1. Attention Deficit Hyperactivity Disorder And Eating Disorders
Roberto Olivardia, Ph.D.

2. Eating Disorders Anorexia Nervosa Bulimia Nervosa
Binge Eating Disorder
Eating Disorder, Not Otherwise Specified
Disordered Eating

3. Studies of obese patients and ADHD
Agrant-Meged et al. (2005)
13 boys and 13 girls in obesity clinic assessed for ADHD
Mean age 13.04
All were morbidly obese
Did not meet criteria for any DSM-IV Disorder
58% were found to have ADHD, significantly higher (p<.0001) than what is found in general population (10%)
Of children with ADHD, only 40% diagnosed before the study

4. Studies of obese patients and ADHD
Altfas (2002)
Bariatric patients (N= 215)
Found 27% had ADD (all inattentive type)
For BMI >40: 43% had ADD
Mean weight loss:
ADD/OBESE patients = 2.6 BMI
NON-ADD/OBESE = 4.0 BMI (p<.002)
Mean weight loss For BMI>40:
ADD/OBESE= 2.9 BMI
NON-ADD/OBESE = 7.0 BMI (p<.004)
ADD patients had more treatment visits with longer duration

5. Studies of ADHD patients and BMI
Holtkamp et al. (2004)
Hypothesis: Hyperactivity protects children from obesity
Opposite was found:
BMI scores for 97 ADHD male patients were significantly higher than reference population (p=0.004).
BMI > 90th percentile: ADD significantly more common than reference group (p<.001).

6. Studies of ADHD patients and ED
Mattos (2004)
86 ADHD adult male and female patients assessed for lifetime prevalence of ED
9 patients (6 females and 3 males) (10.4%) had E.D.
(most commonly BED)
ADHD/ED group was more likely to have a comorbid condition, such as depression or substance abuse, in addition to their eating disorder. (p<.02)

7. How can ADHD predispose someone to develop an eating disorder or become obese?

8. Cognitive Factors Poor organization skills Poor meal planners
Difficult to think in “not now” ways
ADD likely to use caffeine as self-medicating which predisposes for later binge. Caffeine often in form of sodas and coffee with sugar and creams

9. Regulatory Factors Poor self observers/self regulators
Poor interoceptive awareness (same as in ED)
Ignore physical cues of satiety or hunger
Poor sleep habits (Increase in leptin)
Skipped meals leading to overeat on carbs, fats, sugars

10. Regulatory Factors Sense of time is non-linear (now/not now)
High-stimulating jobs where eating is inconsistent or en route.
Buffets difficult to self regulate
In hyperfocus can go hours without eating, then hit with wall of hunger
More likely to eat while doing other things leading to poor regulation of food intake
Sensual aspects of food are incredibly grounding

11. Emotional Factors
Boredom leads to eating as a form of self-stimulation.
Anger, sadness, stress relief
Food as reward, pleasure (not necessarily as a result of dysphoria)
Relief from racing thoughts and distraction
ADD very outcome driven, instant gratification, impatient, needs results quick

12. Emotional Factors Attracted to crash diets, quick fixes
Plateau phase of weight loss or exercise plan very frustrating
Food preoccupation incredibly reinforcing as a grounding mechanism
Purging: Euphoric stimulation

13. Biological/Genetic Factors
ADD brain slow to absorb glucose.
Serotonin in carbs, sugars, boost well-being.
Adrenaline shuts down digestion and diverts energy. ADD more attracted to adrenaline events on constant basis, leads to a dysregulation of digestion

14. Biological/Genetic Factors
Posits that dopamine receptors could overlap with both obesity (DRD2, DRD4) and ADD (DRD4)
ADD: Low levels of dopamine
DRD2: reward deficiency syndrome : Insufficient dopamine-mediated “natural” reward produce need for unnatural rewards (food, drugs)
DRD4: novelty seeking

15. Treatment Recommendations
Address ADD and ED together
Destigmatize ADD
Amenable to treatment since most ADD/ED is BED and BN vs. AN
Therapist must be a “creative coach”
Behavioral scheduling/Structure (especially nights)
Generate list of alternative stimulating behaviors. THINK ADD!
Time management strategies
Sleep hygiene

16. Treatment Recommendations
Protein and fiber for breakfast
Challenge notions of instant gratification and immediate results (“Lose 20 lbs in 20 days!”)
Keep patient on track, since motivation fades
Mood monitoring. Food logs. THINK ADD!
Shopping with patient (store, online)
Psychopharmacological Treatment (Stimulants)

17. Attention Deficit Hyperactivity Disorder And Eating Disorders
Roberto Olivardia, Ph.D.