Navigating ADHD and Eating Disorders

Hannah Mitroff, University of Michigan Dietetic Intern at RCBM explains the correlation between ADHD and eating disorders along with strategies to improve nutrition and eating behaviors for individuals with ADHD.


Correlation Between ADHD and EDs

Attention Deficit Hyperactivity Disorder (ADHD) is a mental health condition that is typically characterized by symptoms of inattention, hyperactivity, and/or impulsivity (1). While often associated with other mental health conditions like anxiety and depression, research from over the past decade found a connection between ADHD and eating disorders, with binge eating disorder and bulimia nervosa being the most common (1). People with ADHD are around 3-6 times more likely to develop an eating disorder compared to their peers, so understanding this connection is important for the holistic and effective care of these individuals (2). 

ADHD and Eating disorders


Common Nutrition Struggles for People with ADHD

People with ADHD often face unique challenges when it comes to nutrition. These challenges can result in irregular eating habits, which could lead to disordered eating behaviors (3).

One of the most common struggles is difficulty with time management and maintaining consistent daily routines (4). These ADHD traits can manifest as skipping meals or eating late at night. A regular and more structured eating schedule can help prevent nutritional imbalances and low energy, which could improve overall ADHD symptoms (4).

Sensory sensitivities around food are also common for people with ADHD (5). Many individuals with ADHD are hyper-aware of how food tastes, feels, or smells, which can make eating unpleasant. This heightened sensitivity may lead to food avoidance, causing a restrictive mindset around food (5).

Families of children with ADHD sometimes adopt restrictive diets, such as eliminating sugar or gluten, to manage symptoms (5,6). While these dietary changes are well-intentioned, they can lead to a more negative and restrictive mindset when it comes to food. Strict dietary rules may lead to stress or anxiety around eating, making it difficult for people to develop a healthy, balanced relationship with food and their body (3).

Stimulant medications, commonly prescribed for ADHD and taken in the morning to increase focus throughout the day, often suppress appetite (6). This can lead to skipping meals or eating very little, only to experience intense hunger later once the medication has worn off, resulting in overeating or binge eating in the evening. This fluctuating appetite can make maintaining a consistent eating routine and a healthy relationship with food hard.

Many people with ADHD have difficulty interpreting their body’s internal signals, such as hunger or thirst (3). The overall disconnect between one’s body and mind can make it difficult for people with ADHD to know when, what, and how to eat. This manifests as overeating, undereating, or developing food aversions, which can contribute to a poorer relationship with one’s food or body (3).

Lastly, impulsiveness in people with ADHD often leads to eating to combat boredom, as their brains seek stimulation and pleasure (3). People with ADHD can have some difficulty practicing impulse control, resulting in eating without considering hunger levels and eating more of the “fun” foods in excess, making it easy to fall into mindless eating patterns. Over time, these patterns can resemble binge eating behaviors (3).

 

ADHD links to Binge Eating Disorder (BED) and Bulimia Nervosa (BN)

Recent research has revealed a significant connection between ADHD and disordered eating patterns, particularly BED and BN (1). Binge eating in individuals with ADHD often looks different compared to those who identify as neurotypical. Many people, regardless of ADHD status, can relate to grabbing an extra cookie after a hard day or choosing to eat out when cooking feels too complicated. Emotional eating can be a part of the normal human experience, however, when ADHD is involved, these occasional indulgences can turn into a more frequent behavior. Some of the challenges tied to ADHD, such as impulsivity, emotional dysregulation, and poor time awareness, can amplify tendencies toward eating disorders like BN and BED (1).

Bulimia Nervosa (BN) involves cycles of binge eating followed by compensatory behaviors, such as purging, fasting, or excessive exercise, to prevent weight gain (1). BN in individuals with ADHD is often tied to emotional dysregulation or feeling like they cannot control their emotions when presented with a stressor (3). Instead of dealing with their emotions, People with ADHD may use food as a way to cope, turning to bingeing and purging as a way to “take control” of the emotions they are feeling (3). Furthermore, the all-or-nothing or black-and-white thinking associated with ADHD drives bulimic behaviors, labeling certain foods as “good” or “bad”. This can also look like, “I have to eat an entire package of a snack or nothing at all.” These thought patterns can drive bingeing and purging behaviors (1). Lastly, interoception challenges, or difficulty recognizing and responding to bodily signals, can confuse hunger and fullness cues, making it hard for someone with ADHD to regulate their eating habits (3). After engaging in BN-related behaviors, it can be hard for people to get back in touch with their body’s hunger and fullness cues.

Binge Eating Disorder (BED) is an eating disorder characterized by recurrent episodes of consuming large quantities of food in a short period, often to the point of discomfort. BED does not involve compensatory behaviors to counteract bingeing like in BN (1). Impulsivity, a characteristic of both BED and ADHD, plays a significant role in the development of disordered eating patterns, as individuals with ADHD may struggle to resist cravings or regulate their intake once they start eating (5). Also, people with ADHD typically exhibit a deficit in dopamine, the brain's reward chemical. This deficit can lead people to seek out highly palatable, calorie-dense foods as a way to stimulate their reward system and brain (3). Lastly, time blindness, or difficulty perceiving how much time has passed, may cause individuals to lose track of when they last ate, making them more likely to overeat. Similarly, ADHD can cause a state of distraction or hyperfocus, and someone may not realize they are overeating until they’ve already consumed a large quantity of food, especially when doing activities like watching TV or being on the computer (2).


