Attention has recently been drawn to the correlation between ADHD diagnoses and eating disorders. Recent studies have indicated that youth with ADHD are nearly six times as likely to develop an eating disorder (ED) as their peers without ADHD (Curtin et al., 2013, p. 195). Furthermore, ADHD symptom severity has been shown to be positively correlated with disordered eating symptomatology even after controlling for anxiety and depression (Nazar et al., 2016, p. 1046). While we can’t yet say if ADHD itself increases the risk of disordered eating or there are underlying traits that increase an individual’s risk for both, correlation has been well enough established to warrant examination.
Of the most common eating disorders ADHD is most strongly associated with those that involve binge eating, namely bulimia nervosa (BN) and binge eating disorder (BED) (Ziobrowski et al., 2018, p. 53). This is perhaps unsurprising as impulsivity plays a prominent role in binge eating and is often a feature of ADHD, and dopamine dysregulation has been implicated in both (Levin and Rawana, 2016, p. 24). It thus seems likely that the neurological underpinnings of these disorders may be closely related.
Another factor that may contribute to the increased risk of disordered eating in these individuals is poor self-image secondary to ADHD. Children with ADHD are more likely to experience rejection and bullying at the hands of their peers, which can precipitate eating disorders (Levin and Rawana, 2016, p. 24). Furthermore, girls with ADHD in particular have been shown to face more negative emotions from their parents which can further contribute to poor self-esteem and thus disordered eating (Levin and Rawana, 2016, p. 24).
It is particularly important to screen for eating disorders in individuals with ADHD, as the presence of an ED may complicate the decision to treat with stimulants. Stimulants may be prescribed for binge eating disorder or obesity in the absence of ADHD, so in the case of comorbid BED and ADHD stimulants may be an excellent choice. However, in EDs that involve restricting or purging (including bulimia), stimulants can be harmful or dangerous. Individuals with eating disorders may abuse stimulants to keep their weight down, and severe bulimia can stress the cardiovascular system which may be a contraindication to stimulant use (Levin and Rawana, 2016, p. 34).
While eating disorders overall are far more common in females than males, boys with ADHD may still be at significant risk for disordered eating. In fact, recent studies suggest that ADHD increases the relative risk of EDs more in boys than in girls (Levin and Rawana, 2016, p. 24). As boys with ADHD may be more likely to suffer from BED which often results in obesity, attention should be paid to developing weight issues in males with ADHD.
Regardless of whether the relationship between ADHD and disordered eating is correlative or causative, the evidence indicating association is strong enough that young people with ADHD should be screened for EDs. The presence of an eating disorder may have a significant bearing on treatment decisions, and disordered eating in and of itself can have long-term health impacts. While anorexia nervosa is notoriously difficult to treat, the eating disorders associated with ADHD often respond well to treatment with medication and / or therapy, thus it is important they are identified and addressed.