Eating Disorders, ADHD And Poor Self-Awareness

Running head: EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 1

Eating Disorders, ADHD and Poor Self-Awareness

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EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 2

Eating Disorders, ADHD and Poor Self-Awareness

Introduction

There has been a controversy on whether eating disorders are linked to ADHD and Poor

Self-Awareness. Many people have eating disorders, but they are never healed even after

treatment. It is also worth noting that, even though people have eating disorders might be very

slim, they have to be on a diet for the rest of their lives. However, their health may later worsen

while seeking treatments for their survival. Even with treatments, they still repeat binge eating,

vomiting during the treatments, and never achieve fully treated. Therefore, finding out why

eating disorders are difficult conditions to treat and seem easy to deal with becomes, thus making

this an important purpose of study. All stakeholders, such as psychiatrists or dieticians, Attention

Deficit Hyperactivity Disorder (ADHD) patients, people with eating disorders and those with

obesity might want to understand the connection of ADHD to eating disorders (ED) in order to

offer or acquire more effective treatment that is grounded on a grasp of these conditions.

For a long time, studies into Eating disorders have indicated that the disorders are not just

tied to food abnormalities alone. However, it is only recently that researchers have delved more

into the study of complex psychological, physiological and cultural attachments connected to

eating disorders, such as binge eating among others. Researchers and health professionals have

disagreed on whether there is a relationship between ED and ADHD, obesity and ADHD as well

as ED and poor self-awareness caused by cultural and ethnic identities. They have also disagreed

on whether cultural identities affect self-awareness of females more compared to males. This

brings up an important question: Is there a relationship between eating disorders and attention

deficit disorder (ADHD), and between eating disorders and poor self-awareness caused by ethnic

or cultural identities?

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 3

Background

It is imperative to define Eating Disorders (ED) and Attention Deficit Hyperactive

Disorder (ADHD) in order to have an understanding of the relationship between ED and ADHD.

An eating disorder is an irregular or inappropriate eating habit that includes excessive or

insufficient food consumption that jeopardizes the emotional and physical health of an

individual. It includes bulimia nervosa (BN), anorexia nervosa (AN), binge eating disorders

(BED), and other eating disorders that have not been defined (ENDOS). According to Nazar et al.

(2008), 70 percent of adults who are diagnosed with ADHD show a sign of eating disorder.

Attention Deficit Hyperactive Disorder is a state that can be identified by the presence of

uncontrolled behavior, inattentiveness, lack of focus and hyperactivity. It is among the most

common childhood disorders that can go on through adolescence and adulthood.

Past studies into eating disorders indicated that, eating disorders are not just tied to food

abnormalities alone as there are other factors, such as cultural among others that trigger poor

eating disorder. It is only recently that, researchers delved more into the research of the complex

psychological, physiological, and cultural attachments connected to eating disorders, such as

binge eating disorders. The stretched researches into other aspects that are tied to eating disorders

have indicated that, eating disorders are tied to attention deficits and poor self-awareness (Davis,

Levitan, Smith, Tweed, & Curtis, 2006).

A strong connection exists between eating disorders and ADHD. Patients who have

eating disorders and ADHD exhibit common characteristics, such as low self-esteem, deficits in

attention and varied degrees of impulsivity (Nazar et al., 2008; Davis, Levitan, Smith, Tweed, &

Curtis, 2006). These deficits lead to overconsumption of food, binge eating and eating without

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 4

hunger. Eating disorders occur mostly because of cognitive and emotional deficits (Ptáček,

Kuželová, Papežová & Štěpánková, 2010). People who suffer from AN and BN have been found

to have difficulties with executive functioning and weaknesses in contextual integration

(Talleyrand, 2010). In addition to that, people with BN also exhibit a disintegrated response

pattern, especially when put in contexts exposing them to negative emotions. On the other hand,

patients who have AN exhibit high level of impaired decision-making and social cognition

(Klump, Bulik, Kaye, Treasure & Tyson, 2009).

These impairments commonly occur in states of acute illnesses, and severely impair the

abilities of judgment and interpersonal interactions. Therefore, eating disorders and the presence

of other psychiatric conditions, which includes ADHD affects or limit the ability of patients to

carry out their daily activities in a normal way (Davis et al., 2006). However, the social

adjustments of these patients tend to be slow. In addition, their social communication skills are

poor and their social networks are limited. Davis et al. (2006) showed that, eating disorders are

linked to medical and social disabilities of psychiatric disorders that are costly to the patients,

their families, and the society.

