Understanding ADHD and Disordered Eating

Understanding ADHD & Disordered Eating

“Binge eating”. This two-word statement is one of an example area of impairment within the DSM 5 criteria for ADHD. To describe the potential challenges that relate to ADHD, food and diet in these two words simplifies an issue that is often far more complex but can present with many common features, many of which are not recognized within the diagnostic criteria.

This article will explore the complex relationship between ADHD and food, why binge eating occurs alongside (or because of) ADHD and hopefully increase awareness and understanding of the broader issues of food, diet and ADHD.

The term “disordered eating” refers to regular abnormal eating patterns and can include dieting, binge eating and restriction. Emotions such as comfort, guilt and shame can play a role in disordered eating patterns. Disordered eating is not currently recognised as a clinical diagnosis, however the impact of disordered eating is significant. Because of the negative emotions often associated with certain eating behaviours, this is a difficult and sensitive topic to approach and discuss.

This article shares a wealth of clinical evidence that helps anyone who relates to this topic to understand that they are not alone in their experiences of this important and impactful issue. Alongside the available clinical research, the evidence base for this subject area is from clinical practice where we have helped others to explore their own relationship with food as part of their journey in understanding and accepting their ADHD diagnosis.

Let’s start with what is recognised within the diagnostic criteria for ADHD in relation to binge eating.

What is binge eating?

The Mayo clinic describe this as “feeling that you don’t have any control over your eating behaviour, for example you can’t stop once you start”. Let’s now apply this to ADHD.

The overeating or bingeing is often coupled with periods of intentional or unintentional (we will explore this later) restriction to compensate for binges – feels a bit all or nothing doesn’t it? There may just be a theme here .....

Taking us away from the topic of food for a second - Think about approaches to starting and completing admin tasks for example. People state that they either procrastinate starting this task until the deadline approaches but once they’ve started may be able to sit for hours doing the task. Some refer to this period of intense focus as “hyperfocus”. The same approach may apply to keeping things in order at home. Unable to maintain consistent order and tidiness until it becomes unavoidable and then manage a full house clean in a day – all or nothing.

Periods of focus can be all or nothing, depending on the level of interest in the task or subject. We often use the term “all or nothing” when describing how it feels to experience ADHD, on a day-to-day basis, and this is relatable for many. The same all or nothing theme can apply to food and ADHD and can therefore impact consistent eating routines.

Let’s look at why and how this occurs so that we can understand this better.

Meal planning and preparation

Planning and preparing meals every day is hard work. It’s doubly hard when you have difficulties with organisation and executive functioning.
People with ADHD often find meal planning and cooking challenging because of the necessary steps to succeed at the task.
First you need to decide on a plan – what food, what time for what meal.
Then consider the recipe – what ingredients do I need? Do I need to buy them? I’ll need to write a list and remember to take it to the supermarket with me and read the list when I am there without being distracted by the far nicer things available to purchase.
If you haven’t given up on the process at this point, well done, there’s more.....
.....Try and follow a recipe! Remember the timings and ensure that multiple things that are required are cooked simultaneously so that this all comes together at the same time.
This is a lot for a person who struggles with decision making, making lists and sticking with them, following written instructions, time management and forgetfulness.

It may seem like the easier option therefore is to eat something that is convenient and quick to prepare or buy. These options are often not the healthiest food choices. But they will seem easier to manage than the many steps required to plan and prepare a meal or multiple meals.

Planning and preparing food can be difficult tasks for people with ADHD.

Managing and sticking to food routines

Taking us back to the “all or nothing” theme again.

People often state that they forget to eat during their day (unintentional restriction). This can be for different reasons. That they have been in a “hyperfocus” mode which means that focus at this time is intense, linear and hard to break away from. Even to eat. Perhaps once that focus on the task in hand is lost by breaking to consider food, it is difficult to regain again.

The problem with this is that the old cliché, “the body needs fuel, as does the engine of a car”, applies. And to ensure that the body accesses the missed fuel, there may be overcompensation through overeating or “bingeing”. This may then be followed by a sense of guilt or shame about the amount of food consumed and lead them to purging or intentional restriction.

Managing food routines with ADHD requires some forward planning or support. The use of timers to prompt for meals and reliance on partners or loved ones to provide verbal prompts are quite commonplace.

Approaches to maintaining a sufficient diet consistently for people with ADHD can feel “all or nothing”.

Boredom alleviating or comfort seeking through food

“Dopamine seeking”– commonly associated with boredom, comfort or overeating.

Chronic boredom can be associated with ADHD and it all comes down to the chemical imbalance which we know affects the brains of people with ADHD. Dopamine is a feel-good chemical, which I like to refer to as the “reward chemical” and it is often underproduced in the brains of people with ADHD.

For context let’s think about the common ways in which the underproduction of dopamine may affect behaviours, common for people with ADHD.

