October is ADHD Awareness Month, a perfect time to explore the intersection of ADHD and eating disorders.
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological condition of self-regulation that has a profound impact on executive functioning. ADHD is a form of neurodiversity, along with other conditions like Autism and Dyslexia. Neurodiversity impacts approximately one in seven people. Dopamine is a hormone and neurotransmitter that allows us to regulate emotional responses via our brain’s reward system. Typically, dopamine transmits at higher levels in ADHD brains than in neurotypical brains. Higher levels of dopamine transporters means the brain removes dopamine too quickly from brain cells, which in turn means dopamine has less time to exert its effects. This influences motivation, planning, organizing, memory, awareness of time, impulse control, and more.
So where is the crossover between ADHD and eating disorders or disordered eating? There are a number of different ADHD traits that can manifest around food, particularly around disordered eating patterns such as bingeing or restricting. Let’s examine a few of those connections and potential solutions.
Executive Functioning and ADHD Overwhelm
Executive function arises in the prefrontal cortex of the brain. Typically, the ADHD brain experiences deficits in one or more areas related to executive functioning. Generally, planning, organization, memory, task prioritization, and time management are more challenging for individuals with ADHD. Because of the increased effort required to execute tasks, “ADHD overwhelm” or burnout is common. This feeling of burnout can impair one’s ability to nourish themselves. Forgetting meals, feeling too overwhelmed to making decisions about food, and a lack of awareness of hunger and fullness cues are just a handful of ways that executive dysfunction shows up in relation to food.
Solutions: Scheduling, removing barriers, asking for help
Use everyday life tools to prioritize nourishment. Meal plans, schedules, reminders, the support of a dietitian or loved one can be life-changing. No matter what the reason –hyper-focus, forgetfulness, or indecision on what to cook – going too long without eating can perpetuate a cycle of restriction and binge eating.
Intuitive eating is a popular concept in eating disorder treatment and recovery, but requires a flexible definition, especially for neurodiverse populations. For some folks with ADHD, listening to hunger/fullness cues may not be accessible, or they may get so bogged down in the steps it takes to eat that it becomes overwhelming and feels anything but intuitive. A meal plan or a schedule can be incredibly helpful and should not be dismissed as too rigid. Also, while increased food diversity is a common marker for recovery within many eating disorder diagnoses, we cannot dismiss the helpfulness of having a smaller repertoire of easy to prep or grab-and-go items that help an individual with ADHD fulfill their energy needs. Many ADHD medications have stimulant properties. Because stimulants can suppress appetite, those with ADHD who seek medication must sometimes learn to push past what feels like a lack of hunger cues to eat regularly during the day. Eating regularly helps avoid a cycle of restriction followed by bingeing that can occur when simulative medications wear off. This level of consideration around eating can feel anything but intuitive, and that’s okay.
Seeking stimulation and impulse control
To keep it simple, the ADHD brain, by not regulating dopamine efficiently, tells the individual to find dopamine wherever they can. Behaviors that activate dopamine can include behaviors we often label as “addictive,” such as use of drugs or alcohol, shopping, spending, sex, or eating. Dopamine serves as the brain’s reward system, and food is an easily accessible way to trigger that system. The ADHD brain’s drive for stimulation can lead to binge-like behaviors or a feeling of being “out of control” around food.
Solutions: Self-compassion, mindfulness, and expanding your dopamine-regulating toolkit
There is nothing wrong with recognizing and indulging in the motivation and reward cycle with food. Food is delicious, food is social, and we need food to live! Unpacking the shame around what we think we “should” and “shouldn’t” eat can decrease our self-judgments. Exploring what drives our cravings can increase our understanding of what drives certain behaviors.
Reducing distractions and practicing mindful eating can also help. Distractions minimize the rewarding qualities of food and lessen our awareness of hunger and fullness cues. ADHD can negatively impact interoception, or awareness of bodily states. Because of this, those with ADHD can benefit from taking the extra steps to focus on the moment and determine whether the body is cueing hunger or a desire for stimulation. This mindful approach can help regulate appetite and improve one’s relationship with food.
If food has become a primary source of stimulation, such that one is experiencing binge-eating and a simultaneous sense of lack of control, consider incorporating other ways to increase dopamine. Fidget toys, puzzles, and even movement or light exercise can also be useful sources of stimulation beyond food. Remember, the goal is never to avoid eating when hungry, to avoid certain foods, or to mask hunger. We need to eat and it is okay to embrace food as stimulation! The goal is to identify other tools that provide stimulation when food has become the only source of stimulation, and to reduce binge-behaviors that interfere with quality of life.
Eating disorder treatment providers benefit from knowing and understanding how ADHD might show up with patients and clients, as can family members and friends. Food- and movement-related behaviors that may be viewed as rigid, excessive, or “non-compliant” may sometimes be the most feasible route for an individual to nourish themselves consistently (such as eating the same breakfast every day) or gain some dopamine (such as fidgeting). To complicate things, sometimes both the ADHD and the eating disorder create shortcuts; sometimes it’s one or the other.
Raising awareness around ADHD helps those who may be suffering in silence to learn and understand more about how their brains work. Learning to live with and accept a diagnosis of ADHD can help those with ADHD alleviate depression, anxiety, and shame. Furthermore, diagnosis and education can open a door to exploring new strategies that maximize one’s unique strengths, new ways to approach tasks and relationships, and new methods for life that work WITH the way the ADHD brain, not against it.