ADHD on the rise
ADHD, or attention-deficit/hyperactivity disorder, is one of the most common mental health conditions among children in the U.S. The diagnosis rate of ADHD has increased over the past 20 years due in large part to increased awareness, decreased stigma and greater access to healthcare.
This brain disorder is associated with difficulty concentrating, staying organized and controlling impulses. Although children and adults with this diagnosis may appear to be bursting with energy, they experience trouble channeling that energy effectively and controlling their impulsivity.
They may act before they’ve thought things through, speak out of turn or say things they later regret and thus both personal and work relationships may suffer.
The connection between ADHD and overeating
We live in a culture where we are constantly enticed with high-caloric foods. This can be particularly challenging for those who eat in reaction to environmental cues rather than due to feelings of hunger.
Like those with disordered eating, people with ADHD often deal with boredom, stress and intense feelings by overeating in order to soothe themselves. Those with ADHD may be likely to forget to eat and to binge later. They may also have trouble planning and shopping ahead, which can result in spur-of-the-moment and uncontrolled eating.
According to a national 2016 parent survey, 6 in 10 children with ADHD had at least one other mental, emotional, or behavioral disorder (source: Data and Statistics About ADHD | CDC).
Research focuses on connections between ADHD and overeating in adolescents and adults. A recent study conducted by researchers at the Child Study Center at New York University’s Langone Medical Center found that men who were diagnosed as children with ADHD were twice as likely to be overweight in a 33-year follow-up study compared to those who were not diagnosed with the condition.
The researchers attributed the higher incidence of obesity occurring in adults with ADHD to lack of impulse control and poor planning skills leading to poor food choices and irregular eating habits.
Armed with data like this, it’s critically important that children and adolescents with ADHD are taught healthy eating habits in order to help avoid developing disordered eating patterns.
Neurotransmitter deficiencies and ADHD
Experts agree that ADHD is caused by an imbalance in brain chemistry. More specifically, the neurotransmitters norepinephrine and dopamine may be in short supply in the brains of those with ADHD.
Although too much norepinephrine can contribute to anxiety, too little can cause problems with concentration and learning. Those with a deficiency in norepinephrine have trouble blocking out distractions and organizing their lives.
Dopamine is essential for controlling impulses and enabling a person to sit still and wait. People lacking dopamine can act impulsively, blurt out opinions, burst out in anger and later feel regret. As dopamine is an essential part of the body’s reward circuit, a deficiency in this neurotransmitter intensifies the urge to indulge in behaviors such as overeating, substance abuse and other risk-taking behaviors to achieve the same reward others get from less harmful behaviors.
People whose brains are low in dopamine often self-medicate with high-caloric food because of its ability to activate dopamine in the common reward pathway.
A deficiency in the two neurotransmitters norepinephrine and dopamine can lead to the following behaviors related to eating:
- Poor awareness of internal cues of hunger and satiety, or fullness
- Inability to follow a meal plan
- Inability to judge portion size accurately
- Inability to stop bingeing or purging
- Distraction by continual thoughts of food, weight and body shape
- Increased desire to overeat, especially high calorie, “reward” type foods
- Poor self-esteem due to repeated failures of self-control
Which came first?
In patients with coexisting psychiatric and eating problems or co-occurring disorders, which came first?
Is ADHD the switch that turns on disordered eating, or does the eating disorder leave the brain so undernourished that it can’t function optimally? This varies depending on the individual person.
In some people, eating disturbances evolve with other psychiatric symptoms. In others, signs of a psychiatric disorder are not apparent until the disordered eating patterns are firmly established. And still in others, problems with mood and problems with appetite seem to have always coexisted.
Regardless of the order of onset, the simultaneous presence of disordered eating and a mental illness means that effective treatment for the disordered eating must address both conditions. This is the only approach that can lead to recovery and prevent the all-too-common patterns of relapse.
ADHD: A commonly missed diagnosis
The relationship between psychiatric disorders and disordered eating is complex. ADHD is the most missed diagnosis in relation to food and appetite problems. Adults seeking treatment for binge eating or obesity should be screened for ADHD. Effective treatment for ADHD can significantly help patients off the roller coaster of disordered eating.
Often the strong urge to binge or to self-medicate with food subsides once the impulsivity and inattention of ADHD are treated. A person can experience a new ability to tune in to the body’s signals, control cravings and improve impulse control.
We know finding care can be tough. Walden is here for you. If you are concerned that you, or a loved one, may have an eating disorder, please reach out by completing the form on this page or email us at intake_coordinators@waldenbehavioralcare.com.
James Greenblatt, M.D. is Chief Medical Officer & Vice President, Medical Services at Walden Behavioral Care. Dr. Greenblatt (he/him/his) is an internationally – recognized pioneer in the eating disorder and integrative medicine fields. Board certified in child, adolescent and adult psychiatry, he understands that all individuals have unique biochemical profiles that lead to a range of different behaviors and, therefore, treatment needs. Dr. Greenblatt received his medical degree and completed his adult psychiatry residency at George Washington University in Washington, D.C. He completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. Dr. Greenblatt also serves as a clinical faculty member in the psychiatry department at Tufts Medical School.
*This blog post does not necessarily represent the views of Walden Behavioral Care and its management. The Walden Blog is meant to represent a broad variety of opinions relating to eating disorders and their treatment.
