“If you treat the ADHD, you reduce the frequency and intensity of binges,” Soutullo says. But finding the right treatment and dose can be tricky. A number of patients will report an increase in binge eating episodes if they are put on the short-acting forms of ADHD medications, as the appetite suppression side effects can lead to a pattern of forgetting to eat, followed by over-eating.
In practice, the connection between the two disorders, and the ways in which the presence of both might affect treatment are not always recognized. “There are misconceptions about ADHD and there are misconceptions about eating disorders,” Lentzsch Parcells says. “When you put them together, that is a population that is really, really underserved.” For Greenberg, who was diagnosed with ADHD at the age of 14, and developed an eating disorder later, the connection between the two were not recognized during her treatment. “These conditions are seen as separate entities,” when in reality, Greenberg says, “there’s so much overlap.”
Many patients struggle with behavioral strategies
For behavioral therapies, having ADHD can complicate recovery from binge eating disorder, as many patients wrestle with staying organized and creating the structured environment. “In terms of behavioral treatments, so often it begins with consistent meal plans, and eating consistently,” which is incredibly hard for people with ADHD, Greenberg says. “What happens when that structure goes away?”
As Greenberg notes, many of the commonly offered treatments and strategies for eating disorders are not designed for patients with ADHD, who commonly have trouble with organization, focus, and time management. This can make the process of recovery much harder, especially as an outpatient.
In the years since Weber received a diagnosis of ADHD, it’s has given her a better appreciation for the overlap between the two conditions. It’s also given her a greater empathy for the patients she works with, many of whom also have ADHD. Given what she’s learned, she’s starting to recognize patterns in her patients, such as difficulties with maintaining structure, that have also hindered her own recovery. “Everything comes back to this diagnosis in a way that is so profound.”
