Tuesday, January 6, 2009

The ADHD and Bulimia Connection

ADHD is a disorder that has numerous comorbids ("comorbids" refer to disorders that often accompany or are seen alongside of ADHD). These include, but are not limited to: Depression, Tourette's, Conduct Disorders, Sleep Disturbances, Restless Legs Syndrome, Body mass and obesity issues, dysgraphia (poor writing skills and abilities), processing disorders, sensory integration disorders as well as several others.

In the midst of all of these co-occurring disorders, there are a few that often evade the attention of both researchers and the general public. One of these is the disorder bulimia nervosa. Bulimia nervosa (which is often simply referred to as bulimia), which is often characterized by eating (and often binging) followed by purging, is a major issue in many industrialized nations, especially among teens and young women. Based on a study by Surman and co-workers, it appears that there is a relatively high correlation and prevalence of bulima and ADHD. A link to a quick synopsis of the study can be found here, but for sake of time, I will summarize a few key findings from the article:

  • Impulsive behavior is a hallmark characteristic of ADHD, and impulsivity is also thought to be a major factor in bulimia as well. It is even hypothesized that some type of underlying factor may be responsible for governing both disorders.

  • Given the fact that the disorder of bulimia is expressed at much higher frequencies in young females in late adolescence and early adulthood, it is interesting to note that correlations between the two disorders were relatively weak for men and non-adult women. Additionally, this is worth mentioning because the percentage of individuals with ADHD is heavily skewed towards the male side. That being said, the fact that there was not more of a correlation between ADHD and bulimia in males could be a reflection of either a poor sample size or representation of t he general population, or a relatively weak connection between the two disorders (i.e., one this is unable to override the so-called gender bias of bulimia favoring women and ADHD favoring men).

  • These results were tallied from 4 relatively large sample pools previously constructed to evaluate the effects of ADHD over an extended, longitudinal, multi-year period of time. This suggests that some of these relatively strong bulimia/ADHD correlations did not appear simply due to random statistical chance.

  • Stimulant medications, such as methylphenidate, which are often the first line of treatment for individuals with ADHD, especially those showing pronounced signs of impulsivity and hyperactivity, have shown potential in the treatment of bulimia, albeit through studies with very small sample sizes.

Taking this one step further, it appears that genetics may be an additional overlapping factor involved in stimulant medication treatment for ADHD. For example, some research suggests that different forms of DAT1 may be responsible for the effects of methylphenidate on appetite and eating behaviors including purging (DAT is short for "Dopamine Transporter Gene"). We have seen previously that there is a connection between the DAT gene and ADHD. Located on human chromosome #5, DAT1 has been linked to Parkinson's, Tourette's and substance abuse.

Additionally, proteins coded for by the DAT gene are expressed in high concentrations in the basal ganglia region of the brain. The basal ganglia is essentially responsible, among other things, for determining how fast a person's brain "idles" For example, "type A" individuals, who are often workaholics, easily stressed, and always on the go at 100 miles per hour often have overactive basal ganglia, while the more relaxed, easy-going, "type B" personalities typically have less activity in this critical brain region. While there also appears to be a significant overlap between bulimia and depression, individuals with bulimia typically display higher basal ganglia activities than those with isolated depressive symptoms.

Given the prevalent distribution of this gene's expressed proteins in key brain regions like the basal ganglia, and the role of involvement of these brain regions in eating disorders, the DAT gene may be an important determining and regulating factor for bulimia and other eating disorders, especially in the context of comorbid ADHD.

Please note: These final remarks are simply this blogger's opinion on the subject:
I personally find this connection between ADHD and bulimia to be interesting. However, I do believe that we should be cautious when investigating ADHD comorbid disorders. It is tempting sometimes to fall into the trap of falsely assuming that correlation always implies causation, and trying to find underlying causes for disorders and attempting to link ADHD to every other disorder under the sun.

However, the role of the DAT genes, which have been tied to ADHD, do offer at least some credence to at least some degree of genetic predisposition to both ADHD and bulimia. This claim is further strengthened by the degree of overlap involving medication treatments of the two disorders, namely stimulants. However, there have been several documented cases of the disappearance of bulimia symptoms following treatment with methylphenidate (Ritalin, Concerta, Daytrana, etc.) for comorbid ADHD.

