Drafting and Peer Review: The Link between ADHD and Eating Disorders
Attention deficit/hyperactivity disorder (ADHD) and eating disorders (ED's) are independently prevalent mental health conditions that can have adverse effects on an individual's quality of life if left undiagnosed. According to Katzman in this 2017 article "As many as 80% of adults with ADHD have at least one coexisting psychiatric disorder [4, 5], including mood and anxiety disorders, substance use disorders (SUD), and personality disorders" (Katzman et al.). This could be telling us that people with ADHD are at a higher risk of developing eating disorders and are also more likely go undiagnosed until adulthood resulting in loss or delay of basic and complex life skills. There is a defect in the care of people dealing with ADHD. Medical professionals do know about the correlation between ADHD and ED's but they are not providing resources for their patients who are dealing with these disorders. There could be more safeguards in place at different levels and working along side others who want the same end goals and work in various public systems.
These systems are very common and most people living in rural as well as populated and urban areas have come in to contact with individuals in these systems. Mental health and medical professionals understand that there is a correlation between ADHD and eating disorders. They have access to the knowledge and not always sharing it. That is up to their discretion and may want to refrain mentioning things unnecessarily and causing worry. In contrast to that, should it be a rule that they should provide the information regardless and allow the patient the empowerment of deciding for themselves if they might need to look deeper into their diagnosis.
Seeking a diagnosis for yourself or your child means making an appointment with a medical or educational professional, this can be scary to some. The CDC says: "If you are concerned about whether a child might have ADHD, the first step is to talk with a healthcare provider to find out if the symptoms fit the diagnosis" (cdc.gov).
After initial research we often seek medical professionals advice on next steps, they know of the correlation between ADHD and ED's but the evidence shows that they are not alerting caregivers to look out for signs and symptoms. So how are these systems in a position to alert the family to these concerns? In all fairness this source; The contributors including Ekern, B and the Staff at Timberline Knolls Residential Treatment Center mention that "There's no one-size-fits-all approach to healing from an eating disorder and co-occurring attention-deficit/hyperactivity disorder." (Ekern, B). School based therapies, teachers, and educational professionals work with children directly and have insight into their daily habits and behaviors. They have specialized knowledge on the topics of ADHD and Eating Disorders. They should know what resources to suggest even if it is their direct superior. In conjunction, home based therapists, respite providers and other home health professionals see the home environment and how the child interacts with their family, pets, and have built a rapport with caregivers and family. They may be in a better situation to bring up these concerns with the family. Finally, family, friend, and self education is key in taking ownership of yours or your childs diagnosis and researching in order to better understand yourself or them. The first steps to this may be asking questions to others in the same or similar situations.
So how are individuals more at risk and why do they so often go undiagnosed? Well, because there are many common misconceptions about this diagnosis. Research goes a long way in clearing up some of these misconceptions such as "people with ADHD are just lazy", "they just need to try harder", and "they'll grow out of that". Among many more that you can read here where Ekern reinforces that "Attention-deficit/hyperactivity disorder involves more than just seeming distracted or energetic from time to time. It is a condition that can seriously interfere with a person's ability to succeed in their daily life. Without professional help, a woman or young girl who is struggling with ADHD may start failing classes at school, not perform as well at work, or act in ways that seem careless" (Ekern, B). This is not only true for females but for every gender. The data is not clear on how evenly ADHD is spread across all genders but there is some data that shows males, or male presenting individuals are far more likely to receive a diagnosis earlier in life through one of the aforementioned public systems when it comes to ADHD but are far less likely to be diagnosed with an eating disorder. In contrast, females, or female presenting individuals are more likely to be diagnosed with an eating disorder earlier in life and far less likely to receive a diagnosis of ADHD.
