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Starved Stuffed and Restless: The relation between ADHD and the disregulation of eating.

By Dr. John Fleming, C.Psych.

Dr John Fleming and TovahIntroduction by Rick Green:

“Dr. Fleming is a psychologist in private practice with more than 30 years of experience in the treatment of eating issues, including obesity.  

John has been providing assessment and treatment for individuals with ADHD for 19 years, and one of those adults was me.  He’s been my ADHD specialist ever since. 

During the past 15 years, he has co-directed a research program investigating the connection between ADHD, overeating and obesity. He has also developed a powerful eight-week program, teaching mindfulness skills to individuals with ADHD.  First published in 2011, this remains one of our most read guest blogs”

For more information visit: www.drjohnfleming.com

Starved Stuffed and Restless:
The relation between ADHD and the disregulation of eating.

How ADHD contributes to imbalanced eating is fundamentally unknown. Still, I will take a stab at outlining what I believe to be the primary contributing elements. This is based largely on over twelve years of working with clients with ADHD, obesity and binge eating.

At one level this relationship is a result of the fact that ADHD represents a problem with a central cognitive capacity which creates a distinct disadvantage in a great many situations. This is why such a high percentage of individuals with ADHD struggle with a variety of comorbid conditions including depression, anxiety, substance abuse, as well as increased difficulties with things like underemployment and marital discord.

A second key piece is understanding the experience of restlessness, which is tied to the problem of regulating emotions and arousal.

In terms of understanding the effect of restlessness, I believe that there is an interaction between restlessness and gender, in that I suspect women are socialized in such a way that provides them fewer socially acceptable ways of responding. Binge eating at home, even if it has the adverse impact of causing socially unacceptable weight gain, allows the engagement of restlessness without the direct social disapproval associated with behaviors that are still somewhat more socially acceptable in men.

Restlessness is a key feature in the hyperactive impulsive subset of symptoms, but unfortunately, because of the childhood bias in the symptom description, it is not given the kind of attention it deserves. Even for those individuals who do not meet the criteria for combined subtype, there is typically a chronic problem with the experience of restlessness. Some people really don’t know what this means and confuse it with the experience of anxiety. Anxiety is attached to some expectation of negative outcome. Restlessness is an undirected urgency that something needs to be done without any particular clarity of where that energy should be expressed.

Being continually overwhelmed is a result of pretty much all the combined features of ADHD. It leaves individuals living in a highly reactive mode, living from moment to moment in response to external pressure. The result is an incredible level of stress which creates a high probability that they will do whatever they can to try produce some type of emotional release. Behaviors such as binge eating provide such a ready escape as do substance abuse, compulsive spending, compulsive sexual activity, etc. Closely related is the strong tendency to eat as a way of coping with boredom.

It’s also critically important to understand that ADHD exists on a continuum which is expressed to different degrees depending upon external as well as internal factors. Externally, this is most affected by level of structure and clarity of expectation. Internally it is hugely affected by level of interest or activation, novelty, competing motivational states, and sleep.

Associated factors that also impact individuals with ADHD are highly susceptible to developing disrupted patterns of sleep. Critically important in the establishment of a regulated appetite is restorative sleep and at least some semblance of a somewhat normal sleep cycle. Individuals with ADHD are prone to stay up far too late because they become caught up in one thing or another, or they are chronically overwhelmed and fall behind with all the things they need to complete. They generally receive far too little sleep and typically suffer from a disrupted sleep phase.

Similarly, someone who does not establish a regular pattern of eating will inherently struggle with trying to regulate a much more substantial food craving. Individuals with ADHD are notoriously bad at remembering to stop what they’re doing and eat. This without all the added overlay of patterns of dieting and the like. This is not avoidance I’m talking about but rather struggling to simply maintain some type of printable order involved life.

While there is so much more that could be said, at least this provides a flavor of the how ADHD may impact eating.

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15 Responses to “Starved Stuffed and Restless: The relation between ADHD and the disregulation of eating.”

