ADHD & Eating Disorders: Is There a Link?

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder often resulting in difficulty concentrating and paying attention. This condition can present as predominantly inattentive, predominantly hyperactive/impulsive, or combined ADHD. Symptoms of ADHD typically depend on the type experienced. Some may struggle with impulsive behaviors, while others may appear disorganized, distracted, or preoccupied with their thoughts.

ADHD can fluctuate throughout life, with symptoms being more apparent in childhood and less intrusive in adulthood. However, the intensity and severity of symptoms vary dramatically from person to person.

Common symptoms of ADHD include:

• Struggling to stay on task
• Difficulties paying attention to details
• Forgetfulness
• Distractibility
• Impulsivity
• Restlessness

What Are Eating Disorders?

Eating disorders are mental health conditions that refer to chronic disordered eating patterns. As with ADHD, symptoms of an eating disorder vary based on the specific type of eating disorder and individual. Regardless, common symptoms of eating disorders include distorted body image, unhealthy dieting, body checking, self-loathing, and preoccupation with perfectionism and control are typical experiences.

Common signs and symptoms of an eating disorder include:

• Rapid weight loss or gain
• Patterns of restrictive eating
• Fatigue
• Irritability
• Purging behavior (including vomiting, excessive exercise, or laxative abuse)
• Gastrointestinal distress
• Low self-esteem
• Fears of losing control while eating
• Intense fear of gaining weight

ADHD & Eating Disorders: Understanding the Link

Research and clinical evidence show a high co-occurrence between ADHD and various eating disorders. ADHD executive dysfunction can increase the risk of developing anorexia nervosa, and hyperfixation can trigger ARFID. ADHD impulsivity and dopamine deficiency can make someone vulnerable to developing binge eating. Additionally, ADHD can cause low self-esteem, which can trigger poor body image and eating disorders.³

Below are nine 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 ways that disregard consequences, and even people with high insight into their mental health conditions can engage in such behavior.

For example, someone with ADHD may display impulsivity by indulging in sugary food to experience temporary pleasure. In these cases, the individual overlooks the possible ramifications of overeating (i.e., stomach aches or gastrointestinal distress) for monetary satisfaction.

2. Low Dopamine Levels

Research shows 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. Individuals with eating disorders and ADHD are dopamine deficient. Therefore, they may be more prone to patterns of overeating and binge eating because it triggers the brain to release dopamine and thereby balances out their deficiency. 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, someone may believe they are a failure because something about them isn’t “perfect.” People with comorbid eating disorders and ADHD often struggle with perfectionism and distorted thinking patterns, subsequently having trouble with flexibility and moderation in daily life.

Those with food rules may believe eating something they deem “bad” ruins their day and overall success. Because of this, some individuals with ADHD and eating disorders may form restrictive habits with food, leading to disordered perceptions of nutrition and body image.

4. Hyperfixation

Hyperfixation is a common feature of ADHD. Hyperfixation can manifest as eating specific or limited meals, maintaining a predictable meal-time routine, or experiencing sensory discomfort around various foods. Such behavior is prevalent in conditions like avoidant restrictive food intake disorder (ARFID).

5. Executive Dysfunction

Executive functions are essential for managing daily life. However, people with ADHD often experience executive dysfunction, contributing to ADHD-induced forgetfulness and ADHD paralysis. In turn, many may engage in disordered eating habits because they struggle with decision-making or forget to eat when hungry.

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, and the individual may believe something is fundamentally wrong with them or they are inferior to others. Unfortunately, low self-esteem can reinforce and exacerbate ADHD and eating disorder symptoms.

7. Sensory Processing Difficulties

Individuals with ADHD often experience sensory overload, which can cause struggles with interpreting bodily sensations, including taste, touch, vision, and hearing. Challenges associated with taste or certain food textures can contribute to eating disorders, including ARFID, anorexia, and pica. Some may avoid eating to limit ADHD-induced overstimulation, while others may crave inedible items due to nutritional deficiencies.

8. Food Sensitivities

People with ADHD may experience adverse reactions to specific foods. After they eat these foods, they may notice their ADHD symptoms temporarily worsen. These foods may include dairy products, artificial colors and flavors, soy, eggs, gluten, and nuts. However, restrictive “ADHD-friendly diets” can also coincide with eating disorders, as individuals learn to associate specific food groups with negative feelings and experiences.

9. Inconsistent Schedules

People with ADHD sometimes find adhering to a consistent schedule difficult due to time blindness. They may struggle to set appropriate meal times, leading to abnormal eating habits. Additionally, stimulants can suppress appetite, meaning someone with ADHD may not eat much during the day, only to binge when their medication wears off. These behaviors can create a restrict-binge cycle that perpetuates eating disorder symptoms.

Common Eating Disorders in ADHD

ADHD and eating disorders have a bidirectional relationship, and people with ADHD are at a heightened risk of disordered eating habits. Eating disorders that commonly co-occur with ADHD include binge eating disorder, anorexia nervoa, bulimia nervosa, and ARFID. While one condition may not cause the other, both can exacerbate symptoms of each other.

ADHD & Binge-Eating Disorder

Research shows a correlation between ADHD and binge eating a significant amount of food in a short amount of time. People who binge often feel out of control with food, and they tend to exhibit shame and discomfort around their eating habits.⁴ Over time, frequent binge episodes can contribute to binge-eating disorder that requires professional treatment.

ADHD & Anorexia Nervosa

Anorexia nervosa refers to persistent patterns of restrictive eating behavior, distorted body image, and tremendous fears of gaining weight. Preliminary evidence links ADHD to anorexia, specifically with the binge-purge subtype. Those with ADHD may restrict food intake but eat large amounts of food before purging by vomiting or using other compensatory methods.

