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Categories: 2012, June
by Roberto Olivardia,
Mike (not his
real name) is a twenty-seven-year-old single male with a thirteen-year history of
binge eating disorder. He would eat two gallons of ice cream, a large
pizza, a dozen donuts, and two hamburgers two to three times per week
until he was sick. He could not stop. He has been to various therapists over the
years, some who were eating disorder specialists, and no therapy or
antidepressant seemed to help. All the while, his weight was dangerously
increasing by the year and his self-esteem was plummeting to nothing.
His last therapist said he was "treatment resistant" and probably did
not want to get better.
When I first met Mike, I saw a man
who desperately wanted to be free of this eating disorder. Upon further
inquiry, I discovered some important details about Mike and his
treatment history. He reported that he could not get himself to the
appointments on time. He would often sleep through them. He had every
intention of filling out a food log, but would lose it or simply forget
to do it. "I always say I will follow through, but I just can’t."
He often skipped meals because he would be working through lunch, unable
to get out of his hyperfocus. Then he was hit with hunger at dinner and
ended up "pigging out." After much assessment, history
taking, and a
comprehensive clinical interview, it was absolutely clear that Mike had
undiagnosed ADHD. It was when we applied this lens to his eating
disorder that Mike made progress for the first time in his thirteen-year
battle with food. He is now of normal weight and working day by day at
managing his food intake.
THERE IS A GROWING SCIENTIFIC
LITERATURE REGARDING ADHD and eating disorders, weight,
and obesity. Eating disorders come in many forms. Anorexia
nervosa is a disorder characterized by starvation and a fear of
fatness. Bulimia nervosa is characterized by binge eating
episodes (eating a larger than average amount of food in a short period
of time to a point of being uncomfortably full). This binge is then
compensated for by a method of purging, including self-induced vomiting,
excessively exercising, fasting, laxative use, or use of diuretics and
diet pills. Binge eating disorder is the binge eating without the
purging. However, there are many people who might not fit the above
criteria for a clinical eating disorder yet struggle with food. In
addition, there is an epidemic of obesity in the United
studies have begun to see an association between ADHD and eating
problems. A study in 2005 assessed morbidly obese teenage boys and girls
at an obesity clinic and found that fifty-eight percent had ADHD, which
is significantly higher than what you would see in the general
population. What was striking was that sixty percent of the adolescents
were undiagnosed prior to the study. A study of obese patients who were
getting gastric bypass surgery found that almost one-third had
inattentive ADD. For those patients who had a body mass index over 40
(morbidly obese), the rate of ADD was almost half. A recent study found
that girls with ADHD are at high risk for bulimia nervosa compared to
their non-ADHD peers. A 2004 study of ADHD patients found that ten
percent of subjects had an eating disorder sometime in their life, which
is higher than what we would expect in the general
ADHD as a predisposing factor
How can ADHD predispose someone to
develop an eating disorder or become obese?
People with ADHD
have difficulty with the executive function of organization. Eating
healthy requires a high degree of organization. If you plan on cooking a
meal for dinner, you need to start thinking about it hours before.
Perhaps you need to defrost the meat. You may need to run to the market
to get ingredients you don’t have at home. Or, you might have to
pick up your child from soccer practice and make sure that the meal is
made before you go. People with ADHD often think about meals at the time
they are due to eat. This leads to relying on fast foods, microwaveable
meals, or takeout food, most of which are high in sodium, sugar, and
is also a challenge for those with ADHD. In order to eat healthy, you
need to be attentive to physical cues of hunger and fullness. Many with
ADHD skip meals if they are hyperfocused on a task. Once a meal is
skipped, metabolism decreases and cravings for fat, carbohydrates, and
sugar increase. Many with ADHD report not getting enough sleep because
it is too hard to shut their minds off at night. When we are sleep
deprived, a hormone in our body called leptin decreases, which then
results in storage of body fat, as well as cravings for fat. It is
harder to lose weight if you are not sleeping properly.
It is common for
people with ADHD to eat while doing another activity, like watching
television. This can lead to overeating, since one’s ability to be
mindful is compromised. Many report feeling grounded and focused by the
sensory aspects (smell, taste, texture, touch, visual) of eating.
Eating can be a
means of quelling the stress, anger, and/or sadness that can arise from
the challenges of having ADHD. The most common emotion I hear my
patients with ADHD reporting that trigger their binge eating is boredom.
When they feel little stimulation, they gravitate to food as the
surefire, accessible form of stimulation. After all, food is always
available, is legal, and is sensory stimulating. Eating can also be a
relief from racing thoughts and distractibility. College students with
ADHD might binge before writing a paper as a way to help them focus.
Patients who self-induce vomiting report a euphoric stimulation that
comes along with purging. They report an intense ability to focus
immediately after vomiting. The problem, of course, is that bulimia is
associated with several serious health problems, notably cardiac
problems that can lead to death.
ADHD brains tend
to have low levels of dopamine, a neurotransmitter that is involved in
reward systems and thrill-seeking behavior. When there are low levels of
dopamine in the brain, people tend to seek out activities that will
elevate these levels and produce a reward. Eating is one such
Treating both disorders
are many factors that make people with ADHD at risk for eating disorders
or obesity, the encouraging news is that these issues can be treated,
provided that the relationship between the ADHD and the eating disorder
is fully understood.
Clinicians too quickly dismiss ADHD as an important factor in this
problem and it comes at a cost. A therapist with knowledge in both areas
is essential. If you cannot find a therapist who specializes in both,
find a therapist who specializes in eating disorders and add an ADHD
therapist or coach to your treatment so that the two professionals can
work in conjunction in wholly treating the eating problem. Eating
disorders are serious and need to be carefully treated and monitored as
they can lead to serious medical consequences. Traditional modes of
treatment might need to be creatively adjusted in order to work with the
Develop an ADHD-friendly list of alternative forms of stimulation.
Meditation might work for some people to reduce stress, but some with
ADHD would find it impossible to quiet their minds that much.
Don’t waste your time on strategies that you intuitively know
won’t work for your ADHD. It can feel defeating for people with
ADHD to hear that something "should" work since it works for the
majority of people. It comes down to whether it works for you. Time
management strategies and scheduling your meals out is essential. Sleep
more. Not only will your body like it, but sleeping will mean that you
are not up late at night eating.
is the most important meal of the day. Start your day with protein.
Impulse control tips are important. Something simple like putting your
fork down while you are chewing can go a long way. Using small plates so
that you put less food on the plate is also helpful. Those with ADHD
respond well to external cues.
with ADHD and bulimia nervosa or binge eating disorder, stimulant
medication can be incredibly helpful in managing their eating disorder,
mainly because it is managing the ADHD symptoms that can give rise to
the eating disorder.
if you struggle with an eating disorder, know that you are not alone.
This is especially true for males. Contrary to popular belief, eating
disorders affect millions of males as well.
Both eating disorders and ADHD can negatively affect one’s
self-esteem. People who have either an eating disorder or ADHD struggle
with feelings of shame, ineffectiveness, and being perceived by others
as being lazy or lacking "willpower." These negative feelings are
exponentially increased when people struggle with both ADHD
and an eating disorder.
Treatment does work and can free people of the painful experience of an
eating disorder. It is important, however, to have the right lens
through which you are seeing the problem and therefore using the most
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