  1. danodea says:

    “Individuals with ADHD are notoriously bad at remembering to stop what they’re doing and eat. This without all the added overlay of patterns of dieting and the like. This is not avoidance I’m talking about but rather struggling to simply maintain some type of printable order involved life.”

    Yep, that’s me. I would like to add something: not only do I forget to eat, but when I do eat I tend not to pay attention to what I eat. I’ll eat whatever’s in front of me, no real enjoyment, just eating to eat so I can get back to what I was doing. Eating fast is not a healthy thing, and eating to enjoy the food tends to make one eat less because eating slowly lets your body recognize it’s full before you’ve overeaten.

    I find, if I can manage to eat slowly and savor the food, I eat less and I tend not to want more of it; I’ve “had enough”. When I don’t savor my food, I eat too much and tend to want more when it’s gone; I haven’t spent enough time enjoying the food and I want more.

    I’m not grossly overweight, but nearing my sixth decade my metabolism has slowed to the point where I can’t burn off the excess and I have too much abdominal fat – which leads to more eating and poorer health outcomes.

    And, as you mention, I’m not sleeping either, which throws off everything. I need both novelty and structure, which aren’t always coexisting conditions. Trying to have a family life can be helpful, but also distracting. Somehow I need to find a balance.

  2. dizzytuber says:

    I’d agree with you there about the depression, anxiety, and underemployment. I’ve started and ran 3 businesses in the ground The shortest time was 3 months, the longest 3 years. Imagine a business owner with ADHD and shouldering ALL of the admin, sales, and manufacturing responsibilities their self. The other part was just overall bad business planning, and no one around to help mentor me.

    Restlessness. Ah yes, it rides shotgun in my life. I constantly feel like if I am not working on something or researching something, building something, I am wasting time and my life away. Sadly, this has cost me several friendships, friends I used to go with to the mountains for hikes, take a road trip, go snowmobiling and sitting around the campfire listening to one friend play his guitar, and more.

    As for a bad diet, I think my problem is more related to the depression and anxiety, rather than ADHD. When I am not eating for long periods, I’m usual either angry or sad. If I am eating candy a lot, it’s because I feel apprehensive and anxious. If I am bing eating, it’s usually because my living situation only gives me a chance to eat one good meal a day. The rest I am left to snacking.

    Now I do recall being lost in the moment, working on projects, and thinking, “ok 10 more minutes I’ll go eat.” Then thinking that again every 10 minutes, until 11 am turns into 10 pm, and you’re thinking, “oh ya, lunch, oh it’s dark.” A good example of this was when I was building a frame for a hovercraft. Maybe this is what the good doctor is speaking about?

    Hopefully this reply made sense. I’ve been having a hard time conveying my messages without people perceiving some sort of aggression in my text. It’s been getting worse of late and I am not sure why.

    Stay Dizzy 🙂

  3. sewmeditate says:

    Thank you. Truly important for me to read this. “..some type of printable order involved life.”

    Restlessness, continually overwhelmed, binge eating (I also purged) and didn’t realize I was doing it, never want to sleep actually get mad that I have to sleep because there is so much fun things to do! or think about, and extreme irritation with myself for my emotions – all are a part of me and eloquently touched upon in this post.

    I appreciate the clarity of this post. I will reread it often to help me understand who what where I am.
    thank you again, I really needed this.

  4. jennco says:

    Finally! I was diagnosed as a senior with ADD. Since then I have wondered whether my compulsive eating is related to ADD. It seems to be a method of self stimulation, of combatting restlessness. I have never forgotten to eat- wish that I could.

  5. maclimber says:

    Thank you for this. I am 63 years old and just discovered I have ADHD in the past 2 years. I have been on Adderall for the past year. I also recently celebrated my one-year anniversary of sobriety. Coincidence? I do not have a problem with food (although I did when I was younger), but the reasons you gave for overeating are almost exactly the reasons that have helped me understand my overuse of alcohol. The restlessness I have felt all my life I thought was a “character defect” until I learned about ADHD. Thank goodness I can live the rest of my life with understanding rather then self-flagellation.

