Nutrition Research Paper

Mykytka 1 Katherine Mykytka Dr. Zemel Nutrition 302 Section 001 March 11, 2008 Attention-Deficit/Hyperactive Disorder and Binge Eating Over recent years, there has been much discrepancy over the relationship between attention-deficit/hyperactivity disorder and binge eating. The popularity of research being done in this area has increasingly grown in recent years. Often associated with behavioral and learning disorders, ADHD has not been commonly linked to any type of eating disorder before now. While some researchers still dispute this theory, the belief that there is a connection between ADHD and binge eating is becoming much more widely held. ADHD is among one of the most common and impairing childhood psychiatric conditions. It is characterized by inappropriate signs of inattention, distractiveness, impulsiveness, and hyperactivity that typically appear before the age of seven, while a large percentage of these symptoms last well into adulthood. Patients with ADHD often have, “impaired neuropsychological functions including inhibition, working memory, planning, and sustained attention, and can be characterized into one of four ADHD types: predominantly inattentive, predominantly hyperactive-impulsive, combined, and not otherwise specified” (Cortese, 2000, p. 406). Attention-deficit/hyperactivity disorder has been shown to have numerous comorbidities as well. In past research, patients suffering from ADHD have been shown to have oppositional defiant disorder, conduct disorder, anxiety disorders, depressive disorders, and speech and learning disorders, among others (Davis, C., 2000). Attention-deficit/hyperactivity disorder rarely comes in a form by itself, but instead brings along many other problems and issues to additionally deal with. Throughout the past few decades, eating disorders have become one of the most prevalent

Mykytka 2 medical problems in the world. An eating disorder can be categorized as any unhealthy behavior or feeling involving food. Anorexia, bulimia nervosa, and overeating are all classified as eating disorders. Common symptoms of eating disorders include refusal to maintain a normal weight proportional to height and age, intense fear of weight gain, unrealistic or distorted ideas about body image, withdrawing emotionally from people, anxiety around meal times, binging, or purging. People with eating disorders need emotional support and psychotherapy, while nutritional counseling and medications are commonly used (Liu, 2008). The specific disorder of binge eating is classified by eating much more rapidly than usual, eating until uncomfortably full, eating large amounts of food, even when not physically hungry, eating alone out of embarrassment at the quantity of food being eaten, or by feelings of disgust, depression, or guilt after overeating. Binge eating is also prevalent in bulimia, but is followed by either purging or strenuous exercise. Although overlooked in the past, a potential comorbidity between ADHD and binge eating has been suggested by recent investigational evidence. Better insight into this potential connection is of relevance for two principle reasons. The first is the contribution to the understanding of possible pathological mechanisms underlying both ADHD and binge eating. The second are the important implications for the management of patients with both ADHD and binge eating. Better knowledge in this field could suggest potentially effective therapeutic strategies for when these two conditions coexist. Before either of these matters can be considered, however, research involving the relationship between attention-deficit/hyperactivity disorder and binge eating must first be examined. In a 2000 Minnesota Adolescent Health Survey, the rates of abnormal eating behaviors among adolescents with and without chronic diseases were observed. While the sample size was quite large, the authors found “subjects with attention-deficit/hyperactivity disorder were

Mykytka 3 significantly more likely to binge than were subjects without the disorder” (Cortese, 2000, p. 409). The body sizes of the adolescents were also assessed. The prevalence of overweight and obesity was significantly greater in the subjects diagnosed with ADHD than those not diagnosed with the disorder. These results are of relevance because they show there is a basis for more accurate investigation in a more controlled clinical setting. In a 2002 study by Saboya Mattos, adults that had been clinically diagnosed with ADHD were observed. ADHD had two observable measures: retrospective recall of childhood ADHD symptoms and current impulsivity traits. This assessment was critical in order to ensure adult ADHD symptomalogy. The measured observations for overeating were comprised of binge eating, emotionally driven eating, and eating prompted by external stimuli rather than hunger. Out of the eighty-six subjects, 8.3% were found to have a binge eating disorder. This was the first study that used a clinically structured observation method and proved a true comorbidity between ADHD and binge eating. Another child-based study was done in 2006 by Amori Yee Mikami that consisted of females ages six to twelve with and without attention-deficit/hyperactivity disorder. Mikami hypothesized that girls with ADHD more commonly show distress through eating and internalizing disorders and have impulsive personality traits central to binge eating. Through a series of clinical tests and interviews, Mikami concluded that girls with ADHD in childhood are at great risk for eating disorders later in life, particularly binge eating. Childhood impulsivity symptoms were found to be the best predictors of adolescent eating pathology, as well as inattention and hyperactivity. Overall, girls with ADHD had higher adolescent body mass indexes than girls without the disorder. Mikami ultimately concluded that binge eating, as well as other eating disorders should most definitely be incorporated into the risks and impairments among girls with attention-deficit/hyperactivity disorder.