The truth is there are many similarities between these two diagnoses even early in life in symptoms between genders including the age of onset. Some others include hyper fixations, disassociating, poor planning and low frustration tolerance. The reason individuals tend to go undiagnosed is because there is a subset or less well known but equally prevalent set of symptoms that are not commonly associated with ADHD. In Dr Shauna Reinblatt's article she states, "ADHD has two subtypes, inattentive and hyperactive/impulsive, and is a common impairing disorder often accompanied by comorbid psychiatric conditions such as anxiety or depression. It has been estimated to occur in 5 % of children in the United States by the DSM-5" and in that same article, "Both ADHD and eating disorders tend to begin early in life but can be chronic and persist into adulthood" (Reinblatt, SP). Keep in mind that this number is just an estimation based on the data available. Its clear that there are many similarities and crossover when it comes to these individuals and how often they will encounter professionals involved in caregiving many of whom are mandated reporters.
When to dig deeper and seek a secondary diagnosis? This answer is surprisingly simple. You will know when to look deeper when there are still aspects of your daily life that are being negatively affected. Once you get diagnosed as ADHD, especially if its early in life, you may feel as if you've overcome this disorder. Adversely this can lead to feelings of failure when simple tasks go undone around the house. Other things people tend to overlook is struggling with hygiene, difficulty with caregiving, planning meals or other events. It can also lead to the ignoring of signs and symptoms as one might think, they have already addressed, treated, and moved on from this disorder. Sadly the results of this kind of thinking can worsen the symptoms leading to unhealthy coping mechanisms such as disordered eating, skin picking, compulsive behavors and many more. It goes without saying that anxiety, and depression can run rampant at these times. A clue to those struggling could be when those close to you bring deficits to your attention. Friends and family will show concern. Medical or school professionals will offer more interventions, and medications. But we will go over that more a little later.
What can this disorder look like in someone who has gone completely undiagnosed? Among psychiatric comorbidities they would struggle immensely with their ability to process sensory information as well as their ability to tell what is going on inside their own body or interoception. This may take the form of poor dental hygiene, years of dental neglect leading to extensive need for repair because the person was unable to recognize this as a serious issue. Someone could be unable to tolerate certain textures limiting the types of food they are able to eat. Similarly, they could be unable to notice their hunger and fullness cues meaning that they go long periods of time without eating, and/or consume large amounts of food in one sitting to achieve feelings induced by the production of dopamine. "Both the animal and human literature suggest that palatable food high in fat and sugar activates the dopaminergic reward system and results in eventual dysregulation of the homeostatic feeding drive as the consumption of palatable food becomes more driven and compelling in some individuals with binge-type behaviors despite increasing negative consequences" (Reinblatt, SP). This information makes sense when looking at it with the knowledge that both ADHD and ED's often go hand in hand and the consequences increase the longer it goes untreated.
Other areas to look would be your task initiation. This can take the form of having issues starting on and finishing important job functions or school projects. Your household is messy and disorganized making your living space less functional but you have the desire to clean and organize but become overwhelmed and ignore the tasks. You have very little to no satisfaction in your job. You switch jobs often despite having bills, or people dependent on you for things like money, housing and medical benefits. You reach a stage of burnout so quickly and feel you have to make frequent job changes to maintain your happiness. Undiagnosed, this can lead to increased stress and contribute to poor mental health and overtime could turn into a severe form of mental disorder such as depression, PTSD, hoarding disorder, and many others that are much harder to treat later in life.
Who is responsible for being aware of and notifying these families of these concerns? The medical care team, first and foremost should be responsible to being knowledgeable on this topic and have resources at the ready should a family ask for them. Educational professionals that work directly with students should have yearly training in all of the signs and symptoms, and how to address then in the classroom as well as know how and when to alert families of concerns. As many know, home is not always a safe place for all kids and adults so they may not get that kind of attention elsewhere. Also, the parents or adults may also be struggling and not recognize their own symptom's let alone their child's struggles. This research article explains "There are strong familial links between ADHD and psychiatric comorbidities such as bipolar disorder, suggesting a genetic contribution [17]. One possible explanation is that ADHD and mood disorders stem from similar neurobiology" (Katzman, Martin A., et al). This reinforces the point that the systems such as medical and educational are going to be the first line of defense when it comes to early diagnosis and treatment before the disorder leads to more deficits that the individual will have to overcome later in life.
