ADHD and eating disorders in adults

Some adults with ADHD wonder whether eating on impulse, forgetting meals during a busy day, or eating late at night is connected to their attention problems. Patterns like these are not, by themselves, an eating disorder. But diagnosable eating disorders are also more common in people with ADHD, and they are serious medical conditions. This page covers what the research shows, how an ADHD evaluation takes eating into account, and why the two conditions together change how ADHD medication is used.

For everyday eating patterns that are not an eating disorder, see ADHD and eating, including binge eating.

The eating disorders this page is about

The National Institute of Mental Health (NIMH) describes four common eating disorders:

• Anorexia nervosa: severely restricting food because of a distorted self-image or intense fear of gaining weight. NIMH notes that it has an extremely high death rate compared with other mental disorders.
• Binge eating disorder: regularly losing control over eating and eating unusually large amounts of food.
• Bulimia nervosa: regular binge eating followed by unhealthy behaviors to prevent weight gain, such as forced vomiting or laxatives.
• Avoidant restrictive food intake disorder (ARFID): limiting the amount and variety of food because of fear of what eating might cause (such as choking or vomiting) or dislike of how foods look or feel.

NIMH stresses that eating disorders are not a choice, can affect people of any body weight, and can be treated successfully.

How often ADHD and eating disorders occur together

The main summary of the research is a 2016 meta-analysis in the International Journal of Eating Disorders. It combined 12 studies of people with ADHD (about 4,000 people with ADHD and 29,000 comparison participants) and 5 studies of people with eating disorders.

Two details matter. First, the link was stronger when ADHD was diagnosed by clinical interview than by self-report questionnaire. Second, the analysis measured an association, not a cause. Its authors called for research on whether people with both conditions have a different course and response to treatment, which is still an open question.

An odds ratio is not the same as a percentage. These figures say an eating disorder is several times more likely with ADHD, not that most people with ADHD develop one.

How an evaluation takes eating into account

Guidelines expect ADHD evaluations to look at coexisting conditions. NICE guideline NG87 says the diagnostic process should include an assessment of coexisting conditions and physical health. For eating, that means it helps to tell the clinician plainly about:

• Eating episodes that feel out of control, and how often they happen.
• Restricting, skipping meals on purpose, purging, laxatives or compensatory exercise.
• Recent weight changes, in either direction.
• Any past eating disorder diagnosis or treatment.
• Whether you have ever used stimulants, prescribed or not, to control appetite or weight.

None of this disqualifies anyone from an ADHD evaluation. It shapes what treatment is safe. Dr. Shershow's adult ADHD evaluation covers current symptoms, childhood and work history, health, medications, sleep and substances, and other explanations for symptoms, and ends with what it found and the treatment options that fit. The practice does not treat eating disorders; if one is suspected, that care comes from clinicians who specialize in it.

Why ADHD medication needs extra care here

Stimulants commonly reduce appetite. The Vyvanse (lisdexamfetamine) prescribing information lists decreased appetite, decreased weight and "anorexia" among its most common side effects in ADHD trials. In drug labels, "anorexia" means loss of appetite, not the eating disorder, but for someone with a history of restrictive eating the effect is the same concern.

NICE gives specific advice that applies:

• Slower changes, closer monitoring. Recommendation 1.7.28 calls for slower dose adjustment and more frequent monitoring when an eating disorder is present.
• Weight checks. NICE recommends measuring weight every 6 months in adults taking ADHD medication, and considering BMI monitoring if treatment has changed weight.
• If weight loss becomes a concern. NICE lists options such as taking medication with or after food, adding meals when the medication has worn off, getting dietary advice, a planned break, or changing medication.

Questions worth raising with a prescriber before starting or changing ADHD medication when there is an eating disorder history:

• How often will my weight be checked, and by whom?
• Which changes in appetite or eating should I report right away?
• If my appetite drops, which of the NICE options (meal timing, extra meals, dietary advice, a break, a different medication) make sense for me?
• How will this plan be coordinated with my eating disorder treatment team?

More on this side effect is in ADHD medication, appetite and weight.

Vyvanse and binge eating disorder

Besides ADHD, Vyvanse has a second FDA-approved use: treatment of moderate to severe binge eating disorder in adults. Its label is equally clear that it is not indicated or recommended for weight loss, that its safety and effectiveness for treating obesity have not been established, and that other stimulant-type drugs used for weight loss have been linked to serious heart problems. Details are on the Vyvanse guide page.

For other eating disorders, NIMH notes that medication can help some symptoms of bulimia nervosa and binge eating disorder, but no medications are FDA-approved for anorexia nervosa or ARFID.

What eating disorder treatment involves

NIMH describes eating disorder treatment as a plan that usually includes psychotherapy, medical care and monitoring, nutritional counseling, and sometimes medication. Some people with a severe eating disorder need a hospital or residential program. NIMH adds that co-occurring conditions should be treated as part of the plan, which is where ADHD care fits: alongside eating disorder treatment, coordinated with it, not instead of it.

Because NIMH also notes that people with eating disorders have a higher risk of suicide, any thoughts of self-harm deserve immediate help. Call or text 988 to reach the Suicide and Crisis Lifeline, or call 911 in an emergency.

When to talk to a clinician

If eating feels out of control, if you are restricting or purging, or if weight is changing quickly, talk with a primary care clinician soon; NIMH recommends that as a first step. If long-standing problems with attention, impulsivity and organization are also part of your life, an ADHD evaluation can sit alongside that care. The adult ADHD self-test can help you put symptoms into words before a visit. To arrange an ADHD evaluation, see ADHD testing in NYC or ADHD testing in New Jersey, or call the office. Related reading: ADHD and impulsivity in adults.