Studies show that someone with ADHD is 30 percent more likely to develop binge eating disorder, or BED. A growing body of evidence is showing that some of the distinct functional abnormalities that characterize ADHD are also found in individuals with BED. Here are details on how the two can be related, and about treatments.
What is binge eating disorder?
Binge eating disorder involves recurrent episodes of eating large quantities of food within a relatively short period of time. These binges are associated with distinct emotions — a profound sense of lack of control during the binge and feelings of shame, distress or self-disgust immediately afterward. Unlike some other eating disorders, BED is not accompanied by inappropriate compensatory behaviors like purging or over-exercising.
ADHD and BED are alike
Nearly all psychiatric illnesses, including ADHD and BED, arise from a combination of factors involving body, brain and mind.
“Eating disorders develop as a result of biological, social and psychological factors,” says registered dietitian Katherine Metzelaar, founder of Bravespace Nutrition. “So, it is very common for eating disorders to intersect with other mental disorders.”
Psychiatrist James Greenblatt, chief medical officer at Walden Behavioral Care in Waltham, Mass. agrees. “There appears to be significant ‘overlap’ in terms of involved neural circuitry,” says Greenblatt, who authored Finally Focused and Integrative Medicine for Binge Eating. “Both [ADHD and BED] demonstrate abnormalities in reward and response inhibition, in addition to emotional processing and regulation.”
Lack of dopamine is a big factor
Dopamine, a chemical messenger in the brain (also known as a neurotransmitter), is involved in the regulation of emotional responses. One of the main responses is motivation and reward. Dopamine plays a key role in helping a person feel calm and focused.
Greenblatt explains that both ADHD and eating disorders like BED involve insufficient levels of dopamine. People who lack dopamine are biologically driven to engage in excessive or unnatural reward behaviors to satisfy the demands of their under-stimulated neural reward circuits.
The low-dopamine level in an individual with ADHD might manifest as a feeling of anxiety, lack of motivation, or inability to concentrate. For an individual with BED, says Greenblatt, the lack of dopamine might manifest in a variety of ways:
- Poor awareness of internal cues of hunger and fullness
- Inability to stop bingeing
- Inability to follow a meal plan
- Inability to accurately judge a portion size
- 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
Another big player is genetics
Recent studies have revealed shared genetic risk factors between ADHD and BED. “While research is ongoing, and there is much more to learn about the ways in which genes influence neuropsychiatric risk,” says Greenblatt, “we have uncovered fascinating evidence regarding genetic associations in ADHD-BED comorbidity.”
Greenblatt cites a 2017 in Psychological Medicine that explored the impact of genetic and environmental factors on the co-occurrence of ADHD symptoms and BED behaviors among female adult twins. The data indicated a significant association between ADHD symptoms and lifetime binge-eating behavior. That association was explained primarily by shared genetic factors.
To gain insight into the genetics of ADHD and its comorbidities, researchers from Europe and the United States joined forces from 2016 to 2021 on a project called CoCA: Comorbind Conditions of Attention-deficit/hyperactivity disorder (ADHD). Their study, along with more than 40 scientific publications, supports the hypothesis that genetic factors cut across psychiatric disorders and help explain the association observed between ADHD and other conditions.
Treating ADHD and binge eating disorder
Hyperactivity/impulsivity is the most visible aspect of ADHD, and bingeing is the most visible aspect of BED. “The crux of both ADHD and BED, however, lies within — in dysregulations of biology and psychology,” Greenblatt says.
The atypical hyperactive and impulsive behaviors are just the tip of an iceberg that extends down to an individual’s unique biochemical makeup. “Effective treatment for both ADHD and BED hinges on the tailoring of interventions to the unique needs of each individual patient,” says Greenblatt, “i.e., personalized medicine that targets the underlying root causes—both biological and psychological—of the disorder. That said, it is vital that both disorders be addressed simultaneously.”
A specific medication is now available for patients who have ADHD and BED. The U.S. Food and Drug Administration has approved a medication called Vyvanse for treatment of moderate or severe BED in adults.
In January 2021, 34-year-old Lindsay Guentzel, a Minneapolis-area radio news producer, was diagnosed with ADHD. Before her diagnosis, she “suffered every eating disorder under the sun,” especially binge eating.
Guentzel says her ADHD treatment of medication and therapy “has essentially eliminated all of my issues with food.” Her relationship with food has completely changed. “I no longer have an all-or-nothing attitude toward food, and I no longer eat past the point of being hungry,” she says. “I used to gorge myself until I was so full and uncomfortable—like each meal was going to be my last and I had to take in as much as possible.”
Now, Guentzel says, she is much more aware of how she’s feeling as she eats and can stop before she reaches the point of being too full. “I think a lot of it has to do with my manic behaviors being calmed and more controlled,” she says. “I also think I’m learning how to regulate my emotions better, and that has meant cutting out food as a coping mechanism.”