James Greenblatt, MD
Attention deficit hyperactivity disorder (ADHD) is a medical condition associated with difficulty concentrating, staying organized and controlling impulses. Although people with this diagnosis may appear to be bursting with energy, they have trouble channeling that energy effectively and controlling their impulsivity. They may act before they’ve thought things through, speak out of turn or say things they later regret. Because of poor planning, missed appointments and forgotten details, both personal and work relationships may suffer.
Our culture bombards us with enticements for high-caloric food, which makes it difficult for those who eat in reaction to environmental cues rather than to the sensation of hunger to eat healthily and in accordance with natural signals of hunger. Those suffering from ADHD and those with disordered eating deal with boredom, stress and intense feelings by overeating in order to soothe themselves. Those with ADHD may be particularly likely to forget to eat and to binge later. Or they may have trouble planning and shopping ahead, which can result in spur-of-the-moment and uncontrolled eating.
The connection between ADHD and overeating
Considerable recent research focuses on connections between ADHD and overeating in adolescents and adults. A recent study conducted by researchers at the Child Study Center at New York University’s Langone Medical Center found that men who were diagnosed as children with ADHD were twice as likely to be overweight in a 33-year follow-up study compared to those who were not diagnosed with the condition. Results from the study show that men with childhood ADHD had a significantly higher body mass index, or BMI (30.1 versus 27.6) and obesity rates (41.1% versus 21.6%). The researchers attributed the higher incidence of obesity occurring in adults with ADHD to lack of impulse control and poor planning skills, leading to poor food choices and irregular eating habits. Children and adolescents with ADHD need to be taught healthy eating habits in order to avoid developing disordered eating patterns.
Attention-deficit hyperactivity disorder is now viewed by experts as caused by an imbalance in brain chemistry. The neurotransmitters norepinephrine and dopamine may be in short supply in the brains of those with ADHD. Although too much norepinephrine can contribute to anxiety, too little can cause problems with concentration and learning. Those with a deficiency in norepinephrine have trouble blocking out distractions and organizing their lives.
Dopamine is essential for control of impulses and for enabling a person to sit still and wait. Animals in the wild freeze in their tracks in response to a threat because of a blast of dopamine. People lacking dopamine act impulsively, blurt out opinions, burst out in anger and later feel regret. As dopamine is an essential part of the body’s reward circuit, a deficiency in this neurotransmitter intensifies the urge to indulge in behaviors such as overeating, substance abuse and other risk-taking behaviors to achieve the same reward others get from less harmful behaviors. People whose brains are low in dopamine often self-medicate with high-caloric food because of its ability to activate dopamine in the common reward pathway.
A deficiency in the two neurotransmitters norepinephrine and dopamine can lead to the following behaviors related to eating:
- Poor awareness of internal cues of hunger and satiety, or fullness
- Inability to follow a meal plan
- Inability to judge portion size accurately
- Inability to stop bingeing or purging
- Distraction by continual thoughts of food, weight and body shape
- Increased desire to overeat, especially high-calorie, “reward” type foods
- Poor self-esteem due to repeated failures at self-control
In patients with coexisting psychiatric and eating problems, which came first? Is ADHD the switch that turns on disordered eating, or does the eating disorder leave the brain so undernourished that it can’t function optimally? Which came first appears to vary depending on the individual person. In some people, eating disturbances evolve with other psychiatric symptoms; in others, signs of a psychiatric disorder are not apparent until the disordered eating patterns are firmly established. In still others, problems with mood and problems with appetite seem to have always coexisted. Regardless of the order of onset, the simultaneous presence of disordered eating and a mental illness means that effective treatment for the disordered eating must address both conditions. This is the only approach that will slowly lead the way to recovery and prevent the all-too-common patterns of relapse and repeated failures.
A commonly missed diagnosis
The relationship between many psychiatric disorders with disordered eating is complex. ADHD is the most commonly missed diagnosis in relation to food and appetite problems. All adults seeking treatment for binge eating or obesity should be screened for ADHD. I believe effective treatment for ADHD can significantly help patients off the roller coaster of disordered eating.
Fortunately, I have witnessed many times a dramatic reduction in disordered eating once a patient is treated for ADHD. The strong urge to binge or to self-medicate with food subsides once the impulsivity and inattention of ADHD are treated. The individual experiences a new ability to tune in to his or her body’s signals, control cravings and improve impulse control.