I am in the process of moving, so I spent this weekend packing boxes. Throughout the weekend, I noticed myself starting to pack items and not finishing before moving on to packing other things.
By the night's end, I was moving around my home as if I was in the vault scene in Mission Impossible and could barely open the front door without knocking over boxes. It was a disaster!
But disaster aside, it reminded me so much of what people with Attention-Deficit Hyperactivity Disorder (ADHD) experience. There are a lot of behavioral and neurological similarities between ADHD and Binge Eating Disorder (BED). Although individuals with BED are more likely to have a different co-occurring disorder, approximately one in five individuals with BED also has ADHD.
Attention-deficit issues among folks with binge eating behaviors are not commonly discussed, and few articles describe the overlap.
Signs & Symptoms
Before I dive in headfirst to all of the similarities, I want to take a step back and discuss what binge eating and ADHD look like. To the outsider looking in, a person with ADHD may appear as if they are not listening, struggle to sustain attention, and have difficulty following through on instructions. As a result, students may make more careless mistakes in the classroom than their non-ADHD counterpoints. They may also avoid tasks that require sustained attention.
Individuals with ADHD often seem off-task either by talking excessively, getting up constantly, or paying attention to unrelated stimuli. In relationships, people with ADHD may come off as disrespectful by often interrupting, finishing others' sentences, and not waiting their turn. People may also become frustrated with individuals with ADHD when they lose items or forget to do daily activities.
People with BED may struggle with concentration due to the rapid thoughts around weight, shape, and eating. As a result, they may switch from diet to diet, looking for a solution to their problems. To engage in their binge eating behaviors, folks with BED create routines to allow them to engage in their disordered behaviors.
Emotionally, people with BED experience a great deal of shame and distress around their eating patterns. Because of their shame, they will eat in secret often. Check out the Conditions page to better understand BED's signs and symptoms.
Behaviorally, there is an overlap between symptoms of impulsivity and concentration. For example, just like individuals with ADHD are hyperfocused on activities they enjoy, people with BED may become hyper-focused on eating activities such as searching for recipes or looking up new diets.
Statistics
More men are diagnosed with ADHD than BED, which more women are diagnosed with. Women often display inattentive symptoms, whereas men display the more overt hyperactivity symptoms. Most women finally receive an ADHD diagnosis when their children finally do.
Eating disorders affect people of all races, but Black and Hispanic people are less likely to receive care for their disordered eating. However, there are some differences in how eating disorders present among different races. For example, black and Hispanic individuals are more likely to display bulimic and binge eating behaviors than white individuals.
Like BED, ADHD affects people of all races, but minority groups are less likely to receive a diagnosis. In addition, black individuals are more likely to receive other impulse control disorders such as Oppositional Defiant Disorder.
ADHD is more likely to be diagnosed in childhood when problems in school may arise. Conversely, BED is more likely to be diagnosed in adulthood.
Neurobiology
In a person without ADHD, dopamine is associated with reinforcing events, and as these events become more predictable, dopamine cell firing occurs earlier. This process fails with individuals with ADHD. This lack of dopamine in the system is why ADHD is often treated with stimulants to help improve the overall levels of dopamine in the body.
Individuals with BED demonstrate fewer dopamine receptors and therefore experience a lesser reward cue to food experiences than individuals without eating disorders. The addition of a stimulant is not effective as the receptor site is not functioning correctly.
Treatments
One medication for ADHD and Binge Eating Disorder is Vyvanse. Vyvanse, a stimulant medication used to treat ADHD, is one of the few approved medications for BED. Additionally, as mentioned above, those with BED have more significant issues with dopamine receptor sites than dopamine levels.
As a stimulant medication, Vyvanse has side effects of suppressing appetite and, in turn, weight loss. There is concern among eating disorder professionals that adding Vyvanse into an individual's treatment may target appetite, countering many of the behavioral interventions used in treatment.
However, the idea is to target impulsivity, generally, which allows individuals with BED the space to manage binge urges as they arise. The key to utilizing Vyvanse as part of the treatment for BED is to assess the nature of the problem entirely. If a co-occurring diagnosis of ADHD exists and impulsivity is a behavioral target, Vyvanse can be a beneficial addition. However, many people with BED do not display impulsivity, and in those instances, other treatments may be more helpful.
Another similar approach to ADHD and Binge Eating Disorder is cognitive-behavioral interventions that address behavioral activation, focusing on building routines around non-motivating activities and increasing engagement in pleasurable events.
If you or a loved one are experiencing the symptoms described above, I would encourage you to work with a mental health professional to fully assess the nature of what you or your loved one are dealing with. Many great mental health providers are out there, including me. Schedule a free consultation if you are ready to set up a time to chat.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
Ballentine, K. L. (2019). Understanding Racial Differences in Diagnosing ODD Versus ADHD Using Critical Race Theory. Families in Society, 100(3), 282–292. https://doi.org/10.1177/1044389419842765
Bello, N. T., & Hajnal, A. (2010). Dopamine and binge eating behaviors. Pharmacology, biochemistry, and behavior, 97(1), 25–33. https://doi.org/10.1016/j.pbb.2010.04.016
Hudson, J. I., Hiripi, E., Pope, H. G., Jr, & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040
Tripp, G., & Wickens, J. R. (2009). Neurobiology of ADHD. Neuropharmacology, 57(7-8), 579–589. https://doi.org/10.1016/j.neuropharm.2009.07.026