After starting a new and interesting hobby, dopamine is increased. This will allow focus on researching the hobby, what you may need to buy for it, ensuring that you have those provisions and starting the hobby. Once this hobby becomes routine, the dopamine is not stimulated in the same way, therefore interest and focus on the hobby is reduced and eventually it is added to the hobby graveyard (we can’t take credit for this, a wonderful term used by a patient of ours recently).

The same applies to a task that is perceived to be not interesting. There is no natural stimulation of dopamine that will enable motivation to start the task or maintain focus to continue with it.

How does this apply to food?

One of the most common and accessible things that stimulates dopamine is food and this is why, for some people with ADHD, it is overused.

We often ask patients at what time of day they binge eat the most? The most common answer is in the evening.

Why is this? Evening times are traditionally “low stimulus” (boring). People without ADHD may use this time to engage in relaxation or low stimulus activities such as watching TV or reading a book. If you are a person that experiences symptoms of external hyperactivity associated with ADHD, think about where all this hyperactivity goes during periods of expected low stimulus such as the evening? Inside. If you are someone that is not overtly hyperactive, you may relate to feeling internally restless or hyperactive.

Internal hyperactivity is associated with racing thoughts, an overactive brain or seeking stimulation which can often be found through food. Often nice food that provides pleasure that is then overeaten (bingeing).

Internal hyperactivity can often feel like multiple “tabs” open in the brain at once. If one of these tabs relates to food, people may find that they overthink about food, the pleasure and enjoyment of nice food which again may lead to unhealthy choices or excessive amounts.

Binge eating in the context of ADHD can often be associated with boredom alleviation or dopamine seeking.

Treatment outcomes

We did not want to make this article about treatment, but we feel that it is important to recognise and understand the role of medication in managing symptoms of ADHD and how this can in turn affect diet, appetite and food.

Stimulant medications are the first choice for treatment options for people with ADHD. The stimulant medications work by increasing levels of dopamine and norepinephrine in the brain, the chemicals that we know to be underproduced in the brains of people with ADHD. Ensuring that treatment is effective and tolerated is a process called medication titration. During titration the potential side effects of the medication are assessed. One of the common side effects of stimulant medications is appetite loss.

This must be closely monitored throughout the medication titration through discussion and weight monitoring.

It is important to understand the cause of weight loss during titration as this may be as a side effect of the medication or where binge eating is associated with symptoms, an effect of the medication in managing symptoms. Put plainly.

Medication can suppress appetite – this is an unwanted effect or side effect for some.

Medication may increase dopamine, therefore manage symptoms better including improved focus and ability to maintain systems and processes for planning and organising, therefore meal planning may feel more manageable – this is an effect of positive symptom management.

Treatment and medication of disordered eating

Final reflections

Our hope and intention as an outcome for this article is that the common issues relating to ADHD, food, diet and disordered eating are highlighted, explored and normalised, because often this issue is coupled with a sense of shame or embarrassment that prevents open discussion or admission.

Understanding the link between ADHD and disordered eating is the first step towards providing the necessary validation that this is a common issue for many people. Recognition and acceptance can then lead to intervention through either medical treatment to manage ADHD symptoms or through the development of strategies both of which will ensure consistent approaches to diet and healthier food choices.

Here are some top tips for helping to manage a consistent dietary routine and manage overeating with ADHD:

Make meal planning manageable
Opt for meal choices that are simple and healthy. Too many steps to the process and too many ingredients involved may feel overwhelming and not achievable.

Plan ahead and involve other people such as family members in choosing meals and buying ingredients
This can even be made into a fun family activity such as a “What’s for tea!?” family WhatsApp group or a fridge meal planner.

Use a list for meal prep ingredients when you shop
This will reduce the overwhelm of vast supermarket food choices that can lead to buying quick and easy meals, unhealthy snacks or items that you may not need.

Set reminders and alarms during the day to encourage you to remember to eat and drink regularly
You may even set up a reward system for achieving this!

Make sure that healthy snacks such as fruit are accessible at home and reduce accessibility to unhealthy foods

Learn to notice your impulsive behaviours so that you allow yourself time to stop and consider food choices in the moment
This will help to reduce the temptation to access fast food. Remember if you eat at regular intervals, your body is less likely to reach that extreme hunger stage which can lead to giving in to quick and easy food options.

Learn to notice when your boredom triggers are so that you can manage these with an alternative activity other than food

Adopt simple life changes that will have a big impact on your health such as increased exercise
This doesn’t need to be onerous but should be fun, accessible and manageable.

Try to have a ‘ready meal’ available for when you are tired, off medication and likely to graze with unhealthy food
Maybe a sandwich on brown bread, made and in the fridge to grab and go.

Don’t berate yourself if you don’t get it right all the time!
This is all about sustainable changes with manageable and achievable goals.

For further information and support regarding ADHD and overeating, we would also encourage you to read our “Below the Neck” Treatment and Tools Tips Paper and look out for our next ADHD and Overeating themed power hour session and webinar.

Understanding ADHD & Disordered Eating