ADHD & Bulimia Nervosa

One of the strongest correlations seems to occur in those with ADHD and binge eating-related symptoms associated with bulimia nervosa. One Swedish study found that 35-37% of participants with bulimia and anorexia binge eating/purging subtype also experienced symptoms of ADHD.

ADHD & ARFID

Avoidant restrictive food intake disorder (ARFID) is a condition that consists of restricting food intake due to fears of choking, disinterest in food, or food sensitivities. Those with ADHD may be distracted when eating, sometimes leading to choking and fears associated with ARFID. Other times, hypersensitivity to food textures can result in avoiding entire food groups, solid foods, or eating in general.

Risk Factors for Eating Disorders & ADHD

ADHD and eating disorders do not share a single cause. Instead, researchers often examine a combination of biological and environmental factors. Several risk factors may increase the likelihood of developing both ADHD and an eating disorder, including genetics, trauma, and environmental toxins.

Risk factors for ADHD and eating disorders include:

• Family history of either condition: Research shows that ADHD is genetic and eating disorders are hereditary. People with first-degree relatives with ADHD or eating disorders are more likely to develop the condition themselves.
• Childhood trauma: Trauma impacts brain regions associated with impulsivity and inattention. Experiencing early stressful events like childhood trauma may increase the 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 evidence suggests 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.

Treatment for Co-Occurring ADHD & Eating Disorders

You do not need to hit rock bottom or have a designated number of symptoms to seek help. Receiving comprehensive treatment for both ADHD and eating disorders is crucial for the best outcomes. Only focusing on one condition at a time may cause the other to worsen. A multifaceted approach of therapy, lifestyle changes, and sometimes medication is best when addressing both ADHD and eating disorders.

Therapy for ADHD & Eating Disorders

Talk therapy can be invaluable when treating comorbid ADHD and eating disorders. Therapists typically focus on helping clients reduce impulsivity, increase self-esteem, and improve the use of healthy coping skills for their ADHD and coping skills for their eating disorder. Finding a neurodiversity-affirming therapist is the first step toward making necessary changes. Recovery is not 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 and eating disorders focuses on identifying maladaptive thinking patterns and replacing them with more realistic thoughts. Clients also learn to replace inappropriate behaviors with healthier alternatives.
• Enhanced cognitive behavioral therapy (CBT-E): CBT-E is a multifaceted approach that blends psychoeducation with various cognitive strategies. Clients focus on understanding and disrupting the self-reinforcing cycles of their eating disorder.
• Dialectical behavior therapy (DBT): DBT for eating disorders and ADHD helps people understand their intense emotions and practice healthier emotional regulation skills. This approach can also support impulse control and mindfulness.
• Group therapy: Peer support can be beneficial for people with eating disorders and comorbid conditions like ADHD. Connecting with like-minded individuals can keep them motivated in recovery. Group therapy for eating disorders and ADHD is available both online and in person.
• Acceptance and commitment therapy (ACT): ACT integrates behavioral strategies and mindfulness to help clients learn to embrace their challenges appropriately.

Medication for Eating Disorders & ADHD

Medications for ADHD and/or medications for eating disorders can be beneficial for individuals with both conditions. Research suggests some of these prescriptions can also help with impulsivity, thus reducing bulimic and binge-eating tendencies. Sometimes, a provider may recommend medications for depression, as some are FDA-approved for treating certain eating disorders.

Medications for comorbid ADHD and eating disorders may include:

• Vyvanse: Vyvanse (lisdexamfetamine) is a stimulant that helps increase attention and decrease hyperactivity in people with ADHD. Vyvance may also help with anorexia and act as a medication for binge eating disorder.
• Prozac: Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) that may help improve symptoms of ADHD, anorexia, bulimia, and binge eating disorder.
• Topamax: Topamax (topiramate) is a tricyclic antidepressant that can be an off-label treatment for ADHD. Similarly, prescribers may recommend Topamax for bulimia or binge eating disorder.
• Xanax: In some cases, medical providers may prescribe Xanax (alprazolam) for eating disorders and ADHD if anxiety symptoms are predominant.
• Adderall: Adderall (amphetamine-dextroamphetamine) is a first-line treatment for ADHD. In rare cases, this medication can help with co-occurring eating disorders.

How to Cope With ADHD & Eating Disorders

Along with professional treatment, implementing lifestyle changes and healthy coping mechanisms can help alleviate some symptoms of ADHD and eating disorders. Practicing emotional self-care is also a positive step when coping with difficulties.

Here are seven tips for how to cope with ADHD and eating disorders:

1. Practice mindfulness: Mindfulness entails focusing on the present moment. Embracing this mindset can help you feel calmer and more empowered over your emotions.
2. Join a support group: Having peer support helps you stay accountable to your goals and connect with others experiencing similar challenges. Support groups are available online and in person.
3. Start journaling: Journaling can boost your mental health because it is a great, creative way to express your feelings and release tension when you feel overwhelmed.
4. Spend time with loved ones: Building your support system is paramount for your emotional well-being. Your loved ones can offer guidance and warmth as you navigate dual diagnoses.
5. Try a new hobby: Exploring a new hobby can help you achieve a state of flow, inspire creativity, and boost mindfulness. Positive activities can also be welcome distractions when managing stressful symptoms.
6. Practice gratitude: Spend time practicing gratitude by appreciating the positive things and people in your life, especially when facing challenges. Looking at the bright side may help relieve some stress and overwhelm.
7. Use positive affirmations: Positive affirmations can help you overcome self-criticism and practice more compassion toward yourself.