What does ADHD have to do with Eating Concerns? Part 2

What does ADHD have to do with Eating Concerns? Part 2

The more we learn about ADHD and eating disorders, the more we are coming to understand that the incidence of ADHD is actually higher in the eating disorder population and is not just eating disorders “looking like” ADHD. Something is happening here that warrants further understanding and exploration of how we approach eating disorder treatment when this comorbidity is present. 

There are biological, cognitive, and behavioral patterns inherent in both that can influence the severity and longevity of the eating disorder, as well as the recovery trajectory. People with ADHD and eating disorders have differences in how their brains process rewards, often looking for dopamine hits that can come from eating disorder behaviors. Disturbance in body awareness as an associated feature interferes with the ability to feel hunger/satiety cues and feelings. Difficulties with decision-making, planning, as well as time-blindness and difficulty with transitions, make it harder to meal plan and nourish oneself consistently throughout the day. People with ADHD often seek certain types of food making it more difficult to eat a wide variety of food. These are just some of the many nuances that show up with clients who have both an eating disorder and ADHD. 

The treatment for ADHD is very clear in the literature. We know that medication is incredibly helpful above and beyond therapy and behavioral modifications alone. As I mentioned before, it gets messy when someone also has an eating disorder as many ADHD medications are known to suppress appetite. But instead of concluding that medicating ADHD for someone who also has an eating disorder is contraindicated, we need to explore the nuances in this as well. 

While ADHD medication may compromise hunger cues, the medication may also help to overcome other barriers to recovery. For example, the client may be better able to strategize and execute on their meal plan as they suddenly have the brain capacity to do so. ADHD medication can relieve some of the symptoms that the eating disorder worked to mitigate, such as dysphoria, distress, feeling overstimulated and overwhelmed. Clients may be better able to tolerate the distress inherent in eating disorder recovery with the help of medications that can calm their minds. 

I am not “that kind of doctor” that can assert medication for clients. I am the kind of doctor who advocates for treating all the presenting concerns our clients face. And the more we understand about ADHD and its relationship to eating disorders, we understand the critical importance of treating both illnesses. If we only treat the eating disorder and neglect ADHD, our clients will likely struggle more on the path to recovery and in their ability to sustain it. Besides this, we would be neglecting ongoing and treatable pain that were treated, which would bring immense relief, increased confidence, self-awareness, and continued motivation. 

We have a lot more to learn and understand about ADHD and eating disorders. And what we do know so far, calls us in the field to look closely at the nuances these presentations bring to treatment, and how we need to be flexible, mindful, and deliberate in how we help treat our clients to optimize their success.

What does ADHD have to do with Eating Concerns? Part 1

What does ADHD have to do with Eating Concerns? Part 1

Attention Deficit Hyperactivity Disorder (ADHD) seems to be the diagnostic soup de jour. We all heard about the Adderall shortages that started in late 2022 and still aren’t fully resolved now in 2024. Everyone is talking about ADHD and more and more people are getting diagnosed with it. Diagnoses are especially escalating among adults, with rates of adult diagnosis increasing four times faster than diagnostic rates for children. 

A lot of people are skeptical about this rise in diagnosis. Are smartphones making everyone develop ADHD? Is it the plastics? Is it our stressful lifestyles and chronic inflammation? Are there really that many more people with ADHD today? Or have there always been this many people with ADHD and we are now better at catching it with increased awareness and access to resources? 

Just as rates of ADHD increase, our field is continuing to grow in its own understanding of this diagnosis. As it relates to my interest in women’s issues, we know that females have historically been underdiagnosed for ADHD given the nuances of its presentation in females and female’s ability to compensate and mask symptoms. 

ADHD also has a unique and messy history with its association to eating disorders. When I started working in the field of eating disorders over a decade ago, I was implicitly and explicitly taught to be skeptical of clients who self-ascribed as having ADHD in addition to an eating disorder. I was taught that 1. Malnourished and starved brains present in similar ways to people who have ADHD, and 2. Our clients are incentivized to claim themselves to have ADHD so they can be prescribed a stimulant that would curb their appetite and further their weight loss goals. I was taught that when clients are re-nourished, their “ADHD symptoms” would resolve, confirming the above assertions. Our clients would then understand that their experiences with ADHD symptoms were really just manifestations of their eating disorder and they would feel the relief that comes with a nourished brain and be incentivized to stay in recovery. 

Join me next week for Part 2 as we discuss more about ADHD and eating disorders. 

