ADHD and Binge Eating: Why They Are Linked

There is no need to wait to get support. If there are behaviors such as intense guilt about food, frequent binge episodes, vomiting or severe restriction, it is important to talk to a specialist about it. Eating disorders are serious but treatable conditions. In an emergency, in Türkiye you can reach the 112 emergency call center, and you can ask for referral from the ALO 183 Social Support Line.

When I sink into a task I forget to eat for hours. I know people who describe this like an achievement; in me it never felt that way. When evening comes I walk into the kitchen with a hunger that has built up all day, and at that point none of the decisions I make about what to eat resemble the morning's decisions.

For a long time I took this for a problem of organization. Yet underneath it were the body signals I had missed all day, the skipped meals and all the tiredness left over for the evening.

Walking into the kitchen in the evening and, after a while, not being able to notice how much you have eaten is an experience described by many people living with ADHD. Research shows that this is not a coincidence.

How often they occur together

The systematic review and meta-analysis by Nazar and colleagues (2016) found that the likelihood of being diagnosed with any eating disorder is about 3.8 times higher in people with ADHD. The risk is not limited to one eating disorder; it was found to be elevated in anorexia, bulimia and binge eating disorder alike.

The meta-analysis by Cortese and colleagues (2016) shows that there is also a significant relationship between ADHD and obesity.

This article focuses on one of the most discussed pictures: binge eating.

What binge eating is

Binge eating is eating, in a short period, markedly more food than most people would eat under similar conditions, and feeling out of control while doing so.

The following features usually accompany it:

• Eating much faster than normal.
• Eating until an uncomfortable feeling of fullness.
• Eating a lot when not hungry.
• Eating alone out of embarrassment.
• Guilt, shame or self-disgust afterward.

The difference from bulimia is that compensatory behaviors such as vomiting or excessive exercise are not regularly carried out after the binge. In the glossary, eating disorder.

Why it is related to ADHD

There is no single reason. Several mechanisms stand out in the research, and they often work together.

Impulsivity

Impulsivity, one of the core features of ADHD, is reflected in decisions about food too. The gap between reaching for food and stopping to check "am I really hungry" is very short. Finishing the food in front of you, grabbing something on the way, unplanned snacking are the everyday face of this impulsivity.

Difficulty with emotion regulation

This is one of the strongest explanations. The systematic review by El Archi and colleagues (2020) found a significant relationship between ADHD and binge eating and addiction-like eating behaviors in the great majority of the studies examined. Some studies in the review suggest that negative affect and difficulty with emotion regulation play a mediating role in this relationship.

That difficulty with emotion regulation is markedly more common in adult ADHD has also been shown by meta-analysis (Beheshti et al., 2020).

In practice this means: food can become an accessible way of quickly soothing a difficult emotion. Distress, boredom, disappointment, tiredness. In the glossary, emotional eating.

Noticing hunger and fullness signals late

In ADHD it can become harder to notice the body's signals in time. Forgetting to eat for hours once you sink into a task, then hunger arriving suddenly and very intensely. At that point selective or measured eating becomes very hard.

In the same way the fullness signal can be noticed late, and the person can keep eating until they are uncomfortable. The details are in the article body signal blindness in ADHD.

Irregular meals

Difficulty with planning affects a regular meal pattern too. Breakfast is skipped, lunch is forgotten, little is eaten through the day, and the hunger that has built up prepares the ground for bingeing in the evening.

For me this is the most concrete item on the list. The evening of the days I have not eaten anything in the morning does not resemble the evening of the days I have. Noticing this reduced the guilt in me, because it showed that the cause of my state in the evening stood not in the evening but in the morning.

Stimulus seeking

Food gives a fast reward. Stimulus seeking in ADHD can, especially in moments of boredom, turn food into an easily reached stimulus.

Binge eating is often not a weakness of will; it emerges at a point where impulsivity, difficult emotions and an irregular day come together.

ADHD medications and appetite

Another detail that needs to be discussed: one of the known side effects of the stimulant medications used in ADHD is decreased appetite. In the glossary, appetite suppression.

This can create a two-way situation:

• During the day, appetite decreases with the effect of the medication and meals are skipped.
• When the effect of the medication wears off in the evening, the accumulated hunger returns intensely, and the evening meal can turn into a binge.

If you take medication and notice this pattern, it is important to talk to your doctor about it. There are adjustments that can be made to meal timing or the treatment plan.

On the other hand, for binge eating disorder itself there are also approved medication options in some countries. Which option is suitable for whom is entirely the doctor's decision.

What helps

The following do not replace treatment; but they target the ways ADHD affects eating behavior.

Fixing the meals. Eating by the clock instead of waiting for hunger. Setting a meal reminder on the phone reduces skipped meals during the day, especially in those who take medication. In the glossary, meal routine.

Not letting hunger build up. A large part of the evening binge comes from the food not eaten during the day. Eating regularly and enough during the day reduces the risk in the evening.

Putting protein first. Eating something with protein, especially at breakfast, can help reduce the fluctuations in hunger through the day. In the glossary, protein first.

Adding friction. Removing the foods that trigger bingeing from easily reached places. In the impulsive moment one more step of difficulty is often enough.

Naming the feeling. When the urge to go to the kitchen comes, pausing for a moment and asking "am I hungry, or am I bored, tired, sad." This question does not always stop it but it brings awareness. In the glossary, naming emotions.

Preparing alternative soothers. Other ways to turn to before reaching for food in a difficult emotion: a short walk, calling a friend, taking a shower.

Not punishing yourself. The guilt that comes after a binge and the excessive restriction that follows it feed the cycle. Restriction can prepare the ground for the next binge. The details are in the article shame and self-compassion in ADHD.

Getting support

Eating disorders are conditions that can be treated with specialist support. It is especially important to see a specialist in the following situations:

• If binge episodes have become frequent and regular.
• If thoughts about food take up most of the day.
• If there are compensatory behaviors such as vomiting, excessive exercise or severe restriction.
• If there is intense distress about weight or the body.

When ADHD and an eating disorder occur together, treatment that takes both into account gives the best result. An approach focused only on food can fall short if it does not address the underlying impulsivity and difficulty with emotion regulation.

The general nutrition framework is in the article ADHD and nutrition.

A common mistake

The mistake I see most often is making a punishment plan for the next day after a binge: I will eat little today, I will make up for it today. This plan is well-meant and it is fuel for the cycle. Restriction prepares the ground for the next binge.

The second mistake is seeing the problem as only about food. Trying to solve it with willpower without touching the meal pattern leaves the trap set in the first ten hours of the day exactly as it was.

The third is waiting for the picture to get worse before asking for help. Thinking "this much doesn't count as a disorder" and waiting for years is common and unnecessary.

What remains

The risk of an eating disorder is markedly higher in people with ADHD, and binge eating is one of the most discussed of them. Behind it are impulsivity, difficulty with emotion regulation, noticing the body's signals late and irregular meals.

Knowing these makes it possible to treat the eating problem not as a weakness of character but as mechanisms that can be worked on.

What changed in me was exactly this. I stopped getting angry at myself by looking at my state in the evening; I began looking at whether I had eaten something in the morning. This changed much more than it sounds.