The Muddy Waters between the Diagnoses of an Eating Disorder and ADD

Diagnosing and treating ADD for people with eating disorders is incredibly complicated. For the majority of these patients, they have not been diagnosed with ADD as children. The lack of a formal and reliable process to diagnose ADD in adults creates a seemingly impossible situation.

Eating disorder symptoms often include the most obvious diagnostic criteria of ADD: inattention, difficulty following through with tasks, poor memory and periods of hyper-focus. Food restriction, binging and purging can affect all of these cognitive skills. If someone firsts develops their eating disorder at a young age, then differentiating an eating disorder from ADD is challenging.

Also stimulants, as neuroenhancers, do have a cognitive impact on people who don’t have ADD. That’s why college students share these medications during the most difficult part of the semester. There are nuances between how these medications affect people with and without ADD as I have written about before. But even these criteria are not foolproof.

When eating disorder patients ask about the diagnosis of ADD, which happens with regularity, the psychiatrist is left with a difficult decision. Treating potential ADD symptoms will likely be somewhat beneficial for the patient who will be more productive and effective. Also the psychiatrist and treatment team would need to monitor eating symptoms to see if the medication affects following the meal plan.

Medical monitoring can also allow the psychiatrist to watch for any abuse of the medication and be sure the patient is not misusing it in any way. Stimulant abuse is a common symptom of an eating disorder but harder to identify if the patient is looking elsewhere for the medication rather than working with the team to take it. 

On the other hand, introducing these medications to eating disorder patients can intensify the desire to restrict and perhaps open the door to new behaviors, even precipitating initial thoughts of abuse. 

In the end, there are no easy answers when diagnosing ADD with eating disorder patients and in treating them with stimulants. A clinician needs to consider the best alternatives, monitor with caution and be willing to change course at any time.

Our collective shift towards using medications for personal gain and the acceptance of the ADD diagnosis already complicate how much people should be taking stimulants. Adding an eating disorder to the situation makes it only harder to navigate. 

And so the best alternative is to balance the possible diagnosis, severity of symptoms and risk/benefits of trying this class of medications. The stronger the trust between the patient and treatment team, the higher the likelihood of success.