We know from clinical evidence and anecdotal data that one of the illnesses that may co-occur with eating disorders is Attention-Deficit Disorder (ADD), with and without hyperactivity (AD/HD). A new resource by Carolyn Piver Dukarm, M.D.explores the possible connection between ADD and eating disorders, specifically those eating disorders that involve binge eating and share the common characteristics of distractibility and impulsivity. Her book, Pieces of a Puzzle: The link between eating disorders and ADD, takes a first hand look at the similarities between binge-associated eating disorders and attention deficit characteristics.
The book also has many useful exercises for eating disorders and ADD patients, discusses various treatment options, and contains a special section for healthcare professionals.
Dr. Patricia Quinn, Director of the National Center for Girls and Women with AD/HD has kindly written a few words to help us explore the possible link between these conditions.
Disordered Eating and AD/HD: Could there be a connection?
Patricia O. Quinn, MD
Director, National Center for Girls and Women with AD/HD
Washington, DC
Attention Deficit Hyperactivity Disorder (AD/HD) is one of the most commonly diagnosed neurobiological conditions, and, at present in the United States, AD/HD has been estimated to affect 4.4% of the adult population. Previously thought to be a disorder of young boys, that has proven not to be the case and it is now firmly established that ADHD affects adults and females as well as males. Another very important recently emerging finding that has direct implications for those diagnosing and treating women and girls is the association between eating disorders and AD/HD. Unfortunately, this critical link has been overlooked for too long and has come into the spotlight only recently.
Eating disorders and AD/HD share several key characteristics including impulsivity (lack of impulse control or self-regulation), depression, and low self-esteem. Perhaps the best way to examine the relationship between disordered eating and AD/HD is to look directly at some of the clinical issues involved. AD/HD with its symptoms of short attention span, distractibility, poor organizational skills, hyperactivity and lack of impulse control is now seen as leading to the poor impulsive control, self-esteem and personal dissatisfaction that contribute to or complicate binge eating and other eating disorders.
Self-regulation, which is a well-documented difficulty for those with AD/HD, can lead to patterns of chronic over-eating or binge eating.
In addition to the symptoms of poor impulse control, depression and low self-esteem, eating disorders (particularly binge eating) and AD/HD are also seen to share several key characteristics including biological, nutritional, psychological and societal influences that contribute to their development.
Those with AD/HD/eating-disordered report a lack of attention and self-awareness and that they often miss meals because they never notice being hungry and only know to stop eating when they feel “stuffed.” They also have difficulty with organization and planning ahead making it difficult to plan a meal of nutritious food at appropriate intervals.
When addressing chronic overeating or binge eating disorder, it may be very helpful to explore if AD/HD might also be impacting eating. Self-regulation requires good inhibitory control. People eat for many reasons other than physiological hunger, including boredom, excitement, anger, sadness, food availability, reward, and stress relief. Surrounded by highly desirable food, it may be difficult to say "no" to the impulse to eat. Again, it is easy to understand how AD/HD might put someone at a disadvantage, since difficulties with impulse control are a central defining attribute of AD/HD. Individuals with AD/HD tend to be dominated by the moment, reactive, and, only later, regretful of their lack of foresight.
Besides contributing to the eating disorder directly, AD/HD may also complicate recovery from disordered eating. Making the dual diagnosis not only provides answers to many questions that may explain failure to consistently follow a treatment program, but also reduces self-blame and begins the process of regaining control. Bulimia, binge eating disorder, chronic overeating, as well as significant obesity are all complex disorders that typically require psychological and medical intervention for resolution. Failure to meet treatment goals or make significant progress in recovery may be the result of overlooking the coexistence of AD/HD. Indeed, the co-existence of these conditions may require more intensive intervention. Treatment that addresses impulsivity and inattentiveness can produce striking improvement, weight loss or the modification of eating behaviors.
For the subset of people with co-existing ADHD and an eating disorder, treating the eating disorder without treating the underlying ADHD may result in only partialimprovement of their eating disorder symptoms. As a result of untreated ADHD, there is a high risk of relapse due to the underlying symptoms of impulsivity, distractibility and disorganization that can perpetuate the eating disorder symptoms. In our experience, patients with ADHD and an eating disorder who are treated with an interdisciplinary treatment plan incorporating nutrition, cognitive interventions and ADHD medications and supplements demonstrated almost immediate, and frequently complete, resolution of eating disorder symptoms.
Recently, a more detailed look at the potential role of AD/HD and its treatment in the management of women with bulimia and chronic overeating was described by Carolyn Dukarm, MD in her book discussing the link between AD/HD and eating disorders. In Pieces of the Puzzle: The Link between AD/HD and Eating Disorders (Advantage Books, 2006, www.advantagebooks.net), Dr. Dukarm offers an extremely detailed diagnosis and treatment program for patients with the dual diagnosis and for the clinicians who treat them.
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