The High Risk of Eating Disorders for Those With ADHD

Few conditions are as wrapped in self-directed shame as eating disorders. As a therapist, I've seen a unique flavor of abashment linked to each disorder in each person. As well, most individuals I meet with a diagnosis of ADHD have fought battles with low self-worth. In a culture that values organization and executive functioning, placing individuals with ADHD at risk of judgment and negative evaluation from an early age, it is natural that many struggle to give themselves the full compassion they deserve.

Something that often goes unrecognized, however, is the link between eating disorders and ADHD. A study of college students found that those with ADHD were 18 times more likely to struggle with an eating disorder and that those with ADHD often had more significant eating disorder behaviors than those with an eating disorder alone (Schiros, and Antshel, 2023). These individuals may present with neurodiversity-specific needs in treatment.

Binge Eating and ADHD

Among all eating disorder behaviors, ADHD has been most associated with binge eating. While binge eating behaviors are the most common eating disorder behaviors (Wick et al., 2020), it often is overlooked. People usually associate binge eating with overeating and addictive behaviors. Research suggests it may have a more complex physical, psychological, and social etiology.

Binge eating disorder (BED) is a condition where individuals go on eating binges, often to the point of discomfort and pain, repeatedly eating a full day's worth of food in one meal. When purging follows these binging behaviors, the diagnosis given is bulimia nervosa.

Binge eating has been linked repeatedly to ADHD, both in cases of binge eating disorder and bulimia nervosa. A study of college students found that higher scores on the binge eating scale often correlated with higher scores on a self-report measure for ADHD (Hanson et al., 2020). fMRI research has demonstrated that when presented with pictures of food, individuals diagnosed with ADHD had, on average, stronger reward pathway activation than those without (Martin et al., 2020).

In my experience, ADHDers have often reported the use of food as medicine to improve motivation, focus, and mood. This, coupled with the neurological activation, places those with ADHD at particular risk for binge eating behaviors. Inattention and impulsivity-related ADHD symptoms appear to be linked to eating disorder development (Martin et al., 2022).

Treating Eating Disorders and ADHD

Many medications used to treat ADHD, such as stimulants, appear to suppress appetite. Stimulants have been utilized on a limited basis to treat binge eating, however, there are risks, including misuse, making the practice controversial. Individuals at risk for bulimia, in particular, could be at an increased risk of using stimulant medications as a method of purging (Keshen et al., 2022).

Neurofeedback has also been utilized to treat ADHD for some time. These treatments utilize EEG sensors to measure brain waves while providing re-enforcement, often in the form of achievements in a game to encourage adaptive patterns. Newer protocols of neurofeedback that regulate responses to appetizing pictures of food have shown promise in treating binge eating (Blume et al., 2023). As well, multiple types of psychotherapy, including cognitive behavioral therapy, interpersonal therapy, and exposure response prevention therapy, have been used successfully to treat binge eating.

Specific types of psychotherapy and other interventions that target food-related impulsivity may also be helpful to ADHDers who struggle with binge eating (Ince et al., 2021). Neurodiversity-affirming psychotherapy interventions may be central to treating these complex cases.

In Conclusion

The connection between ADHD and eating disorders is complex. Yet, with treatment, recovery is possible.