The multifaceted impact of ADHD on eating habits

Did you know that attention-deficit/hyperactivity disorder (ADHD) not only impacts academic and work-related tasks but can also affect our eating behaviours? 

This neurodevelopmental difference, characterised by persistent patterns of variable attention, hyperactivity, and/or impulsivity, shapes eating habits through several intertwined mechanisms. In this article, we explore the roles of interoception and sensory processing, hyperfocus and executive functioning, stress and emotional regulation, body image, and binge eating, all in the context of ADHD.

Interoception and sensory differences

Interoception is our ability to recognise and interpret internal bodily signals, such as hunger, fullness, and thirst. People with ADHD often struggle to recognise these signals, which can result in irregular eating patterns (2). For instance, forgetting to eat, eating past fullness, or confusing hunger with thirst are common patterns we see in nutrition practice (2). We notice how poor or dysregulated interoception can contribute to both undereating and overeating (2).

Individuals with ADHD can easily miss the subtle cues that would typically guide our healthy eating rhythms. It’s also worth noting that some ADHD medications, in particular stimulant medications, can lower appetite, potentially exacerbating these eating challenges and reinforcing the need for monitoring and support to maintain balanced nutrition (1).

On top of these interoception challenges, ADHD can significantly affect the sensory experience of eating. It’s quite common for individuals with ADHD to be more sensitive to food textures, tastes as well as smells, leading to food aversions, selective eating, or, in some cases, minimal diets (3).

These sensory-driven preferences can cause nutritional imbalances or deficiencies (3). Over time, these nutrient gaps may end up disrupting hormonal and bodily balance, potentially intensifying some ADHD traits and symptoms (5). For many of our clients, this cycle of sensory avoidance and resulting deficiencies can further complicate both physical health and effective ADHD management (3).

Hyperfocus and executive functioning challenges

A common misconception about ADHD is that it means a person cannot focus at all. In reality, ADHD is better understood as a condition of variable or dysregulated attention, where focus swings between distractibility and periods of intense concentration, known as hyperfocus (8).

During hyperfocus, individuals with ADHD can become so absorbed in an engaging task that they easily lose track of time and ignore their bodily needs, such as hunger or thirst. This situation can often lead to forgetting to eat and skipping meals, which may be followed by overeating or bingeing once attention shifts back to physical needs (8).

Executive functioning challenges, for instance, difficulties with planning, organisation, and task initiation, can also interact with hyperfocus to further disrupt eating routines (4). For example, poor planning may mean that meals are not prepared or thought of in advance, making it easier to skip meals during those periods of hyperfocus or resort to impulsive, less nutritious food choices when hunger finally registers (4). These combined difficulties can negatively impact adherence to nutrition plans and contribute to erratic eating patterns (7).

Stress, emotional regulation, and body image

Chronic stress commonly co-occurs with ADHD and can significantly disrupt eating behaviours (6). Stress often triggers emotional eating or cravings for high-sugar, high-fat foods, which can all contribute to dietary patterns linked to increased ADHD symptoms (6). Also, stress affects the gut-brain axis, potentially worsening both digestive health and ADHD symptoms (5).

Individuals with ADHD are more likely to experience gastrointestinal issues such as constipation, diarrhoea, bloating, or abdominal pain (5). Emerging evidence suggests that an imbalanced gut microbiome (i.e. the community of microorganisms in our digestive system) may also influence neurotransmitter production (e.g. serotonin, dopamine), impacting mood and cognitive function and potentially exacerbating ADHD symptoms (5).

Low self-esteem is also a frequent challenge for neurodivergent individuals, including those with ADHD (8). It is often rooted in early experiences of rejection sensitivity and negative feedback. In a society saturated with social media, filters, and cosmetic enhancements, unrealistic beauty standards can easily intensify body dissatisfaction. This observation is particularly true for younger women with ADHD, who may be at higher risk for body dysmorphia (9) suggesting the need for more research in this area.

This struggle with body image can significantly affect dietary habits: impulsivity and emotional dysregulation linked to ADHD often lead to patterns like binge eating, emotional eating, or restrictive dieting as individuals seek comfort or control through food (6). These cycles not only reinforce poor self-esteem but also increase the risk of developing eating disorders in people with ADHD (1).