Strategies to Improve Nutrition and Eating Behaviors for Individuals with ADHD

While nutrition does not cause ADHD and nutrition does not cure ADHD, the foods you eat can play a role in managing ADHD symptoms(7). Good nutrition can help support brain function, improve focus, and regulate energy levels, which are all important for people with ADHD (8). There is no “one-size-fits-all” solution for nutrition and ADHD, so we want to encourage people to do what works best for them. Here are four tips and tricks to help you manage nutrition with ADHD:

  1. Practice mindful eating: Take your time with meals to help increase awareness of hunger and fullness cues. Take small bites, chew slowly, and appreciate what you’re eating. These behaviors can help the brain catch up with how the stomach is feeling. This slow and mindful approach might initially feel uncomfortable, but after practicing, it can help prevent potential binges by improving self-regulation (9).
  2. Eat every 3-4 hours: Eating regularly, or every 3-4 hours, can help regulate hunger and fullness, focus and energy levels, and blood sugar (10). Set phone reminders or put mealtimes into a calendar to promote consistent eating patterns. This regular eating and structure during meals are important steps in preventing more impulsive food choices and overeating later in the day.
  3. Utilize prepared foods: Including protein sources (like meat, beans/legumes, eggs, tofu, etc.) and fruits/vegetables is an essential part of any person’s diet. Protein can help you feel full longer and help maintain regular blood sugar levels, whereas fruits and veggies provide your body with fiber and important micronutrients (8). However, cooking can be overwhelming, especially for those with ADHD. Using frozen protein sources and vegetables and pre-cut and portioned fruits and veggies can simplify meal prep, making it less overwhelming to maintain a balanced diet. These options help ensure these individuals get essential nutrients without the stress of lots of food preparation and cooking (10).
  4. Make peace with food: Food freedom is important because it allows people, regardless of ADHD status, to develop a healthier, more balanced relationship with eating (10). Often, the impulsive feelings and negative emotions tied to ADHD can lead to restrictive thinking, where certain foods are labeled as "bad" or “off-limits.” This mindset can create feelings of deprivation, leading to overeating or eating in secret when this urge becomes overwhelming (10). By reminding yourself that you can eat all types of food without guilt, individuals with ADHD can break the cycle of restriction and bingeing and work towards a balanced diet filled with fun and nutritious foods.


References

  1. Ptacek R, Stefano GB, Weissenberger S, et al. Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced. Neuropsychiatr Dis Treat. 2016;12:571-579. Published 2016 Mar 3. doi:10.2147/NDT.S68763
  2. Reinblatt SP. Are Eating Disorders Related to Attention Deficit/Hyperactivity Disorder?. Curr Treat Options Psychiatry. 2015;2(4):402-412. doi:10.1007/s40501-015-0060-7
  3. “ADHD as a Co-Occurring Disorder with Eating Disorders.” Eating Disorder Hope, www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/adhd.
  4. Hundley, Stephanie. “How ADHD Can Impact Our Relationship to Food and Body.” Willow Shore Counseling, 26 June 2023, www.willowshorecounseling.com/blog/how-adhd-can-impact-our-relationship-to-food-and-body. Accessed 5 Sept. 2024.
  5. “ADHD and Eating Disorders - Center for Discovery.” Center for Discovery, 24 July 2019, centerfordiscovery.com/blog/adhd-eating-disorders/.
  6. Pinto S, Correia-de-Sá T, Sampaio-Maia B, Vasconcelos C, Moreira P, Ferreira-Gomes J. Eating Patterns and Dietary Interventions in ADHD: A Narrative Review. Nutrients. 2022;14(20):4332. Published 2022 Oct 16. doi:10.3390/nu14204332
  7. Lange KW, Lange KM, Nakamura Y, Reissmann A. Nutrition in the Management of ADHD: A Review of Recent Research. Curr Nutr Rep. 2023;12(3):383-394. doi:10.1007/s13668-023-00487-8
  8. Harris, Becca. “ADHD Diet: Nutrition Tips from a Dietitian.” The Nutrition Junky, 6 Feb. 2023, thenutritionjunky.com/adhd-diet-nutrition-tips-from-a-dietitian/.
  9. Omiwole M, Richardson C, Huniewicz P, Dettmer E, Paslakis G. Review of Mindfulness-Related Interventions to Modify Eating Behaviors in Adolescents. Nutrients. 2019;11(12):2917. Published 2019 Dec 2. doi:10.3390/nu11122917
  10. Bunich, Kristin. “The Intuitive Dietitian.” The Intuitive Dietitian, 24 Mar. 2024, www.theintuitivedietitian.com/blog/adhdmealplanning#:~:text=A%20Framework%20of%20Eating. Accessed 6 Sept. 2024.