Unique Features of ADHD in Eating Disorders: Understanding the Connection
When we think of eating disorders, we often picture perfectionism, control, and anxiety. But there’s a growing body of research showing that Attention-Deficit/Hyperactivity Disorder (ADHD)—typically associated with inattention, impulsivity, and hyperactivity—is frequently present in those struggling with disordered eating.
In fact, the connection between ADHD and eating disorders is not only underrecognized—it’s uniquely complex.
This post explores how ADHD and eating disorders intersect, why they are often missed when they co-occur, and what treatment teams and families should consider when supporting individuals with both diagnoses.
How Common Is the Overlap Between ADHD and Eating Disorders?
Recent studies suggest:
Individuals with ADHD are significantly more likely to develop binge eating disorder, bulimia nervosa, and emotional eating patterns (Nazar et al., 2016).
Girls with ADHD, especially the inattentive subtype, are more likely to develop disordered eating in adolescence, despite being historically underdiagnosed.
Between 20–30% of patients with binge eating or bulimia symptoms may meet criteria for ADHD, though many are undiagnosed at the time of eating disorder treatment (Levy et al., 2015).
Yet, many clinicians and treatment programs still overlook ADHD as a contributing factor—especially in females, who often present differently than boys.
How Does ADHD Contribute to Disordered Eating?
1. Impulsivity and Binge Eating
ADHD is characterized by difficulties with inhibitory control. This can contribute to:
Impulsive food choices
Difficulty stopping eating once started
Emotional dysregulation leading to “stress eating”
Eating in response to stimulation-seeking or boredom
This makes individuals with ADHD particularly vulnerable to binge eating disorder (BED) or bulimic behaviors.
“Impulsivity is one of the strongest predictors of binge-type eating behaviors, especially in adolescents with undiagnosed ADHD.”
— Mikami et al., 2010
2. Inattention and Disconnected Eating
Those with ADHD may:
Forget to eat or miss hunger cues
Go long periods without food, then binge in the evening
Struggle to plan meals or grocery shop
Get distracted while eating and lose track of fullness
This chaotic eating pattern often mimics disordered eating—but is actually rooted in executive functioning challenges rather than body image concerns.
3. Executive Dysfunction and Meal Planning
Meal prep, consistent shopping, and structured eating require planning, time awareness, and follow-through—all areas where individuals with ADHD struggle.
Without support, this can lead to:
Skipped meals
Reliance on convenience foods or restriction
Shame around “failing” to eat “right,” fueling a diet-binge cycle
4. Emotional Dysregulation
ADHD is associated with difficulty managing intense emotions. Food may be used to:
Soothe discomfort
Manage rejection sensitivity
Create a sense of control or reward
This emotional vulnerability can drive both restrictive and binge-type behaviors.
5. Rejection Sensitivity and Body Image Issues
Many people with ADHD experience Rejection Sensitive Dysphoria (RSD)—a heightened emotional response to perceived criticism or failure. In a world that often emphasizes appearance and performance, individuals with ADHD may:
Feel like they are “never good enough”
Fixate on body size as something they can control
Use restriction or over-exercise to feel competent
This overlaps with traits often seen in anorexia nervosa and orthorexia.
The Gendered Gap: ADHD in Girls and Eating Disorders
Girls with ADHD are:
Less likely to be hyperactive
More likely to present with inattention, anxiety, daydreaming, and perfectionism
Frequently missed or misdiagnosed with depression, anxiety, or disordered eating first
This can delay both ADHD and eating disorder diagnosis and result in treatment plans that fail to address neurodivergence.
What ADHD-Informed Eating Disorder Treatment Should Include
✅ 1. Executive Function Support
Use of planners, alarms, and visual reminders for meals
Meal delivery or simplified meal prep options
Step-by-step guidance for grocery shopping or cooking
Scaffolding routines to prevent long fasts followed by binges
✅ 2. Medication Evaluation
Stimulant medications like methylphenidate or amphetamine-based medications may:
Help regulate appetite by reducing impulsive eating
Improve focus and emotional regulation
However, they can also suppress appetite or be contraindicated in active restriction, so close monitoring by a psychiatrist is essential.
✅ 3. Therapy Adapted for ADHD
Combine CBT or DBT with executive function coaching
Include emotion regulation, shame reduction, and body neutrality
Validate both the eating concerns and the ADHD-related challenges
✅ 4. Flexible Nutritional Support
Use nonjudgmental language (no “good” or “bad” foods)
Encourage structured, scheduled eating over hunger-based cues (which may be blunted)
Offer grab-and-go or repetitive meals if helpful for consistency
✅ 5. Identity-Affirming Care
Explore how neurodivergence and eating behaviors intersect
Normalize non-linear progress
Include discussions of sensory sensitivities, stimulation needs, and rejection sensitivity
Final Thoughts
ADHD and eating disorders share more than we realize—but the treatment system is still catching up. Many individuals, especially girls and neurodivergent youth, slip through the cracks because we focus too narrowly on body image and control.
For individuals with both ADHD and disordered eating, healing must involve more than just food. It must include:
Emotional validation
Practical tools
Neurodiversity-affirming care
And a recognition that impulsivity, inattention, and chaos aren’t character flaws—they’re part of a different way of being.
When we treat the whole person—not just their symptoms—true recovery becomes possible.
References
Nazar, B. P., et al. (2016). The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. International Journal of Eating Disorders, 49(2), 104–118.
Levy, L. D., Fleming, J. P., & Klar, D. (2009). Treatment of refractory binge eating disorder with topiramate in patients with comorbid ADHD: A case series. CNS Spectrums, 14(5), 286–289.
Mikami, A. Y., et al. (2010). Social functioning in children with ADHD: Relation to eating disorder risk. Journal of Abnormal Child Psychology, 38(5), 705–717.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
Edebol, H., et al. (2013). Self-reported symptoms of ADHD among adult eating disorder patients. European Eating Disorders Review, 21(5), 345–351.
