Attention Deficit Hyperactivity Disorder And Eating Disorders Roberto Olivardia, Ph.D. Roberto_olivardia@hms.harvard.edu

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

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

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

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).

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)

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

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

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

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

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

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

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

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

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

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)

Attention Deficit Hyperactivity Disorder And Eating Disorders Roberto Olivardia, Ph.D. Roberto_olivardia@hms.harvard.edu