As a result, we may be faced with a "chicken and egg" question: "Does bulimia increase the risk of ADHD or does ADHD increase the risk of bulimia?" (or even "Are they both side effects of an even larger underlying cause?"). Another plausible explanation is that ADHD is a culmination of secondary effects involving bulimia and other eating disorders. Constant purging will typically wreak havoc on the digestive system and lead to improper food and nutrient absorption. I have hinted in previous posts that digestive disorders such as celiac disease can often manifest symptoms which closely approximate those of ADHD. Given the mounting evidence connecting ADHD (or other disorders which exhibit closely related symptoms which could potentially lead to a "false" diagnosis of ADHD if one is not careful) to nutrient deficiencies, it is quite possible that ADHD and its symptoms are secondary effects of nutritional deficits caused by eating disorders such as bulimia.

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Anonymous said...

I have been fighting bulimia for 15 something years and nothing works except being on concerta. I is very sad for me since I believe in alternative medicine and fitness but I have not been able to find anything that works 100% like this drug. I hate the fact that I have to take it but without it I will have good days and bad days.

Anonymous said...

I Have had Bulimia since I was 12 at 49 I have just been told i have a d h d the low dose of Ritulin has completely taken my urge to Binge away I have now more confidence and feel like now somebody is home when I am being taught to remember a task I failed miserabley at school however I have an incredable ability to write poetry that can leave even the most emotionaly void person touched by that which they read

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Anonymous said...

I found this post by chance and I must say that it hit close to home for me! I'm a 23 year old female who was diagnosed with ADHD over a year ago. Additionally, I had/have been battling bulimia for over 6 years. Ever since being diagnosed, I was put on Concerta and have found my desire to binge and purge has subsided. I actually feel in control in my everyday life and don't need to purge to feel that. However, I did relapse into my purging cycle when I stopped taking concerta for a few weeks. The idea that bulimia and ADHD might be correlated never crossed my mind until now. It definitely makes a lot of sense and has me thinking. Interesting!

bulimia said...

Make sure to eat breakfast. This is because breakfast is the meal most frequently skipped by those who have eating disorders. Moreover, eating breakfast will provide your body with the needed calorie for the day, so even if you skip latter meals, you are not depriving yourself too much of essential nutrients.

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Anonymous said...

Where can I find a doctor to talk to about this?

sports handicapping services said...

becomes increasingly larger list of disorders that people suffer is unfortunate luckily most are treatable

Anonymous said...

I was diagnosed with ADHD when I was 12, it wasn't until I stopped taking my medication at 14 that I then took on a raging eating disorder that still plagues me to this day. I recently went to my doctor to express my desire to get on ADHD meds to treat both issues, knowing fully well that one affected the other...but he thought I was just trying to get on addictive meds and put me on an anti-psychotic instead (syraquel). I went back and fought him about it and be agreed to try Strattera.
I'm thinking about printing out as much as I can find about this correlation between bulimia and ADHD and giving it to him to read. My huband is on Adderall for his ADD, so I think my Dr. made a judgment on me before finding out about my history and just assumed that I wanted the same drugs to get "high" or something. Regardless, my husband is nice enough that he gives me his meds when he doesn't need them for work, so I get to have days where I am a normal, happy mother and wife.

adderall weight loss said...

Adderall has been used by some people for weight loss for awhile now

Anonymous said...

I was diagnosed with adhd 3 months ago at 27 having battled bulimia since I was 13. I am on dexamphetamines (5mg x 5 per day) and even after going through recovery with bulimia nothing has stopped the urge to binge like this medication. I have purged about 4/5 time in the last 3 months. Before medication, for a short few periods the least I purged was once a week and throughout my life it has ranged from 10 times a day to 3 times a day on average. I never knew there was a link with bulimia and adhd until my psychiatrist said the chaos of bulimia often masks the diagnosis of adhd. For me, this has been the best thing I have ever done. I finally have a 'normal' life and in control. I am achieving all the things i wanted to achieve but couldn't before I began this medication

Anonymous said...

My sister has had bulimia for about 6 years now, and I feel that adderall and adhd medication has made her worse off.

