Comorbid ADD with an Eating Disorder

The most common dilemma regarding an eating disorder and the diagnosis of ADD is either distinguishing between the two or deciding someone has both diagnoses. 

Without even thinking about risks of the medications and ulterior motives in attaining prescriptions of stimulants, the clinician needs to take any concerns with attention, organization and memory seriously.

The central issue is a simple question. Is the eating disorder itself causing the cognitive symptoms or is underlying ADD the culprit? Ultimately, both situations are extremely common, and the answer is not always obvious and often takes a long time to answer definitively.

If a patient’s eating disorder is dominant, then the next best step is to hold off on the diagnosis. All eating disorder symptoms (restricting, binging, purging, laxative abuse, over-exercising, etc.) can have a significant effect on cognitive function that can mimic ADD. In this situation, it’s best to keep open the possibility of this concurrent diagnosis and instead focus on recovery.

If a patient has been previously diagnosed with ADD using Neuropsychological testing, then the diagnosis is not in question. It may not be appropriate to use stimulants yet depending on the state of the eating disorder symptoms, but it’s also critical to state that these two diagnoses can exist together and may in fact be correlated.

If a patient has improved significantly from their eating disorder and continues to have symptoms that could be ADD, then it is imperative that the clinician consider this diagnosis.

One option is to do Neuropsychological testing, but these results are not as reliable in adults as in children and can be prohibitively expensive.

Another option is to start a trial of stimulants and to monitor both food and changes in attention carefully. Stimulants work quickly at the correct dose and also can be diagnostic. When effective, they can aid in emotional stability and eating disorder recovery.

Although the steps in considering and diagnosing ADD are fairly clear when stated objectively, the nuances of the actual diagnosis are often more cloudy. I’ll start to look into these complications in the next post.