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The boom in women being diagnosed with ADHD has shone a light on a common comorbidity: binge eating disorder. Strong Women editor Miranda Larbi looks into the link between disordered eating and ADHD.
Binge eating disorder is the most common eating disorder in the UK, affecting an estimated 22% of adults. You probably know someone struggling with it right now – especially if you’ve got mates, family members or colleagues also living with ADHD.
The recent boom in women being diagnosed with attention deficit hyperactivity disorder (ADHD) has thrown a spotlight on how the condition can interact with food choices. While diet culture has hampered how we view nutrition and wellbeing generally, ADHD can often pose a unique set of culinary challenges for those still working out how to best manage their symptoms. And the big one tends to be around the binge-restrict cycle.
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“I’ve battled with binge eating my entire life,” says Zuva Seven, a writer currently based in Cape Town. Getting an ADHD diagnosis meant finally being able to make sense of her issues with food, she tells Stylist: “It made me realise that it wasn’t a personal failing. I don’t enjoy cooking as it takes a lot of my energy, so I tend to order food for convenience, which definitely stems from my diagnosis. But being around and talking to other ADHDers with the same issues has been helpful.
“That said, there isn’t much research I can find on the issue to truly feel like I know what I’m doing, tacrolimus use in psoriasis and getting medical support on top of everything else is quite expensive.”
“Binge eating disorder (BED) is much more common in adults with ADHD than in the general population,” explains Becca Harris, registered dietitian and founder of The Nutrition Junky. It’ll come as no surprise to learn that there’s no specific research into how much more prevalent BED is in women with ADHD, given the gender gap in ADHD diagnosis. But studies have found concrete links between BED and ADHD. A 2017 study published in BMC Psychiatry, examined 1,165 adults with eating disorders and found that over a third tested over the threshold for ADHD.
Another paper, published in the same year, assessed the self-reporting of ADHD symptoms and lifetime binge-eating behaviour in over 18,000 adult twins. Scientists found that ADHD symptoms were “significantly associated” with lifetime binge-eating behaviour and BED – something they said was “largely explained by shared genetic risk factors”.
If up to 75% of the 1 million women in the UK living with ADHD are still undiagnosed (as the ADHD Foundation claims), then that suggests that there are hundreds of thousands of women around the country who may be struggling with disordered eating too.
“It’s not uncommon with ADHD to forget to eat or ignore hunger for hours, then feel suddenly ravenous,” explains writer Jennifer Barton, who was diagnosed a year ago. “You’re starving but also too disorganised or exhausted to prepare something that might benefit you more, so you end up grabbing junk food and eating more than you need.”
She says that she used to ‘self-medicate’ with sweets and caffeine to the point of having over 15 espressos in a day “in an effort to function”. “Ireally had to force myself to eat meals rather than just forgetting for hours and then having a massive bag of crisps. Now I try to make as much food in advance as I can, which I refrigerate/freeze so I always have something healthy to heat up because even though I am on meds, I will still always reach for the easy junk option if it’s there.”
ADHD medication can suppress appetite – is that making matters worse?
While her medication helped her to deal with many aspects of ADHD, she says that it also suppressed her appetite for the first few months – something she found worrying, given her past history of disordered eating.
Dr Mohamed Abdelghani, consultant psychiatrist at Dyad Medical, explains: “Almost all ADHD medication can suppress appetite, although the degree to which appetite is affected depends very much on the medication and the individual patient.” He tells Stylist that if someone has a suspected eating disorder, it’s up to the psychiatrist to consider it in parallel with the ADHD treatment, so as not to make the eating disorder worse. It’s because of that, that “all patients must be screened for an eating disorder and informed about the likely side effects of the medication from the outset, with regular monitoring thereafter”.
Parenting has been Barton’s saving grace. ”I found it was much easier to start eating properly when I had to feed my kids anyway, and it motivated me to start learning to cook, find more nutritious foods. I am mostly plant-based/wholegrains now and it’s been such a game-changer because it’s easy to make the food in advance.”
Why are people with ADHD more at risk from binge eating?
But why might women with ADHD be more at risk from binge eating? That 2017 paper suggested a genetic predisposition towards binge behaviour – but does that mean it’s hereditary and necessarily beyond control?
“There is no simple explanation for this as many ADHD symptoms can contribute to binge eating behaviours,” Harris tells Stylist, going on to say that a number of things can make people with ADHD more susceptible to binge eating, including:
Having lower interoceptive awareness
That means you’re less attuned to hunger cues until you feel the hunger in other ways (eg. trouble focusing, dizziness, irritability). “If someone feels restricted like this throughout the day, they are more likely to engage in binge eating behaviours later,” Harris says.
Impulsivity or reward-seeking tendencies may cause people to turn to food for stimulation
That’s because, Dr Abdelghani explains, “dopamine helps to regulate emotional responses and scientific research has found that levels of dopamine could differ between those with ADHD and those without”.
