The relationship between ADHD and eating disorders
It is estimated that 20% of children with ADHD develop an associated eating disorder (ED) (Ravi & Khan, 2020).
It's important to note that some medications used to treat ADHD often cause loss of appetite as a side effect, which returns once the medication is no longer in use. However, when we talk about co-diagnosis (or comorbidity), we're not referring to this. Instead, we're referring to the simultaneous presence of inattention or impulsivity and hyperactivity, along with systematically restricting food intake, binge eating, self-induced vomiting, or obsessive exercise to burn calories.
ADHD, a common disorder in the child population
ADHD is primarily associated with two eating disorders: bulimia nervosa and, especially, binge eating disorder . The association with anorexia nervosa, however, is uncommon. Studies indicate a higher risk of developing an eating disorder in boys diagnosed with ADHD than in girls (Kessler 2014, Bleck 2013, Hudson 2007). In adults, a history of ADHD diagnosis is associated with a higher risk of an eating disorder.
The risk of a person with ADHD having an eating disorder is three times higher than that of the general population (Palazzo Nazar et al., 2016).
And the risk of a person with an eating disorder also having ADHD is estimated to be double. It is estimated that around 30% of cases have a dual diagnosis of ADHD and an eating disorder.
This can be understood if we consider that ADHD involves inherent impulsivity , whether acted out or not. It is often latent but inhibited in inattentive presentation ADHD. This impulsivity, with an organic basis, facilitates compulsive (repetitive) behaviors such as binge eating and self-induced vomiting. Or the excessive exercise, which the high energy levels of ADHD often make appealing. Exercise, on the other hand, when practiced in a healthy way, can help channel impulses and contribute to self-control.
For the same reason, and because they provide immediate gratification, video games are often especially popular with people with ADHD. This is why it's important to regulate screen time from a young age, just as you would with candy or trading cards. At the same time, specific online applications have been developed to help regulate behavior and curb impulsive responses.
Mindfulness to improve the symptoms of children and adolescents with ADHD
As children grow, the gratifying and calming effect of eating can also serve to manage the frustration generated by the difficulties inherent in ADHD (problems organizing themselves, achieving "typical" learning, emotional instability, difficulties in social or work relationships, sometimes impulsive choice of partners with whom the person feels more alike...).
In addition to the appetite-suppressing effects that some ADHD medications can have, as we've already mentioned, it's important to remember that children with ADHD need special attention to maintaining a healthy diet . Excessive consumption of simple sugars can further overstimulate them. The increased energy expenditure caused by hyperactivity can predispose them to consuming more sugary or high-calorie, but low-nutrient, foods—something parents should be mindful of, as with any child. It's recommended that they maintain regular meal and sleep schedules. It's common for children with ADHD to have difficulty falling asleep and going to bed early because, aside from screen time (an important factor to consider and limit), their internal clock may activate the sleep signal later than that of other children.
Notes on the approach to an eating disorder with ADHD
We would like to highlight a couple of relevant aspects when receiving this dual diagnosis. Often, the emotional regulation difficulties inherent in ADHD are compounded by, and magnified by, those inherent in any eating disorder. Individuals with combined presentation ADHD (inattentive and impulsive) may be more prone to irritability, anger outbursts, and agitation, and may find it more difficult to persevere. in treatment (as with any other long-term task). This is more pronounced in children and adolescents because they have less self-control, but it also occurs in adults. It can also make them more prone to substance use (alcohol, cannabis, and others), which can further aggravate the situation. In short, combined or predominantly hyperactive-impulsive ADHD is more often associated with behavioral problems. And well-prescribed medication can promote emotional and behavioral regulation.
Challenges for people with eating disorders and ADHD
ADHD often contributes to a rapid eating pattern due to impulsivity. Exercise prescriptions should also be evaluated on a case-by-case basis, as it can be beneficial for someone with ADHD and is not necessarily obsessive.
Regarding pharmacological treatment, having a dual disorder may make medication more necessary as part of the therapeutic approach. This is both to alleviate eating symptoms and to improve attention and reduce impulsivity, thus allowing for better effectiveness of therapies.
It's important to keep in mind that ADHD responds to specific medications that differ from those used for other psychological problems. If prescribed correctly, these medications can help with both eating disorders and ADHD simultaneously, and can also improve other co-occurring symptoms such as anxiety or depression, if present. However, if there is substance abuse or an associated anxiety disorder, some of these medications may be contraindicated. As is often the case, they are more effective when combined with psychological therapy, which should never be neglected.
Pharmacological treatment of ADHD in children and adolescents
Similarly, in cases of inattentive ADHD, certain medications with sedative or hypnotic effects may need to be avoided. Each case should always be considered individually.
Regarding therapy, as with school-aged children, adaptations are recommended. Individuals with ADHD and an eating disorder who participate in group therapy or extended sessions may have different needs if the duration exceeds their ability to sit still or pay attention, and this should be taken into account.
In short, the co-occurrence of an eating disorder with ADHD adds a double layer of complexity to treatment, but it's important to know that there are specific resources (pharmacological and psychological) for both problems, and that these can complement and enhance each other . The key is for professional teams to have a thorough understanding of both disorders and how to address them, as well as to collaborate with the individual and their support network to find a solution together, even if it may take a little longer.
Featuring