Using myself as an example, I can share some of my personal experience and my research journey in better understanding this diagnosis. Its important to note that I have struggled with school and my weight my entire life. I grew up constantly embarrassed because I suffered from incontinence at night and was teased about it by my siblings and other family members. It wasn't until later that I realized I just had poor interoception and could not tell when my bladder was full leading to years of humiliation that took a huge toll on my self esteem. I was diagnosed with ADHD just two years ago as an adult. I was offered only medications as an intervention choice. Due to my medical background I knew there was more they could offer and was shocked when all they had to offer me was pills, and medical marijuana. I did try many different avenues but was always left feeling lost and overwhelmed because there were still so many areas being affected despite me having an official diagnosis. I also recognized many of my own behaviors being portrayed by my teenager that they had obviously learned from observing me. I was not satisfied with what the medical community had offered me. I felt there was so much more to this than what I had been told. With this project I was able to make connections through research and find more resources for myself and my teenager to prevent further harm or regression from both of us.
How to begin independent research? When searching or helping someone search for information on ADHD and/or eating disorders, it brings up a vast amount of data that, as someone who struggles with attention, may be too daunting of a task causing someone to give up early and delay learning information that may help them. Narrowing the topic to just two or more comorbidities can help immensely in finding relevant and helpful resources. Individuals and caregivers who are struggling with one diagnosis or another and show them through research that they may not have all the pieces of the puzzle and how this may be affecting their ability to complete daily life tasks. Searching the internet with this in mind can make the information you find more useful. If you see some of the same behaviors that you are struggling with in someone else they are probably a safe person to bring up the subject with. Chances are that they are also wanting someone to talk to about these topics but don't know where to start. Finally initiating contact with a medical professional whether you are a parent, caregiver, or it this is about yourself. Medical and school professionals should always be safe people to take your information to and ask questions.
Can one just continue on going undiagnosed and somehow still live a happy and healthy life if they do not seek out or do not want traditional medical or therapeutic intervention? In short the answer is yes but lets expand on that a little. The popular social media platform Tiktok reached the height of its popularity around the start of the pandemic. People with ADHD tend to be creative as well as introverted. This led to many creators on tiktok discussing their own struggles with ADHD and I think bring to light a lot of the common misconceptions about ADHD and its link to disordered eating in a way that had not been available before this. This has also led to a lot of self-diagnosing overall. It is great that there is a platform where people can find and share tips and tricks that work for them in managing their daily life, easing the severity of the disorder, and making their home and job duties more functional and leading to an increase in independence. Individuals that have undiagnosed ADHD or ED's have the right to their own bodily autonomy meaning they have the right to choose or refuse any treatment that is offered including seeking a formal diagnosis. This is a perfectly reasonable avenue with one caveat, that this way of living is not negatively affecting yourself, or your family. That your behaviors are not impacting others or yourself in a way that could cause irreparable damage be it physical or emotional. The lack of a diagnosis or treatment interventions could potentially be dangerous and lead to more issues down the line, and self treatment without proper knowledge or when to try something new is specialized knowledge that takes years of practice and study. I, for example, would not try to detox and treat a dependent drug user with treatment interventions that I had found on the internet because I could end up doing more harm than good. I would support them, empathize with them, and encourage them to seek out professionals that have far more experience than I. Using this same approach to ADHD, we could help each other a lot more than offering unconventional methods that "might" work.
This is not just a childhood problem that one day someone will just "get over it" or something to grow out of. This website offers this: "Eating disorders are complicated. Treatment requires a team - usually a psychologist, nutritionist, physician, psychiatrist, and, most often, a family/couples therapist. When a sufferer also has ADHD, seeing treatment through an ADHD lens is essential. Knowing how the eating disorder is affected by ADHD symptoms, and how it, in turn, affects ADHD symptoms, must be central to treatment. Not managing the ADHD usually leads to treatment failure. If the eating disorder therapist is not an ADHD expert, add an ADHD therapist to the team" (Roberto Olivardia). Clearly it is a medical diagnosis that requires different levels of intervention based on the severity and frequency of the symptoms that should be addressed as early in life as possible to provide the maximum amount of assistance to the individual in need. I emphasize the importance of early diagnosis and intervention in order to prevent the most harm from occurring but there are so many adults that are in need and may not even know it, that's why we need to inform ourselves and any friends or family that would benefit from this information and help one another live happier and healthier lives.
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