The recent discovery of the association between eating disorders and ADHD can have significant implications for women and girls with attention-deficit/hyperactivity disorder. Unfortunately, this critical link has been overlooked for too long and has come into the spotlight only recently for several reasons. Most of the early studies of ADHD were conducted using male-only populations or in preadolescents — two groups where the incidence of eating pathology is low. Unfortunately, it was not until we started following females with ADHD into adolescence that this link became apparent. A higher incidence of eating disorders in adult women with ADHD was also recently noted, but only when data was examined retrospectively.
The ADHD/disordered eating connection is not difficult to understand. Eating disorders and ADHD share several key characteristics, including impulsivity (lack of self-regulation), depression, and low self-esteem. However, women and girls with ADHD develop eating disorders for many reasons. Symptoms of ADHD can contribute to the development of binge eating and other disordered eating patterns as a woman loses her ability to control what she eats and how she responds to events in her environment. Many women with ADHD eat for stimulation or to feel better. Others get distracted, forget to eat, and then have no control once they impulsively start eating. These eating patterns often result in chronic overeating and obesity as women have no idea of how many calories they are consuming each day. When two samples of adults with and without ADHD were retrospectively examined, significantly greater rates of bulimia nervosa were identified in women with ADHD versus those without ADHD (12% vs. 3% for one sample and 11% vs. 1%, for the other sample). Although preliminary and requiring further confirmation, these findings suggest that bulimia nervosa may be associated with ADHD in some women.
Two studies of adolescent girls previously diagnosed with ADHD also found a significant incidence of eating disorders (). In the first study of adolescent girls with and without ADHD found that those with ADHD were 3.6 times more likely to develop an eating disorder, defined as either anorexia or bulimia nervosa. During the study’s 5-year follow-up, 16% of the girls with ADHD (20 girls) and 5% of the control subjects (5 girls) developed an eating disorder. Compared with the control subjects, the girls with ADHD were 5.6 times more likely to develop bulimia and 2.7 times more likely to develop anorexia nervosa. These girls with ADHD also had significantly higher rates of depression, anxiety disorders, and disruptive behavior. Occasionally, I have seen girls with ADHD and anxiety, who stop eating as a means of controlling a world that they see as being out of their control. Few, however, develop full-blown anorexia nervosa. Usually, these girls continue to maintain an appropriate body image and they do not develop a drive for thinness; they simply want to gain an element of control.
In the second study, 93 adolescent girls with ADHD-combined subtype, 49 with ADHD-inattentive subtype, and 88 girls without ADHD were assessed for eating disorders (). In this study, baseline impulsivity symptoms best predicted adolescent eating abnormalities, as did the diagnosis of ADHD-combined subtype. In addition, peer rejection and parent-child relationship patterns were seen as predictive of eating disorders in the girls with attention-deficit/hyperactivity disorder.
Some girls with ADHD and anxiety stop eating as a means of controlling a world that they see as being out of their control
Treatment for many of the eating patterns described earlier may be accomplished by treating the ADHD symptoms that underlie them. In an article published in the May 2005 issue of the Journal of Women’s Health, Dr. Carolyn Dukarm, an eating disorder specialist, described six patients with bulimia and ADHD who were treated with dextroamphetamine. All six patients reported no further episodes of binge eating and purging following treatment. In five of the six patients, ADHD had not been previously diagnosed, perhaps due to the fact that all six had the inattentive subtype of the disorder. These cases, along with the recent clinical study findings seem to confirm the association between bulimia nervosa/binge eating and ADHD in girls and women, and have important clinical and treatment implications. In 2006, Dr. Dukarm presented a more detailed look at the potential role of ADHD and its treatment in the management of women with bulimia. In Pieces of a Puzzle: The Link Between ADHD and Eating Disorders, Dr. Dukarm offers an extremely detailed diagnosis and treatment program for patients with the dual diagnosis and for the clinicians who treat them.
Selections from the book: “100 Questions & Answers About Attention-Deficit Hyperactivity Disorder (ADHD) in Women and Girls”, Patricia O. Quinn, MD, Director National Center for Girls and Women with AD/HD, Washington, DC, 2011