In Defense of Emotional Eating

In Defense of Emotional Eating

The term “emotional eating” is often used with a negative connotation. Eating for emotional reasons, rather than to satisfy hunger, is usually talked about as something physically and emotionally unhealthy. Here’s my take: Emotional eating isn’t inherently unhealthy! 

Of course, “emotional eating” can sometimes be an ineffective form of coping with emotions or distress. Avoiding emotions through eating can be part of an unhelpful cycle. (Then again, so can avoiding emotions through NOT eating!) However, it makes sense for us to involve food in our experience of many emotions, pleasant and unpleasant!

Eating out of celebration can connect us to our culture, to family and loved ones, and to sensory delight. For me, homemade cherry pie is a food I eat exclusively for emotional reasons! It’s tradition in the family I grew up in to have cherry pie on birthdays and other special occasions, usually AFTER a big meal of Taiwanese dumplings shared together. I’m almost never hungry by the time we get out the cherry pie, so I guess that means I’m always “emotionally eating” when I eat cherry pie. If that’s wrong, I don’t want to be right! The delicious experience of filling my belly with dumplings, then savoring tart cherries and flaky pie crust is a big part of what makes those special days significant. This type of emotional eating is precious to me because it has been a tradition in my family since I was a child.

Eating for nostalgia, to remember a person, a place, or a tradition, can be beautiful and meaningful. Whenever I eat a fresh peach, whether I’m physically hungry or not, I cannot help but find myself “emotionally eating.” To me, the smell of ripening peaches instantaneously takes my mind back to the kitchen of the home where I grew up. The taste of fresh peaches is the taste of decades of Labor Days spent laughing with my siblings. A bowl of cut-up peaches set on the table is a love note from my mom or dad. For me, peaches are often a part of “emotional eating” that I deem as healthy for myself and my relationships.

Eating because we are feeling stressed or sad makes sense, and can be a helpful choice. Eating can be soothing to our bodies. From the very moment we are born, we are meant to find soothing and safety through eating. Eating is supposed to feel good! When approached intentionally, “emotional eating” can be a helpful tool for coping and self-care. For me, sometimes crunching my way through a bowl of cereal (especially Honey Bunches of Oats with almonds. IYKYK.) is part of what helps me soothe myself enough to face the stresses of another couple of hours of parenting little kids. I see these moments of “emotional eating” as an effective way for me to sit with and work through stress so I can move on with my day.

Food is fuel for our bodies, and it is also so much more. Eating for emotional reasons can add variety, meaning, comfort, and connection to our lives. There needs to be no shame in “emotional eating.” Emotional eating is a normal part of the human experience, sometimes in helpful ways, and sometimes in unhelpful ways. Of course, if eating for emotional reasons has become part of a cycle that is not adding to your well-being, you deserve to have support and help with breaking that cycle, and with learning more effective ways to cope. And even then, eating for emotional reasons can still play a healthy, helpful role in your life. Making room for “emotional eating” is, in many ways, an essential element of having a peaceful relationship with food because eating and emotion can never fully be separated. Food and emotion are inherently intertwined, sometimes in painful ways, but also in beautiful and meaningful ways.

Body Reflections

Body Reflections

If you struggle with body image, your relationship with the reflection of your body in the mirror might feel complicated. Maybe you find yourself spending too much time in front of the mirror, picking apart your reflection, and feeling upset about what you see. Or maybe you find yourself avoiding glimpses of your reflection, not wanting to see your body because you don’t feel good about it. Maybe you experience a mix of both. If your body’s reflection is a source of stress in your life, you aren’t alone–body image stress is something everyone experiences at least occasionally and something many experience chronically.

For today’s blog, I want to take the word “reflection” and use its other definition–not the one that means an image thrown back to you by the mirror. Reflection (noun): thought or consideration. The end of the year is a time when we naturally reflect–look back on and consider our experiences, thoughts, and emotions. If body image is a struggle for you, you might find it helpful to do some reflection on your relationship with your body beyond its reflection in the mirror. Here are a few questions that might help you reflect.

  • What were some meaningful experiences I had this year? How was my body a part of those experiences?
  • Where did I struggle in my relationship with my body this year?
  • Where did I grow in my relationship with my body this year?
  • How did my body support me this year? How did I support my body?
  • What were the sensations my body enjoyed this year? Think about experiences with each of your senses: touch, taste, sight, sound, smell.

Focusing on the reflection you see in the mirror can distract you from a deeper, more meaningful type of reflection. What you see in the mirror only tells you a small part of the story of your body and its experience, function, and meaning. Looking deeper–into your relationship with your body, into the experience of being alive in your body–yields so much more complexity and so much more meaning than looking in the mirror does.