David, 35, feels that the only thing that gives him relief from his ADHD chaos is food. He makes several stops on his way home from work. Along the way and later at home, he might order and eat four hamburgers, four orders of French fries, a pizza, two bags of potato chips, two gallons of ice cream, and a dozen cupcakes. His numbness after such a binge turns into frustration and disgust. Then he vomits. He swears he will never binge and purge again, something he has told himself for 10 years.
Approximately 20 million women and 10 million men suffer from a significant eating disorder at some time in their lives. Although eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder, have been recognized for many years, their association with ADHD is relatively new.
Anorexia nervosa (AN) is characterized by restricting food intake (sometimes to the point of starvation) leading to a low, unhealthy body weight. Individuals with this disorder are fearful of gaining weight, especially in the form of body fat. Bulimia nervosa (BN) is marked by recurrent binge-eating episodes. A binge is defined as uncontrollably eating a large amount of food in a short period, compared with what most people eat. Due to feelings of self-loathing and anxiety after the binge, individuals with BN compensate through self-induced vomiting, laxative use, excessive exercise, fasting, or the use of diuretics to prevent weight gain. Binge eating disorder (BED) is characterized by binge eating episodes without the purging behaviors that are present in BN.
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Research has demonstrated that individuals with ADHD have a greater risk for developing binge eating disorder or bulimia nervosa than their peers without ADHD. A study conducted at Harvard Medical School, in 2007, found that girls with ADHD were almost four times more likely to have an eating disorder than those without ADHD. Another empirical study found that 11 percent of women with ADHD, compared to 1 percent of women without, reported a history of bulimia nervosa.
On a Binge
Many people with ADHD have poor impulse control and find it hard to regulate their emotions. This combination sets the stage for binge eating. Haley, 28, compares it to a drug problem. “Food is my heroin,” she says. “It sounds dramatic, but it is true. As hard as I try to prevent a binge, it is like driving over the same pothole that blows out your tires every day. I hate what binge eating does to my weight. It makes me feel worthless, which makes me turn to food again. It’s an abusive relationship.”
For individuals with bulimia nervosa, food is self-medication for anxiety, stress, anger, and boredom. Eating is stimulating, and food fills the gap. People with ADHD who feel inadequate and incompetent turn to food as a source of comfort. Eating is used as an unhealthy outlet to take control of their lives. Both people with BED and people with ADHD have trouble heeding their internal cues of satiety and hunger.
The risk factors for AN are also more significant for people with ADHD. Patients with ADHD and anorexia nervosa have stated that information on proper portions and healthy foods leaves them overwhelmed. Individuals with ADHD take an all-or-nothing approach in decision-making. Although people with anorexia nervosa eat very little, they are obsessed with food. They read cookbooks and watch food shows. A hyperfocus on food may be appealing to individuals with ADHD, since it simplifies their thinking about the subject.
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Tyra, 44, who was diagnosed with anorexia nervosa as a teen, says, “Controlling my weight is my only success. I felt like a headless chicken in my younger years. I was constantly overwhelmed and getting nothing done. Back then, there was no support or recognition of ADHD. Everyone thought I was either not trying hard enough or was stupid. After hearing that for so long, I started believing it myself.”
It has been widely reported that teens and young adults with AN often fear becoming adults and taking on adult responsibilities. Starvation is an expression of arrested development. Individuals with ADHD, due to executive function problems, find that tending to careers, relationships, and money management are difficult to do. Starving the body to keep maturity at bay is an unconscious expression of the wish to delay growing up.
Treatment Game Plan
Eating disorders are complicated. Treatment requires a team — usually a psychologist, nutritionist, physician, psychiatrist, and, most often, a family/couples therapist. When someone with an eating disorder also has ADHD, seeing treatment through an ADHD lens is essential. Knowing how the eating disorder is affected by ADHD symptoms, and how it, in turn, affects ADHD symptoms, must be central to treatment. Not managing the ADHD usually leads to treatment failure. If the eating disorder therapist is not an ADHD expert, add an ADHD therapist to the team.
Patients with ADHD plus an eating disorder are often seen as “not wanting to get better” because the ADHD was either undiagnosed or clinically underappreciated. Patients with eating disorders are often ambivalent about treating the problem. They want relief from the torment, but they equate treatment with gaining weight.
Cognitive-behavioral therapy (CBT) addresses negative and distorted thought patterns and unhealthy behaviors in a practical manner. Structuring meals, developing an accountability to eat healthy, and learning alternative coping skills are important strategies.
Traditional talk therapy is helpful, but only in concert with CBT. Eating disorder symptoms must be dealt with head-on. Talking about your childhood and how it has contributed to your eating disorder will not be effective if you are binge eating and purging several times a day.
Stimulants are a first-line treatment for ADHD symptoms, but they aren’t used much for certain eating disorders, since they suppress a patient’s appetite. Research has shown, however, that using stimulants for patients with ADHD and bulimia promotes impulse control that can prevent binge eating. Stimulants also help the person with ADHD and an eating disorder execute the treatment plan. In fact, Vyvanse, a stimulant and ADHD medication, is the first FDA-approved drug for the treatment of BED.
In addition to stimulants, SSRIs may be effective in treating BN, by easing mood, anxiety, and obsessive-compulsive symptoms. No medication has been found effective for anorexia nervosa. Using stimulants to treat AN is controversial, and needs to be assessed carefully. Stimulants can be useful, provided that they don’t cause the patient to lose more weight.
Eating disorders are a serious medical condition. Approximately 15 percent of males and females with eating disorders will lose their life to this illness, often through cardiac arrest or suicide. Recovery is possible, though, for patients with ADHD who have an eating disorder, provided that the right team of professionals treats both. Your life is worth the fight.
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