Eating Disorders and ADD, Overview

One particularly thorny diagnostic conundrum when treating people with eating disorders is the overlap with attention deficit disorder.

This diagnosis is particularly complex for many reasons. First, it has been diagnosed much more readily in the last decade after being misdiagnosed or under-diagnosed for generations prior. Second, the diagnostic criteria are for children, and diagnosis in adults is controversial and lacks any clear standard for the clinician to follow. Third, it has become in a patient’s interest to seek this diagnosis for accommodations in school and for so called “neuroenhancers,” known clinically as stimulants like Adderall and Ritalin.

The confusing clinical territory and incidental personal gain make the diagnosis and treatment difficult for any clinician to navigate.

However, when treating people with eating disorders, another added wrinkle is that these medications also can cause appetite suppression and weight loss as side effects. This fact makes these prescriptions very appealing to this cohort of patients.

Even more confusing, the diagnosis of ADD in patients with eating disorders is clouded by the fact that poor nutrition, binging and purging can all cause cognitive side effects that mimic ADD. Thus, the diagnosis is almost impossible to determine in an adult with an eating disorder unless the ADD symptoms started first. 

The final piece of the puzzle is that for ADD is actually the primary diagnosis for a small number of patients with eating disorders. And for these patients, treating previously undiagnosed ADD actually cures the eating disorder. The eating disorder symptoms actually managed the overstimulation and inattention common with ADD. Once treated, these patients no longer need the eating disorder to cope. Although this group is very small, it does mean the clinician can’t rule out undiagnosed ADD for any eating disorder patient.

Due to the complex relationship between eating disorders and ADD, I will use the next several posts to delve further into these issues and cover the following topics:

1. The diagnosis of ADD in the context of an eating disorder
2. The use of stimulants for people with eating disorders
3. Risk of abuse of stimulants in people with eating disorders
4. Use of non-stimulant medications for people with eating disorders who have ADD
5. Stimulant use as a neuroenhancer or party drug
6. Taking patients in recovery off stimulants
7. Indecisiveness, a common symptom of ADD and it’s role in recovery