February 1-7th is Eating Disorder Awareness Week in Canada. I work with many individuals who have co-morbid eating disorders and Attention Deficit Hyperactivity Disorder (ADHD), as these two disorders are often comorbid in a variety of formats. Even if someone does not meet eating disorder criteria, folks with ADHD do have an increased risk of disordered eating patterns. The reasons why disordered eating patterns and ADHD are commonly experienced in the same individual are vast, and this blog post will hopefully clarify some of those reasons.
ADHD Brain Development
When the ADHD brain develops, the pathways that are responsible for delivering the neurotransmitters norepinephrine and dopamine do not develop properly and as a result, these pathways do not function very well in people with ADHD. These essential neurotransmitters play a vital role in the regulation of arousal, attention, cognitive function, stress reactions and rewards. The lack of these neurotransmitters in folks with ADHD results in deficits in executive functioning skills including (but not limited to): planning ahead, making decisions, organizational skills, paying attention to details, and motivating oneself. These executive functioning deficits impact the development and course of disordered eating patterns and other co-morbid disorders, as these are necessary skills to have in order to nourish one’s body appropriately.
The deficit in executive functioning that impacts individuals with ADHD’s ability to make decisions and plan ahead results in cognitive impulsivity. What this means is that rather than contemplate all the choices available to them, individuals with ADHD may pick the first option or the easiest and quickest option, which may not be the most appropriate choice. Nourishing your body requires a lot of choices and planning: you have to plan your meals, grocery shop, and make your meals. All which are steps that ADHD individuals will struggle with because of the deficits on executive functioning skills including planning, decision making and organizational skills. This can lead to disordered eating and exacerbate eating disorder symptoms, as individuals with ADHD may not have the ability to execute all the planning and decision making that comes with making meals and nourishing their body appropriately.
Individuals with ADHD have a hard time motivating themselves to do things that are not immediately rewarding, because of the lack of dopamine in the brain. This can also impact their ability to nourish their bodies appropriately as feeding yourself takes a lot of planning and is not immediately rewarding until you eat. You have to plan your food, go get the groceries, then make it: all which take time. This may discourage people from eating appropriately, as they may put off eating all day until it is urgent. This may result in individuals eating very quickly which reduces their ability to pay attention to hunger signals and may result in overeating or binging. In addition, not eating regularly often reduces the ability for individuals to control how much they are eating and their food choices, as their body may experience cravings for higher calorie dense foods quickly as it thinks it is starving.
The deficit of dopamine in the ADHD brain may result in individuals engaging in “dopamine chasing”: engaging in highly dopamine releasing activities such as eating, riding roller coasters and driving too fast. For the majority of people, when they eat food, dopamine is released and they experience pleasure. Food is easily accessible and something that we know gives us comfort, so it is often a coping tool that folks with ADHD will turn to. This can lead to over eating and binge eating, as it feels good to eat and sometimes, we don’t want to stop! We have all had the experience of eating an extra slice of pizza when we know we are too full, for individuals with ADHD stopping this pleasurable activity can be even harder. In addition because individuals with ADHD often will eat very quickly, they may not pay attention to their hunger signals as much and this could lead to binging and overeating.
Self-esteem can have big impacts on the development and course of eating disorders, even without those with ADHD. ADHD children are told 20,000 more negative messages about themselves by the time they are 8 years old compared to non-ADHD children. These negative messages get compacted over their lifetime and impact the development of their self-esteem. As a result, individuals with ADHD are more likely than non-ADHD individuals to have low self-esteem. Self esteem may contribute to disordered eating patterns and the development of eating disorders, as individuals may try to control their weight to increase their self esteem and fit-in, or they may over eat or binge eat to try to cope with the negative feelings and experiences they have.
ADHD medication side effects
Some ADHD medications are stimulant medications and one of the side effects of stimulant medications people often experience is a reduction in appetite or hunger signals. Individuals with ADHD may not feel hunger cues and forget to eat, which leads to disordered eating patterns. This can lead to binge eating in particular, because if an individual hasn’t eaten all day and then their meds wear off, suddenly they may find that they have difficulty controlling how much they eat and their food choices.
Eating Disorder Impact on ADHD Symptoms
Similarly to how having ADHD can impact the development and course of Eating Disorders and disordered eating habits, eating disorders can negatively influence the symptoms of ADHD. When the body is not receiving adequate nutrition the ability to focus, regulate mood, plan and organize are all impacted. Individuals who do not eat regularly, who engage in restriction, or purging and who have ADHD may find that when their eating disorder behaviors are active that their ADHD symptoms also increase in intensity. ADHD comes with strong emotional reactions, and not having adequate nutrition can really impact this area of ADHD. If you have ever been hangry, perhaps you can relate to this connection.
Managing Co-Morbid ADHD & Eating Disorders
Seeing a licensed professional to help you work through your symptoms and implement strategies for managing ADHD and Eating Disorders can be a very step forward in helping individuals manage these often co-occurring disorders. I recommend a multi-disciplinary approach to working with eating disorders and ADHD, as there are many areas of specialization that individuals could benefit from having professional expertise. Team members may include a registered psychologist who is familiar working with ADHD and eating disorders, your medical doctor or GP, dieticians, and registered nurses. If you are interested in learning more about developing your personal team to help you on your mental health journey, feel free to reach out by booking an appointment or contacting me.