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

By Dr. John Fleming, C.Psych.

Dr John Fleming and Tovah Introduction 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”

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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.