottom or have a designated number of symptoms to seek help. It’s important to receive comprehensive treatment for both eating disorders and ADHD simultaneously.
Keep in mind that only focusing on one condition at a time may cause the other condition to worsen. That’s why it’s important to be transparent about all your mental health issues during your initial assessment. Treatment for adult ADHD should target understanding, managing, and reducing problematic symptoms, as they often reinforce one another.
Therapy for ADHD & Eating Disorders
Talk therapy can be incredibly helpful for treating comorbid ADHD and eating disorders. Therapy goals typically focus on reducing impulsivity, increasing self-esteem, and improving the use of healthy and positive coping skills.
Because there isn’t one specific best treatment method, it’s important to find a multifaceted approach that works well for you. Connecting with the right therapist is the first step toward making necessary changes. Recovery isn’t a linear process, but staying committed to treatment can help you feel much better.
Therapy options for comorbid eating disorders and ADHD include:
- Cognitive behavioral therapy (CBT): CBT for ADHD or eating disorders focuses on identifying maladaptive thinking patterns and replacing them with more realistic thoughts. You will also learn how to replace inappropriate behaviors with healthier ones.
- Enhanced cognitive behavioral therapy (CBT-E): CBT-E is a multifaceted approach that blends psychoeducation with various cognitive strategies. You will learn how to understand and disrupt self-reinforcing cycles of your eating disorder.
- Dialectical behavioral therapy (DBT): DBT helps people understand their intense emotions and practice healthier regulation skills. It can also support impulse control and mindfulness.
- Eating disorder group therapy: Peer support can be beneficial for people with eating disorders and comorbid conditions like ADHD. Connecting with like-minded individuals can keep you motivated in your recovery.
- Acceptance and commitment therapy (ACT): ACT integrates concepts of behavioral strategies and mindfulness. It can be helpful in learning how to embrace your challenges appropriately.
Medication Options for Eating Disorders & ADHD
ADHD medication can be beneficial for those with ADHD, as it works to improve focus and concentration. These medications can also restore a sense of emotional balance. Research suggests that some of these medications can help with impulsivity, thus reducing bulimic and binge eating tendencies. Sometimes, medications for depression are also prescribed, as they are FDA-approved for treating certain eating disorders.
Medications for comorbid ADHD and eating disorders include:
- Lisdexamfetamine dimesylate (Vyvanse): Vyvanse is a stimulant that helps increase attention and decrease hyperactivity in people with ADHD. It is also associated with fewer binge episodes for people with moderate or severe binge eating disorder.
- Fluoxetine (Prozac): Prozac is a selective serotonin reuptake inhibitor that may be prescribed for children with ADHD. It’s also sometimes prescribed for anorexia, bulimia, and binge eating disorder.
- Topiramate (Topamax): Topamax is not a first-line medication for ADHD, but it is sometimes prescribed as an off-label medication for ADHD symptoms. Similarly, it may be prescribed for people with bulimia or binge eating disorder.
- Alprazolam (Xanax): In some cases, if anxiety symptoms are predominant, medical providers may prescribe Xanax for eating disorders and ADHD.
- Amphetamine-dextroamphetamine (Adderall): Adderall may be prescribed for people with ADHD. In rare cases, it may be used for co-occurring eating disorders.
How to Cope with Comorbid ADHD & Eating Disorders
Along with professional treatment, it’s important to implement lifestyle changes and use healthy coping mechanisms to help alleviate some symptoms of these two disorders. Practicing emotional self-care is important. You want to reduce stress and maintain your well-being, as this will ideally reduce self-sabotaging behaviors.
Some healthy coping skills to try include:
- Practicing mindfulness: Mindfulness entails trying to stay in the present moment. Embracing this mindset can help you feel calmer and more empowered over your emotions.
- Joining a support group: Having peer support helps you stay accountable to your goals and connected to others during difficult times.
- Journaling: Journaling is a great, creative way to express your feelings and release tension when you feel overwhelmed.
- Spending time with loved ones: Building your support system is paramount for your emotional well-being.
- Trying a new hobby: Trying a new hobby can help you achieve a state of flow, which can inspire creativity and mindfulness. It can also keep you focused on a task, rather than ruminating on your symptoms.
- Practicing gratitude: It’s always beneficial to think about what you’re grateful for, especially if life feels challenging. Try to dedicate some time each day to focus on your gratitude.
- Setting boundaries: Strong boundaries support your mental health. Consider areas or relationships in your life where you need to set limits.
- Practicing positive affirmations: Affirmations can help you overcome self-criticism and practice more compassion towards yourself.
Living with ADHD and an eating disorder can be challenging. You may feel frustrated by your symptoms or prognosis. However, it is possible to get help and improve your situation. Getting the right treatment can make a tremendous difference in how you feel.