Pearly Craig said...

The frame of thinking that she is fat when in reality she is not might be an indication that ED can be linked to mental condition. This an cause confusion especially when one is looking for bulimic symptoms.

Unknown said...

Hey my friends I tell you some tips. As you may know, I am now a recovery coach here at Bulimia Help. My recovery inspires me every day to continue sharing the message that a lifelong recovery is possible and within your reach. In order to accomplish this, you have to let go of those thoughts and false beliefs that are holding you back.

Julia. said...

I have only recently been thought to have ADD, this only being highlighted by having M.E. and now struggling with inactivity. Since being unable to use my usual coping strategies of walking, talking and generally keeping busy..very busy, I have begun binge eating, then purging..bulimia! I hate this, being sick is having a seriously detrimental effect on my already ailing health, stomach acid burning my throat, yet somehow don't seem able to stop myself. I am ordinarily a determined person and have achieved many things I wanted, yet this I simply can not get to grips with. I am, all being well, seeing an ADHD specialist soon and really hoping to be prescribed stimulant medication, especially now after reading this blog. I feel as thought I'm hanging on for dear life sometimes, no idea what I'm doing and totally lost. Thank you for providing me with hope! :D xxx

Unknown said...

Im 27, male and was diagnosed with adhd (combined) about five years ago. Ive struggled with bulimia since I was ten, though its pretty well gone away completely since i started medication. Was taking concerta for 2, 3 years and now take adderall xr for 2 , 2 1/2 years now, currently at 25 mg 2x daily. Though im noticing as the efficacy of it decreases with time (despite week long breaks every couple months) its something that is coming back into consideration in my head. I eat helathy for the most part, take efa's, b complex , and cal/mag daily to try and mitigate some of my tolerance issues. When i take a week off i def purge atleast a couple times, but work hare to avoid triggers and be mindful of it. I find it funny that you state it doesnt affect men , or adult women at same relative correlation. Though eating disorders in men are likely under reported, partly because they arent typically as recognized in the medical community. Anyhow, great article

Anonymous said...

I think about this more often.

Maybe something like the Genderdifferences maybe Women getting closer to Bulimia, Men more often named as eating disorder.

I think there ist some other Task related to the ADD. As a good compliance in Eating is planning and looking foreward. As a Women on Diet is looking back for a day or longer periods und also foreward to a goal to be a bit thinner.

ADD Persons are lacking in this. They tending to make a decision once, fighting against Food is more simpel as to fight reaching a usefull goal for healthy or maybe the next Summer or Date.

You get it? ADD Person cant controll self as good as other and cant go for a planning period as good as others. They need a easyier enemy in front of the Face.

Maybe something on this Thoughts, maybe not.

A nother one i missed in this Researching is the natural of somatotypes. Ectomorphic, Mesomorphic, Endomorphic. How strong may this influence a Eating Disorder Type? And how correlates that in ADD disposition? The Genderquestion may affect in that too. Dont know ... complicated.

I thank for this Blog, know it since few days, best informations on ADD ever :-)

maggie.danhakl@healthline.com said...


I hope all is well with you. Healthline just published an infographic detailing the effects on the body of Bulimia. This is an interactive chart allowing the reader to pick the side effect they want to learn more about.

You can see the overview of the report here: http://www.healthline.com/health/bulimia/effects-on-body

Our users have found our guide very useful and I thought it would be a great resource for your page: http://adhd-treatment-options.blogspot.com/2009/01/adhd-and-bulimia-connection.html

I would really appreciate if you could review our request and consider adding this visual representation of the effects of bulimia to your site or sharing it on your social media feeds.

Please let me know if you have any questions.

All the best,
Maggie Danhakl • Assistant Marketing Manager

Healthline • The Power of Intelligent Health
660 Third Street, San Francisco, CA 94107
www.healthline.com | @Healthline | @HealthlineCorp

About Us: corp.healthline.com

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Anonymous said...

I was rather upset when I first heard of the ADHD/bulimia connection because both of these issues had hurt my life and I could have done soooo much better had I been treated for the ADHD sooner. When I was started on Adderall my bulimia urges basically disappeared. If I take a medication break my urges can flair.
Thank you for sharing your info here!

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