People suffering from obesity exhibit similar symptoms of as those having ADHD.

Obesity can be defined as a condition originating from inappropriate eating habits. Riverin and

Trembley (2009) noted that, some people who seek treatment for obesity are found with

symptoms of ADHD, especially when they are adults. Delayed reward and reduced sensitivity to

negative feedback are characteristics of both adolescents and adults and can be found to have

ADHD (Davis et al., 2006). When obese people do something good, they often use food as

reward. Therefore, for a long time, eating has been used as a reward in treating people with

ADHD, thus creating a strong relationship between obesity and ADHD. However, in most

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 5

instances, food rewards used as self-medication are significantly abused. ADHD patients need

regular rewards to feel good as a way of compensating for the disorder (Riverin & Tremblay,

2009; Holtkamp et al., 2004).

In addition, patients with ADHD have an association with substance dependence, which

in most cases is food. ADHD patients have used food as a source of mood enhancement. Since

the deficiency of dopamine in the brain reward pathways causes ADHD, these patients have a

higher risk of substance abuse (Cortese, et al., 2007). Therefore, they use highly delicious foods

as a therapeutic proxy, which acts as a reward pathway, thus showing the linkage of ADHD to

eating disorders. In Western countries, obesity is a problem that is often observed in children.

Holtkamp et al. (2004) reported that, the obesity cases in the Western world have shown strong

relationship with ADHD, which in most instances have been overlooked because less

externalizing factors in obese children are not noticeable.

The other strong relationship between ADHD and binge eating is impulsive and

inattentive components of eating disorder. Delayed aversion and deficient inhibitory control

mechanisms contribute to abnormal eating behaviors (Klump et al., 2009), because the above

conditions manifest in poor planning and difficulties in monitoring one’s behavior in an effective

way leading to overconsumption of food (Davis et.al, 2006; Nazar et al., 2008). In addition,

Klump et al. (2009) noted that, deficits in attention and other executive functions could make it

problematic for a person with ADHD to follow a regular eating pattern. This failure could

ultimately lead to abnormal eating behaviors. This is because there is a high probability that

patients with ADHD could be inattentive to their signs of hunger, and thus forgetting to eat when

they get other interesting things to do (Cortese, et al., 2007).

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 6

Eating disorders are tied to poor self-awareness that is influenced by ethnic identity. It is

notable that, culture plays an essential role in developing strong self-awareness on its people.

Different cultures have ideals to be followed by all people and this include food consumed by

those belonging to the culture. On the other hand, if they do not have this body for one reason or

another, they develop low self-esteem that turns into poor self-awareness. This factor contributes

to inappropriate eating behaviors that could be considered as eating disorders.

Franko, Becker, Thomas, and Herzog (2007) acknowledge that, even though anorexia

was originally believed to be featured mainly in white and European women, their research data

indicates that, eating disorders occurs even in ethnically and socio-economically diverse

populations. For instance, white women are likely to develop poor self-awareness, which could

lead to eating disorders as a result of the fact that their culture despises fat women. Women from

minority ethnic groups show lower rates of symptoms of eating disorders as compared to white

women (Franko et al., 2007).

The significant differences that occur with respect to eating disorders in terms of ethnic

and cultural differences are all tied to cultural beliefs that are defined by a specific ethnic or

cultural group. Gordon, Castro, Sitnikov, and Holm-Denoma (2010) states that, acculturation has

also changed the way eating disorders are conceived because it accelerates the acceptance and

adoption of body ideals, for instance, concerning eating disorders. This has been clearly

manifested by acculturated Latinas and Europeans compared to their counterparts who are not

acculturated (Gordon et al., 2010).

Ethnic and cultural beliefs regarding body size, affect males and females in different

ways as women and girls are more conscious about their body shapes as compared to men. This

is due to the fact that, the society has developed an ideal, which expects women to have certain

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 7

body shapes, and in most cases not to be fat or overweight. Therefore, this becomes more

demanding when it has to do with cultural expectations. Consequently, women are significantly

prone to developing poor self-awareness and develop eating disorders, to fit into the societal or

cultural ideals. For instance, Baillie (2011) state that, in the western culture, there is a general

emphasizes on thinness and this belief is accountable for the existence of eating disorders and

body dissatisfaction especially for women. In the U.S. 10, million women and 1 million men are

suffering from eating disorders such as anorexia and bulimia.

