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If you have attention-deficit hyperactivity disorder (ADHD), you are at increased risk for developing an eating disorder. Surprised? “The evidence is consistent,” says Lisa Ranzenhofer, Ph.D., a clinical psychologist and research scientist at Columbia Center for Eating Disorders at Columbia University Medical Center in New York City. How much more at risk? One study that pooled the results of more than a dozen previous investigations showed that, in individuals with ADHD, the risk of an eating disorder is nearly three-fold compared to those without ADHD.
What’s more, women and girls with ADHD may be more at risk. A study from the University of Virginia found that adolescent girls with ADHD (inattention combined with hyperactivity/impulsivity) were more likely than girls with ADD (inattention only) or those with neither to develop symptoms of bulimia nervosa. The study authors believe that because ADHD goes undiagnosed in girls more frequently than in boys, depression and other problems may develop, including self-esteem issues and dissatisfaction with body image. Moreover, impulsive behaviors, which often go hand-in-hand with ADHD, can lead to binge eating and bulimia (purging oneself after eating large amounts of food).
But, “not all studies show a stronger connection in women,” says Ranzenhofer; keep in mind that men and boys with ADHD are at increased risk for eating disorders, too.
Types of Eating Disorders
What Are the Types of Eating Disorders?
“Eating disorders involve behavioral disturbances to eating that have a significant and impairing effect on health and functioning,” says Ranzenhofer. According to the National Eating Disorders Association, there are 11 different types:
Anorexia Nervosa. People with anorexia nervosa restrict their calories to the point of dangerous weight loss. They may also exercise compulsively.
Avoidant Restrictive Food Intake Disorder (ARFID). When a person avoids and restricts food, but not because of fears about weight gain or body shape. Think of ARFID as extreme picky eating that can lead to malnutrition and, in children, stunted growth.
Binge Eating Disorder. Regularly eating large quantities of food at once, often quickly and to the point of discomfort, is the classic sign of binge eating disorder.
Bulimia Nervosa. People with bulimia nervosa binge eat and then engage in compensatory behaviors including self-induced vomiting.
Compulsive Exercise. A form of obsessive compulsive disorder, or OCD, this is marked by compulsive, dangerously excessive exercise as a means to “purge” calories and/or gain psychological permission to eat.
Laxative Abuse. The abuse of laxatives to purge the body of unwanted calories (though it’s important to note that laxatives do not actually do this!)—laxative abuse can lead to severe dehydration and colon damage.
Orthorexia. This disorder is characterized by an obsession with “healthy” eating. People with orthorexia may eliminate many groups of food that they consider unhealthy or not “pure” until there is very little left that’s acceptable to them to eat.
Other Specified Feeding or Eating Disorder (OSFED). A kind of catch-all for people who don’t fit the exact clinical criteria of anorexia nervosa, binge eating disorder, or bulimia nervosa, OSFED is still a dangerous condition of disordered eating. This diagnosis includes individuals who did not meet the strict diagnostic criteria for anorexia nervosa or bulimia nervosa, but still have a significant eating disorder.
Pica. This less-common eating disorder is when a person eats non-food substances, such as hair, dirt, clay, soap, paint chips, and chalk.
Rumination Disorder. When an individual regurgitates their food and then re-chews it, swallows it again, or spits it out. This sometimes stems from a gastrointestinal abnormality in infants and children which then becomes habitual.
Unspecified Feeding or Eating Disorder (UFED). When a person exhibits disordered eating symptoms that are outside of the other diagnoses or from multiple diagnoses, they are said to have UFED.
While there is a wide range of types, “evidence of an association between ADHD and eating disorders seems to be strongest for bulimia nervosa,“ says Ranzenhofer. “For anorexia nervosa, the evidence is more mixed.”
It’s important to note, as well, that “the association between ADHD and eating disorders is not necessarily stronger than the association between eating disorders and other psychiatric disorders including mood disorders, anxiety disorders, and substance use disorders,” she says.
Types of Eating Disorders
What Are the Types of Eating Disorders?
There are many different theories, but “the explanation that likely has the most evidence behind it is the mechanism of impulsivity or impulse control,” says Ranzenhofer. “Both conditions involve difficulty inhibiting behavior.”
Patricia Quinn, M.D., director of the National Center for Girls and Women with AD/HD, agrees. “People eat for many reasons other than physiological hunger, including boredom, excitement, anger, sadness, food availability, reward, and stress relief,” she says. “Surrounded by highly desirable food, it may be difficult to say ‘no’ to the impulse to eat. It is easy to understand how ADHD might put someone at a disadvantage, since difficulties with impulse control are a central defining attribute of ADHD. Individuals with ADHD tend to be dominated by the moment, reactive, and only later, regretful of their lack of foresight.”
In her book, Pieces of a Puzzle: The Link Between Eating Disorders and ADD, Carolyn Piver Dukarm, M.D., explains that healthy eating habits require planning and organization, both areas of weakness for those with ADHD. Many people with ADHD skip meals because of being distracted or hyper focused, she says. Their hunger then becomes so intense that they overeat. Those unhealthy eating habits, in turn, can become routine.
Anorexia Nervosa and ADHD
There are several sub-types of anorexia nervosa, some of which involve purging or binge-purging behaviors. As with other types of binge-purge eating behavior, there appears to be a link between ADHD and a binge-purge form of anorexia nervosa but not between ADHD and the food-restrictive type of anorexia.
Bulimia Nervosa and ADHD
The inattentive form of ADHD is most closely associated with symptoms of bulimia. The shared executive function deficits, poor emotional regulation, and mood challenges of ADHD and bulimia help explain the association between the two disorders.
Binge Eating Disorder and ADHD
Along with bulimia nervosa, binge eating disorder is the most common eating disorder in both people with ADHD and the general population. The disorder also plays a role in the development of overweight and obesity. The disturbed eating/feeding symptoms of both binge eating disorder and ADHD are based on an inability to regulate impulsive behavior.
How Do You Treat ADHD and Eating Disorders?
As with any coexisting condition, an accurate diagnosis is the first step. When either the ADHD or the eating disorder goes undiagnosed, treatment only targets part of the problem. “A good eating disorder evaluation should include assessment of other comorbid psychiatric diagnoses, including ADHD,” says Dr. Ranzenhofer. The provider will make treatment recommendations on the basis of severity of each condition and known effective treatments.
In general, Dr. Quinn suggests a treatment plan that includes nutrition education, cognitive behavior therapy, ADHD medications, and nutritional supplements. Some experts believe that including an antidepressant medication is helpful if there is underlying depression. Your doctor may also talk to you about the drug Vyvanse (lisdexamfetamine dimesylate), which is FDA-approved for the treatment of both ADHD and binge-eating disorder.
Bottom line: There’s help available, so if you feel like you or a loved one may be experiencing disordered eating, schedule a visit to your primary care provider, or reach out to the National Eating Disorders Association helpline here. You don’t have to face this alone.
This article was originally published May 21, 2012 and most recently updated April 9, 2024.
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