ADHD & Binge Eating Disorder (BED)
Binge Eating Disorder (BED) is defined by the National Eating Disorders Association (NEDA) as “a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory behaviors (e.g., purging) to counter the binge eating” [2]. BED is the most common eating disorder found in the United States, affecting roughly 3.5% of women and 2% of men - an estimated 30% of that subpopulation also have ADHD [4]. A review conducted in 2017 found strong associations between ADHD and eating disorders in eight of eleven studies, and specifically between ADHD and BED in 20 of 27 studies [3]. A 2015 review noted that impulsivity is the most significant predictor of disordered eating in people with ADHD, as 40-50% of children with ADHD experience impaired response inhibition, which can make it difficult to stop eating when their impulse tells them they want to eat [3].
Individuals with ADHD tend to crave certain types of stimulation, and struggle with self-control and self-regulation due to problems with executive function [4]. Binge eating may happen in people with ADHD because their lack of body cues means they cannot tell or do not care when they are full, or because they are trying to satisfy their brain’s need for stimulation by overeating [1]. Inattention may also play a role, as people with ADHD may not be focused on their eating habits, and thus not recognize their hunger until they end up overeating later [4]. Some studies have suggested that heightened neural-reward response to food is the cause of binge eating in people with ADHD, meaning their brains release an increased amount of dopamine, the chemical responsible for feelings of pleasure and reward, in response to food stimulus [1]. Certain foods, especially simple carbohydrates like those that are high in sugar, may be more common fixations for people with ADHD because they stimulate dopamine release at higher rates than healthier foods [1]. Stimulant ADHD medications that correct neurotransmitter deficiencies, such as methylphenidate and amphetamine, suppress appetite during the day, which means that when the effects wear off in the evening, their appetite increases and they end up binge eating [1]. Studies show that lower levels of dopamine may cause greater impulsivity, which could lead to cravings for high-calorie foods that trigger dopamine release and activate the pleasure centers in the brain [3].
People with ADHD frequently struggle with time management and hyperfocus, which can also lead to binge eating [3]. Following regular dietary habits often involves planning and budgeting for time - without that type of regulation many individuals end up not eating all day and then binge eat when they get home [3]. Hyperfocus is a symptom of ADHD involving overwhelming levels of focus on one thing at a time [3]. In a state of hyperfocus, someone with ADHD may skip meals and binge eat later when their hunger cues have returned [3]. People with ADHD are also highly affected by sensory input, which means they tend to find feelings, tastes, smells, temperature, and texture from eating particularly satisfying [3].
The genetic commonalities between ADHD, BED, and clinical obesity are responsible for transmitting dopamine in the brain, explaining the relationship between these two conditions [4]. ADHD and BED also tend to co-occur with other mental health problems such as anxiety and depression, which means individuals who struggle with one of these conditions are at risk for experiencing another [4].
Binge eating behaviors do not necessarily equate to Binge Eating Disorder (BED), as the former is an unhealthy tendency and the latter is a diagnosable condition from specific criteria in the DSM [3]. The criteria for diagnosing BED includes eating more food than most people would under similar circumstances in any 2-hour period; feeling an inability to control what or how much one eats; experiencing a noticeable level of distress around your binge eating patterns; and binge eating at least twice a week for six months, or once a week for three months [3]. It also involves at least three of the following criteria: eating faster than usual; eating to the point of discomfort; eating a lot of food when not hungry; eating in private because of feelings of shame or embarrassment, and experiencing disgust, guilt, or depression following an episode of overeating [3]. BED does not involve compensatory behaviors for binge eating such as fasting, purging, or overabundant exercise [3].
Patterns of eating commonly associated with ADHD, such as eating for stimulation, do not necessarily have a negative impact, but doing so regularly and past the point of feeling full can have a tangible effect on one’s health physically, mentally, and emotionally. Diets high in sugar can affect energy levels and mood, and studies suggest that highly processed foods with additives and preservatives may affect behavior and cognitive development [1]. Specifically in individuals with ADHD, studies have shown that nutritional deficiencies can impact behavior and cognitive function, particularly with regards to Vitamin D which influences the formation of dopamine, and magnesium which increases attention and decreases hyperactivity [1]. Studies have identified a number of risks concerning mental health that are associated with BED and ADHD, such as feelings of guilt and shame that prompt further binge eating, creating a vicious cycle; a higher risk of restriction or deprivation in response to feelings of guilt, shame, and remorse; depression and anxiety fueling further disordered eating behaviors, causing a vicious cycle; eating in isolation due to feelings of embarrassment, causing stress around social situations; and lifestyle disruptions when priorities are skewed because an individual follows a craving or seeks stimulation [3].
ADHD and BED can also lead to a number of risks concerning one’s physical health. This includes physical discomfort where overeating in a short period of time causes nausea, gas, bloating, stomach pains, and more; an increased risk of developing certain chronic diseases such as high blood pressure, high cholesterol, or type 2 diabetes; unintentional weight gain, though this depends on the level of physical activity, types of foods an individual fixates on, and the frequency with which one binge eats; and finally, fluctuations in energy levels while one’s body breaks down large amounts of food [3].
For individuals struggling with BED, especially those also diagnosed with ADHD, there are a number of options to address unhealthy patterns. These approaches should be individually designed in a process between the individual and a medical professional, but may include certain medications (especially stimulants), behavioral therapy, and changes in lifestyle and diet [3]. Any approach is best carried out with support from family and friends and patience with oneself in directly combating symptoms of diagnosed conditions such as ADHD and BED.
Sources:
[1] Flight, Hazel. 7 June 2022. “ADHD: why it can make it harder to keep eating habits in check - and what you can do about it.” The Conversation.
[2] NEDA. (2022). “Binge Eating Disorder.” National Eating Disorders Association.
https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed
[3] Strong, Rebecca & Roberts, Dannell, PhD, BCBA-D. 17 June 2022. “Why You Might Eat for Stimulation with ADHD, Plus How to Handle It.” Healthline.
https://www.healthline.com/health/adhd/adhd-eating-for-stimulation
[4] Understood. “ADHD and eating disorders.” Understood.Org.
https://www.understood.org/en/articles/adhd-and-eating-disorders-what-you-need-to-know