ADHD in Eating Disorder Recovery
ADHD is extremely common in individuals with eating disorders. Sometimes ADHD comes first, before any eating disorder behaviors or symptoms are present. Other times, symptoms of ADHD present after one has been engaging in an eating disorder.
It can therfore be very difficult to tease apart which symptoms belong to what, as there are so many overlaps.
For example:
Is your child having trouble focusing in school because they have ADHD, or are they having trouble focusing due to inadequate nourishment caused by their eating disorder?
Are they constantly fidgeting or struggling to sit still because they have ADHD, or because their eating disorder makes it very challenging for them to reside in stillness (whether that is because they find it challenging mentality to be IN their body, and/ or because they try to maintain constant movement to burn calories).
Other eating disorder symptoms that are also symptomatic of ADHD are as follows:
Compulsive eating
Erratic meal times or skipping meals
Eating past fullness simply because there is food in front of you
Higher sugar cravings
Seeking dopamine through ED behaviors such as purging and binge eating
Putting off a meal or restricting food for a period of time so that when you do eat it feels more rewarding (reward sensitivity)
What research shows us is that individuals with ADHD are significantly more likely to develop an eating disorder. ADHD can lead to impulsive and compulsive eating habits, mindless eating, and irregular or chaotic eating patterns and timing. We see this most often in binge eating disorder and bulimia.
It is therefore imperative to address and support ADHD simultaneously to the eating disorder when appropriate. Here at The Center, this is supported holistically through coaching, nutrition and naturopathic medicine.
There are many ways to support ADHD, and yes, medication is one of them.
The concern we have with this, is that these medications are an appetite suppressant. So much so, that we often see individuals who have found access to these medications in order to sustain their restrictive eating behaviors (kids will sell them at school, for example). We have also seen all too often young people with eating disorders requesting to get tested for ADHD in order to be able to go on the medication, which aids in their ability to engage in restrictive food behaviors.
When in eating disorder recovery, one has to:
Learn to reconnect with their hunger and fullness cues
Honor their natural appetite and move through the process of learning to be comfortable with this
Find supportive alternate activities to behaviors like binge eating and purging
Move through the urges to engage in purging, binge eating, and restricting without engaging in them, and build a tool box of ways to support this healthfully
Sit in the discomfort of all of the above
When on medications for ADHD, it will suppress these normal cues of hunger, fullness, urges, and appetite in general. This creates a disconnect between what we need to learn in recovery to be well, and what is being experienced by the individual on medication.
For example:
How can we ask someone to learn to honor their hunger if that feeling is being suppressed?
How can we inevitably teach someone to move beyond mechanical eating and towards intuitive eating (in readiness) when they have a suppressed appetite?
How can we teach someone to “urge surf” when they have the trigger and urge to binge eat if that is being suppressed while on medication?
I pose these questions not to say I have all the answers, and certainly not to tell you what is wrong or right, but rather to create space for thought. That space in between all or nothing is where all the magic happens in eating disorder recovery. There is nuance to everything, and nothing in health or recovery is one size fits all. For some, going on medication will be the right choice for a variety of personal and clinical reasons. For others, and arguably most, it will be much more appropriate to move through eating disorder recovery without being on an appetite suppressing medication. In this scenario, their ADHD is still supported in numerous other ways, and once firmly rooted in their recovery, they can assess if/ what ADHD symptoms are still present and how best they want to continue to support that in a way that supports ADHD as well as their ongoing recovery. We cannot ever support one at the cost of the other.
I feel it is imporant here to share that I speak from personal experience. In university I was diagnosed with ADHD and put on medication. I was also struggling with binge eating disorder and exercise bulimia. The prescribed medication was detrimental to the eating disorder and allowed me to restrict quite severely. My weight plumeted along with my phsyical health and mental health. It also caused me to restrict in my life (as what happens on your plate is happening in your life) and I retreated into isolation for days at a time, using medication to go deeper and deeper into the eating disoder.
I finally realized that the medication was taking so much away from my life and chose to come off of it. I could not have recovered from the eating disorder if I had not made this choice. The extent to which it suppressed my appetite would have made connecting with my body, hunger and fullness cues, and likes and dislikes impossible. I also needed to learn to navigate the urges to binge and over exercise in healthful ways, which meant I needed to have those urges, not suppress them, in order to learn to move through them and ultimately recover.
Once recovered, many of the ADHD symptoms ceased to exist as well. I was calmer, could be still in my body, learned to be a great learner through knowing myself and my learning style, and was no longer erratic and self destructive. I honestly do not know if I would be diagnosed as ADHD if I had been tested once recovered vs while sick with an eating disorder. Which is why I feel sharing this blog today is so important.
As always, if you have questions or would like to learn more about our Youth Recovery Program or Meal Support Services, we offer free discovery calls and are always happy to connect.