Mykytka 4 Clearly, this research expresses some sort of connection between binge eating and ADHD. That leaves the question of what is it that causes the relationship. Many hypotheses exist in this area of study. Since clinical these subject studies indicate there being a correlation, investigators have begun to take a better look at the physiological and neurological aspects of the comorbidity in order to explain why the link exists. Registered dietician Levitan Davis suggests that, “Deficient inhibitory control as well as delay aversion, which are both expressions of the impulsivity component of ADHD, may contribute to abnormal eating disorders, including binge eating. Deficient inhibitory control, which manifests as poor planning and difficulties monitoring one’s behavior effectively, could lead to over consumption when not hungry due to the relative absence of concern for daily caloric intake. A strong delay aversion could favor the tendency to binge on ‘fast food’ with high caloric content in preference to home cooked meals with lower caloric content, which take longer to prepare” (Davis, L., 2005, 1218). The impulsiveness that comes along with ADHD can create unwarranted desires. Commonly, these desires manifest themselves as food. The impulsivity is then taken a step further and becomes an aspiration for large quantities of food in any form, most commonly high-fat, high-carbohydrate food that is readily obtainable. Another possibility is that ADHD and binge eating are the expression of neurobiological mechanisms. Insufficient dopamine levels are commonly linked to ADHD. This deficiency is also linked to reward deficiency syndrome, a disorder characterized by a need for unnatural, immediate rewards such as gambling, risk taking, or inappropriate eating (Brown, 2000). Another common psychopathological factor associated with lowered dopamine levels is depression. Depression is also often linked to eating disorders, and in these cases, significant weight gain is seen more often than not. The overeating is seen by the patient as a way of “self-medicating” in order to compensate for the hormone deficit. Therefore, lowered dopamine levels in a patient

Mykytka 5 could be responsible for a myriad of disorders, most importantly, the concurrence of ADHD and a binge eating disorder. The physiological connection between attention-deficit/hyperactivity disorder and binge eating has only been briefly researched. Individuals with ADHD, “show diminished activation in the hippocampus when engaged in decision-making tasks that involve weighing the pros and cons between small immediate rewards and large future rewards. Those with ADHD also tend to respond more readily to immediate sensory stimuli than to engage in complex processing” (Davis, C., 2005). This deficiency comes into play when considering binge eating tendencies. Patients suffering from ADHD often want immediate food satiety due to their desire and responsiveness to sensory activity. The deactivation in the hippocampus could very well be the cause of this inability to process complex issues; however, there are many parts of the brain that contribute to higher thinking. Therefore, it is not an absolute that the hippocampus is responsible for the difficulty in decision making involved with ADHD and binge eating. More research would be needed in order to truly make a correlation. If there truly is a relationship between attention-deficit/hyperactivity disorder and binge eating, treatment for one disorder may induce a medicating effect for the other. ADHD is most commonly treated with drugs that elevate dopamine levels. These medications may be able to act on the brain pathways involved in ADHD as well as those that cause abnormal eating behaviors. Many trails have suggested that, “ADHD drugs may act on the synapses in the hypothalamus that are thought to play a role in modulating satiety and feeding behavior” (Schweickert, 2007, 299). Nevertheless, stimulant medications alone may not be sufficient to improve the disordered eating habits of patients with ADHD. Alternatives such as behavior therapy focusing on attention, organizational strategies, and response inhibition should also be considered. Since binge eating may very well be an expression of the impulsiveness associated with ADHD, therapy dealing with

Mykytka 6 frustration and anxiety difficulties could be quite beneficial. The fact of the matter is that if the two disorders have a pathological connection, management and therapeutic strategies could be drastically improved with more insight to their linkage. The unpleasant personal, social, and nutritional implications associated with both ADHD and binge eating could be greatly improved with the correct treatment and therapy. While the comorbidity of attention-deficit/hyperactivity disorder and binge eating is only of recent interest, it is most definitely in need of greater attention and further research. Physicians and dieticians have long overlooked this comorbidity, but emerging data from these studies suggests that the rate of binge eating in patients with ADHD is higher than expected. Individuals suffering from ADHD having a diminished ability to assess future adverse health consequences of over-consumption, the counteractive implications of increased body weight, a diminished ability to wait for healthy food choices, and commonly indulge in the possibility of using palatable food to satisfy sensory impulses. These characteristics likely foster the connection between ADHD and binge eating. Better insight to this connection could greatly improve the nutritional status of so many suffering from overeating. With the United States at such an unfortunate current health standing, a breakthrough in this comorbidity could get many overweight individuals back on the right path. America has made it a challenge to maintain appropriate eating behaviors for a healthy lifestyle, so those with already low inhibitory control have an even greater disadvantage. With fast food restaurants on every street corner, temptation for the highly impulsive is difficult to avoid. The proper treatment for individuals with ADHD and binge eating could be an enormous relief and an aid to recovery. More research studies using clinically diagnosed ADHD patients, appropriate control groups, controlled confounding variables, and scientifically sound methods are greatly encouraged by all current researchers in the field. Only then will the medical and dietetic words be able to truly help

Mykytka 7 those suffering with these disorders.

Mykytka 8 References Brown, Thomas. (2000). Attention-deficit disorders and comorbidities in children, adolescents, and adults. Washington, DC: American Psychiatric Press, Inc. Cortese, Samuele. (2000). Attention-deficit/hyperactivity disorder (ADHD) and binge eating. Nutritional Reviews, 65(9), 404-411. Davis, Caroline. (2005). Associations among overeating, overweight, and attentiondeficit/hyperactivity disorder: A structural equation modeling approach. Eating Behaviors, 7(2), 266-274. Davis, Levitan. (2005). Attention-deficit/hyperactivity disorder: A selective overview. Biological Psychiatry, 57(11), 1215-1220. Liu, Aimee. (2008). Gaining: The truth about life after eating disorders. New York: Wellness Central. Mattos, Saboya. (2002). Cormorbid eating disorders in attention-deficit/hyperactivity disorder adult clinical sample. International Journal of Eating Disorders, 26(3), 248-250. Mikami, Amori Yee. (2006). Eating pathology among adolescent girls with attentiondeficit/hyperactivity disorder. Journal of Abnormal Psychology, 117(1), 225-235. Schweickert, Lori. (1997). Efficacy of methylphenidate in binge eating comorbid with attentiondeficit/hyperactivity disorder: A case report. International Journal of Eating Disorders, 21(3), 299-301.