He explains that patients with ADHD tend to have lower levels of dopamine which often leads to unhealthy or reckless behaviour including comfort eating and the type of binge eating we see in eating disorders such as bulimia. “We find then that in many cases, treating the ADHD first through medication and therapy can often result in success with regards to specific comorbid eating disorders, as long as the patient is strictly monitored throughout the treatment.”
ADHD medications can decrease appetite
As previously mentioned, some medications can change appetite. “However, when the medication eventually wears off, the person will still experience hunger if food was restricted,” Harris continues. “Unfortunately, this means that stimulants can further contribute to binge eating behaviours in some people.”
The importance of ADHD diagnosis for getting to the nub of binge eating
While BED might be relatively common, it’s worth saying that many women may not be aware that they’re in a binge-restrict cycle until they seek ADHD support. And that’s partly because BED was only recognised as an actual disorder in the DMS-5 (the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition)a few years ago – with public awareness still playing catch up.
It’s for that reason, Harris continues, that an ADHD diagnosis can be an important part of recovery. She explains that symptoms and comorbidities like BED might start to make more sense post-screening, and that ADHD treatment could offer tools for better managing the issue. “Separating yourself from the disorder and realising that the behaviour is not an issue of self-control can be incredibly liberating.”
Skye Rapson from Unconventional Organisation also flags research that suggests the link between BED and ADHD “may be related to reward processes in the brain which show similarities between those who have ADHD and those who struggle with excessive eating”. While her organisation deals largely with people who have been diagnosed with or suspect that they may have ADHD, Rapson says that clients regularly discuss how much more difficult their eating symptoms were to manage before receiving an ADHD diagnosis, after which they were able to access the right support and tools.
Fran Lever has struggled with BED since she was a teenager and received an ADHD diagnosis a few months ago. “I always knew that something was up because of the control element – I’ve always struggled with diets as I lose that control and temporarily regain it when I binge.” She calls herself an “emotional eater”, becoming easily overwhelmed by food, especially when it comes to protein and calories.
Receiving her diagnosis has meant having to put systems in place, which has seen Lever plan meals. “I can’t casually or socially eat most of the time unless it’s planned ahead of time. If I don’t manage to get three meals a day, I’m bingeing during the meals I do get to try to claw back that control.”
Rapson explains that a diagnosis of ADHD “can help people to understand why they struggle with reward-based decision making or executive functioning”. “They may have specific issues with dopamine stimulation or working memory that can make it difficult to cook food or to follow through with dietary decisions they had made previously. Being able to understand that you have ADHD will allow you to seek support in a way that works for you and how your brain works, rather than seeking support that works better for neurotypicals.”
Expert tips for managing ADHD nutrition
Of course, there’ll be many women out there who still haven’t got an ADHD diagnosis for various reasons, and that could be holding them back from receiving adequate support. But whether you are diagnosed or strongly suspect that you’ve got it, there are plenty of things you can do to support a better relationship to food and nutrition.
- Seek support. If you’re struggling with disordered eating, then your first move should be to visit your GP. They’ll be able to help put you in touch with eating disorder specialists and/or ADHD therapists. Or get in touch with the eating disorders charity Beat, who can help advise you on the best way forward.
- Learn to identify your hunger cues. “If you aren’t accustomed to feeling hunger in the traditional sense (ie. hunger pangs), take some time to learn how your body feels when it is hungry,” Harris says. She recommends starting by setting reminders on your phone to check in with yourself every three or four hours. You can then use those prompts to think about how energetic or focused you feel.
- Set up a routine. “Planning when you’re going to make and eat food in advance can make it so much easier to follow through on days that you’re struggling with executive functioning,” Rapson says. “An executive functioning or ADHD coach could help you to develop and test these routines.”
- Find other activities that bring you pleasure. Rapson recommends creating a ‘dopamenu’ of alternative dopamine-promoting activities to do when you’re feeling bored or under-stimulated. That might mean giving post-work yoga a go, trying walking meetings, trying embroidery or something totally new.
- Eat enough carbohydrates, protein and fibre throughout the day. Carbohydrates are the main source of energy for your cells, and protein and fibre help you feel full longer. By really focusing on eating a balanced meal, you’re going to give yourself the best chance at maintaining stable energy and output.
- Invest in a freezer. Rapson says that using a freezer rather than putting everything in the fridge can help with meal prepping. Rather than having a fridge full of food that needs eating soon, batch cooking and freezing means having easily accessible, nutritionally balanced snacks and meals at hand.
- Find what works for you. Diets don’t really work for anyone, but if you’ve got ADHD, they’re probably just going to exacerbate matters. If using a timer for meals or eating regular snacks throughout the day works best for you, crack on.
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