Asians who are acculturated to western values show a little concern to body image and

eating problems (Baillie, 2011). On the other hand, those who live in western societies, but are

highly tied to their native cultures, are at a high risk of symptoms of eating disorders. Chinese

and Caucasian people do not show differences with respect to disordered eating and image

disturbance, clearly showing that, values on the ideal body image impose symptoms of

disordered eating and body image disturbance on people (Baillie, 2011). Although there are no

differences in eating disorder symptoms and body dissatisfaction, there are differences in terms

of body esteem.

Talleyrand (2010) indicates that, women and girls demonstrate great levels of sexual

attractiveness and physical attractiveness as compared to their male counterparts. Males show

little concern with their body shapes or set ideals because they are measured by other aspects like

wealth as opposed to the beauty of the body. This shows that, self-awareness as influenced by

ethnic or cultural identity is connected to eating disorders (Talleyrand, 2010).

Girls suffering from ADHD are at risk of eating disorders, particularly bulimia nervosa

(Biederman, Ball, Monuteaux, Surman, Johnson & Zeitlin, 2007). This is because they

experience higher occurrences of anxiety, mood changes, disruptive behavior disorders, and the

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 8

onset of menarche at an earlier time than normal girls does (Talleyrand, 2010). In cases where an

eating disorder or ADHD is found, symptoms of the other types of disorders are also present. It is

only in certain cases where a case of either ADHD or an eating disorder occurs without

symptoms, which show the existence of the other (Biederman et al., 2007).

Discussion/ Conclusion

An issue of concern to health professionals, researchers and people affected with ADHD

or eating disorders have failed to understand relationship existing between ADHD and eating

disorders. Secondly, these professionals would be interested in understanding how poor self-

awareness influenced by cultural relates with eating disorders. Thirdly, the professionals may be

interested to find out how obesity is related to ADHD and whether obesity is an aspect of eating

disorders. Lastly, they may be willing to find out whether there are therapeutic methods that can

be applied to solve these issues.

Eating disorders have a strong relationship with ADHD. This relationship can be

attributed to the fact that people who are diagnosed with ADHD have characteristics, which

make the affected person develop inappropriate feeding styles such as overconsumption of food,

eating without hunger and binge eating. This happens mainly because people with ADHD lack

focus and has issues of inattentiveness to the extent that they fail to pay attention to their eating

habits, thus developing eating disorders.

As indicated by Ptáček, Kuželová, Papežová & Štěpánková, (2010), people suffering

from AN and BN have hardships with executive functioning and contextual integration because

of cognitive deficits. In order to control one’s eating habits, a person should be able to

consciously control his or her eating habits by paying attention to the eating schedules, the types

of food and the amounts of food that they ingests. However, people with ADHD cannot do this

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 9

effectively because of their lack of attentiveness and lack of focus (Cortese, Bernardina &

Mouren, 2007). This way, they develop eating disorders since they fail to control their eating

schedules, the types of food and the amounts of food they consume. This is a characteristic of

binge eating disorder, which is proved to be connected to ADHD.

In addition, patients who are diagnosed with ADHD have high susceptibility to changes

in the growth and development patterns (Klump, et al., 2009). This is attributed to the fact that,

these patients are used to taking stimulants given in terms of medication to treat these disorders

and taking these stimulants makes the patients used to them. Therefore, when the stimulants are

not available, they turn to food in order to get the effect offered by medical stimulants. This way

they develop inappropriate eating behaviors that gradually become an eating disorder.

In appropriate eating habits is another factor indicating the relationship between ADHD

and obesity. Obesity has been understood as a condition that comes about because of

inappropriate eating habits. Some individuals who seek treatment for their obese condition have

been found to have certain symptoms that identify ADHD in them. In addition, obese conditions

have certain aspects that share similarity to symptoms of ADHD. For example, reduced

sensitivity to negative feedback and delayed reward are symptoms that are found in people with

ADHD.