Stress, emotional regulation difficulties and body image issues often interact and can further reinforce disordered eating patterns (6).

The link between ADHD and binge eating tendencies

As outlined above, difficulties with impulse control and emotional regulation in ADHD can increase the risk of binge eating behaviours, which often co-occur with ADHD (1). Poor interoception, hyperfocus-induced meal skipping, and stress-related eating all contribute to cycles of restriction and bingeing (2). Sensory sensitivities may drive individuals to seek out highly palatable foods, for instance, those that are intensely sweet, salty, or fatty, which are more likely to be consumed in excess.

In addition to these behavioural and psychological factors, neurotransmitter imbalances, particularly involving dopamine and norepinephrine, are central to both ADHD and binge eating (6). These can lead individuals to seek immediate gratification, making highly rewarding foods particularly appealing, which may increase the risk of binge eating tendencies (1).

We now also understand that genetic factors may contribute to both ADHD and binge eating behaviours (1). Research has identified correlations between specific gene variants related to dopamine regulation and a higher likelihood of experiencing ADHD traits and binge eating (1). However, it's important to note that the genetic contributions are complex and may involve multiple genes and environmental factors (1).

All these vulnerabilities interact with environmental and psychological triggers, making it especially challenging for individuals with ADHD to sustain balanced eating habits (1).

As you can see, the impact of ADHD on eating habits is somewhat complex and multifactorial. It involves various factors. That's why it's crucial to tackle these issues in a holistic way and promote self-compassion.

Dietary support, supplementation and/or medication when needed, stress management, as well as tailored interventions such as coaching or therapy when appropriate, can help improve both eating behaviours and overall well-being in individuals with this neurodevelopmental difference.

Having said all this, we need to acknowledge that ADHD is complex, and its presentation can vary significantly between individuals with ADHD. While the experiences described in this article are common, they may not apply to every person with ADHD.

References:

• Reinblatt, S.P. (2015) ‘Are eating disorders related to attention deficit/hyperactivity disorder?’, Current Treatment Options in Psychiatry, 2(4), pp. 402–412. doi:10.1007/s40501-015-0060-7.
• Martin, E., Dourish, C.T. and Higgs, S. (2023) ‘Interoceptive accuracy mediates the longitudinal relationship between attention deficit hyperactivity disorder (ADHD) inattentive symptoms and disordered eating in a community sample’, Physiology & Behavior, 268, p. 114220. doi:10.1016/j.physbeh.2023.114220.
• Jakobi, B. et al. (2024) ‘The role of diet and the gut microbiota in reactive aggression and adult ADHD—an exploratory analysis’, Nutrients, 16(14), p. 2174. doi:10.3390/nu16142174.
• Aarts, E. et al. (2017) ‘Gut microbiome in ADHD and its relation to neural reward anticipation’, PLOS ONE, 12(9). doi:10.1371/journal.pone.0183509.
• Wan, L. et al. (2020) ‘Case-control study of the effects of gut microbiota composition on neurotransmitter metabolic pathways in children with attention deficit hyperactivity disorder’, Frontiers in Neuroscience, 14. doi:10.3389/fnins.2020.00127.
• El Archi, S. et al. (2020) ‘Negative affectivity and emotion dysregulation as mediators between ADHD and disordered eating: A systematic review’, Nutrients,12(11), p. 3292. doi:10.3390/nu12113292.
• Kaisari, P. et al. (2018) ‘Associations between core symptoms of attention deficit hyperactivity disorder and both binge and restrictive eating’, Frontiers in Psychiatry, doi:10.3389/fpsyt.2018.00103.
• Ashinoff, B.K. and Abu-Akel, A. (2019b) ‘Hyperfocus: The Forgotten Frontier of Attention’, Psychological Research, 85(1), pp. 1–19. doi:10.1007/s00426019-01245.
• Van Eck, K., Morse, M. and Flory, K. (2015) ‘The role of body image in the link between ADHD and depression symptoms among college students’, Journal of Attention Disorders, 22(5), pp. 435–445. doi:10.1177/1087054715580845.