  6. afterdistresssolace says:

    thank you for this article !! very insightful and empowering to me. one of the many that spoke to me was the distinction made between anxiety and restlessness — “Some people really don’t know what this means and confuse it with the experience of anxiety. Anxiety is attached to some expectation of negative outcome. Restlessness is an undirected urgency that something needs to be done without any particular clarity of where that energy should be expressed.”

  7. cherryblossom says:

    wow

  8. browna7 says:

    This is intriguing on many levels for me personally. I am often told, “You need to eat more” or “You have lost too much weight”. In actuality, I eat a ton and feel I need to eat more due to the amount of energy I expend in my many physically oriented endeavors. Though I detest fast food, I eat it just to get more calories than found in the foods I enjoy most.

    Indeed, staying up late due to getting caught up is very true. For me, it is often hard to determine when to stop and how to stop what I am doing. Things have a way of manifesting into the song that never ends.

    Awfully so, I have been trying to gain a normal sleeping cycle for years. Is this even possible?

    What is order or how is getting a normal flow in life done? Truly asking without being rude, who has a normal flow and what does it look like?

    As well, are most individuals with ADHD visual learners?

  9. wolfshades says:

    I’ve been thinking about this a lot too. I do believe there’s a relationship between ADD and eating, just as there is between ADD and any addictive behaviour. I always thought though that what we’re lacking (or what we seek all the time) is stimulants. Whether it is in the form of cool ideas – hence our inability to focus on any one thing for too long – or coffee, or illegal drugs, or alcohol, or in this case, eating. Thoughts?

  10. Geoduck says:

    YAY! An article about how ADD people forget to eat. I tell people this and they look at me like I’m the dumbest bunny there ever was. My brothers do this too. It drives our spouses bananas. Nice to know we are not idiots.

    I also do the get caught up in something and stay up late thing. Especially TV and computer.

    Very odd, this sleep thing. I tend to fall asleep just fine, but then wake up and can’t get back to sleep.My sleep patterns are awful, but really awful during the estrogen shifts that happen around ovulation and menstruation. This has gotten worse since having my last child.

    I have never been a binge eater, and have been accused of being hyper, but not so much restless. I think I tend to mask any restlessness by doing things like knitting during meetings. As long as my hands are busy, I’m fine. I was a pen clicker, too. So I was fine, just driving everyone else around me bonkers. LOL!

  11. jceleste says:

    i have an insatiable appetite. all i do is think about food. it’s exhausting. i just wish i could, just once, feel satisfied. content. i think it’s because for a moment, while feeling full, i don’t have to feel/ deal with the restlessness & despair i have physically & mentally. and, i am tired of my husband making ‘comments’ to me about it.

  12. OooShiny says:

    The more I read, the more shocked I am to be reading about myself. I’m a 33 and female and have always had issues with binging and with sleep patterns. My weight started to pack on in adulthood, but I have always noticed my habits with overeating. When I go out in search of food, I am indeed feeling completely RESTLESS (sometimes I shop, instead, if I have the money). I am finally getting a real assessment in 12 days. I am DYING to try out medication.

  13. Kristen says:

    Very interesting. I have struggled with an eating disorder in the past, and noticed that when I went off Adderall, my appetite was absolutely insatiable no matter what I did. The 10 pounds I lost while taking it was quickly replaced by an additional 20.

  14. ludragonslegacy says:

    Wot this really fits me. Especially with the staying up late part. I’m usually up until 2am and get about 2-3 hours of sleep a night because of the fact that I am always feeling behind on everyting. I’m planning on training myself during my 1 week break from school to get more sleep every night and now I think I’ll try setting a schedule for eating as well

  15. JudyC says:

    Thanks for providing the public with this info. I’m just wrapping up my thesis on grad students with AD/HD, and found that–especially the younger students (in their 20’s) know very little about their diagnosis…Anyway, seems to me I read the same thing about girls: that we are socialized in such a way that eating compulsively is more socially acceptable than acting out. Fits for me! I thought I read this or heard this from Quinn and/or Nadeau. If anyone could confirm the source for me, I’d greatly appreciate it since I’m mentioning it in the discussion section of my paper.

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