People with obesity use food as their reward or motivation when they have achieved

something or done something good. This shows a relationship between obesity, that is an aspect

of improper and inappropriate eating habits, and ADHD. As Davis et al. (2006) point out, food

has been used as a treatment mechanism for people with ADHD. People with ADHD get used to

having food as their reward mechanisms, thus developing an attachment to food, something that

increases their chance of becoming obese. As a result, becoming obese is an aspect of developing

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 10

eating disorder in the process of treating or dealing with ADHD. People suffering from obesity

and ADHD use food as a way which encourages their mood enhancement that offers them a

significant satisfaction. Consequently, a person who has ADHD can easily become obese in the

result of poor eating habits, using food as a reward mechanism, or because of using food as a

mood enhancer. As shown by HoltKamp et al. (2004), in the United States a considerable number

of children who are obese have been diagnosed with ADHD. This shows the strong link that

exists between ADHD and eating disorders.

Poor self-awareness influenced by cultural and ethnic identities has a very strong

relationship with eating disorders. It is clear that, every individual across the globe lives within a

particular society that has its cultural and/or ethnic ideals and standards. Each person is expected

to fit into these ideals and standards. While other societies may favor slender body shapes, other

may favor bigger body shapes (Gordon, et al., 2010). Conformity leads to positive self-

awareness while failure leads to negative and poor self-awareness.

Poor self-awareness influenced by the failure to fit into the cultural or ethnic body ideals

is linked to eating disorders. First, a person may develop poor eating habits by avoiding eating or

eating irregularly in order to become slim as required by the cultural ideals. On the other hand, a

person may develop inappropriate eating habits by consuming a lot of food in order to become

fat as required by the cultural ideal. Either of these leads to eating disorders because of the poor

self-awareness caused failing to fit in the cultural ideals. Franko et al. (2007) acknowledge that

eating disorders occur in ethnically and socio-economically diverse populations. For instance,

white women are prone to poor self-awareness that could lead to eating disorders, just because

their culture despises fat women.

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 11

Furthermore, cultures place different ideals on males and females. In most cases, females

are the ones expected to maintain certain body shapes. When this happens, they are more likely

to develop eating disorders when they fall prey to poor self-awareness because of failing to fit in

the body shape ideals defined by their cultures or ethnic groups. This is why girls and adult

women have been found to have eating disorders more than boys and men do. For instance,

Baillie (2011) asserts that, in the western culture, there is more emphasizes on thinness and this

belief accounts for the presence of eating disorders and body dissatisfaction, especially for white

women.

Therapeutic methods, which can be used to treat ED and ADHD are currently not

available. Current research only shows methods that are used to treat eating disorders and ADHD

differently, as opposed to conditions that coexist in an individual. For instance, patients with

anorexia and bulimia can be treated through therapeutic methods that alleviate shame and

isolation, such as cognitive-behavioral therapy. For ADHD, behavioral therapy can be applied to

treat this condition. However, it is not clear whether the two therapies can be used to treat a

patient who has the two conditions.

It is evident that, a relationship exists between eating disorders and attention deficit

disorder (ADHD), as well as between eating disorders and poor self-awareness caused by ethnic

or cultural identities. The cultural or ethnic body ideals and identities that define the body types

that people should have, contribute to poor self-awareness when one develops a certain eating

habit to fit in the ideals. These ideals affect men and women differently and are accountable for

the differences in eating disorders among men and women.

Health professionals, such as psychiatrists and dieticians and other interested parties,

such as researchers and people affected with ADHD or eating disorders might ask about common

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 12

therapeutic strategies that would benefit both the patients with ADHD as well as those suffering

from binge eating. In consideration of this, the relationships between ADHD and eating disorders

and the relationship between eating disorders and poor self-awareness influenced by cultural or

ethnic identities have not been deeply researched on. Therefore, the answer to this question is

still undergoing research.

As a result of the above, there is the need to carry out further research, in order to gain a

clear understanding of the link between ADHD and binge eating. This will significantly help in

the establishment of a more suitable clinical management and, eventually, a better life quality for

patients with both conditions. The paper explains a strong connection that exists between eating

disorders and ADHD and the link between eating disorders and poor self-awareness influenced

by cultural or ethnic identities.

Additionally, further research must be done to establish how this information can be used

to treat eating disorders that have arisen because of poor self-awareness. Also, the research

should be conducted to establish whether the current therapeutic methods, such as behavioral

therapy and cognitive-behavioral therapy could be applied in the treatment of the two conditions

where they coexist.

EATING DISORDERS, ADHD AND POOR SELF-AWARENESS 13

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