Connections Between ADHD & Avoidant/Restrictive Food Intake Disorder

We often think of mental illnesses in exclusive terms, or their diagnosis as absolute. In reality, that’s far from the case.

It is not infrequent for one mental health condition to help develop or sustain another. And, in fact, many people struggle with comorbid, or co-occurring, mental health disorders.

One pair of mental health conditions that often occur together are attention deficit hyperactivity disorder (ADHD) and avoidant/restrictive food intake disorder (ARFID). But if you struggle with both of these conditions, it can be tricky to find the appropriate treatment.

While both maladies can be aided through therapy, medication, or a combination of treatments, some medications for one have the potential to negatively impact the other. It is important to work with nutritionists and mental health professionals who can help you both build healthy eating habits and work through your attention-related concerns.

Understanding ARFID

While people have likely been struggling with avoidant/restrictive food intake disorder for some time, it’s one of the most recent psychiatric disorders to be officially pathologized.

ARFID was first introduced in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), replacing what was previously understood as the feeding disorder of infancy and early childhood. The diagnostic criteria for ARFID are more inclusive and apply to a wider array of symptoms.

Some of the primary characteristics of ARFID include: [1]

• Lack of interest in food. Rather than actively avoid food, patients are simply uninterested in feeding themselves, or they may forget to eat altogether.
• Extreme food sensitivities. ARFID patients are frequently highly concerned with the texture, taste, or smell of foods, and they often restrict their diets accordingly.
• Fear of certain foods. Some people with ARFID refuse to eat certain foods—or just in general—due to a fear of choking or getting sick. Many have experienced something scary, like choking or diarrhea, after eating in the past, and may tie that unpleasant experience to food in general.

Picky eating or highly selective eating are other hallmarks of ARFID. Some studies estimate up to 30% of people with this feeding disturbance have been picky eaters since childhood. [2] And due to the relatively new understanding of the condition, it’s possible that many young patients who were thought of as picky eaters were actually experiencing undiagnosed ARFID.

ARFID vs. Anorexia Nervosa

Due to the highly restrictive diets and significant weight loss typically involved with ARFID, the condition may look very similar to anorexia nervosa (AN). However, ARFID is different from AN—and unique among most other eating disorders—as it does not involve body image disturbance or a focus on body shape, size, or weight.

Losing weight or achieving a specific body shape is not the driving factor for someone with ARFID. Rather, their disordered eating patterns are motivated by fear of certain foods, sensitivities to certain smells or textures, or a general disinterest in eating. While research is ongoing, some experts have sought to classify ARFID as an autism spectrum disorder.

In either case, the disordered eating behaviors involved in both ARFID and AN can lead to serious medical consequences, including nutritional deficits, dramatic weight loss, or lack of weight gain in young children. In extreme cases, oral nutritional supplements may be necessary to stabilize someone’s physical health, before any mental health treatments can begin.

Understanding ADHD

Attention deficit hyperactivity disorder is a neurodevelopmental disorder that is typically diagnosed in childhood. People with ADHD struggle with concentration, impulse control, and hyperactivity, which can set the stage for the development of an eating disorder.

When it comes to its influence on disordered eating patterns, ADHD has been tied to:

• Binge eating: Low impulse control is a shared trait among binge eating episodes, such as those experienced in binge eating disorder (BED) and bulimia nervosa (BN), as well as ADHD.
• Anorexia: While people with ADHD often struggle concentrating, they can also experience something called hyperfocus, where they become fixated on the minutiae of a task or idea. This can manifest as a fixation on nutritional labels or certain aspects of diet that can lead to disordered eating or limited food intake. [3]
• ARFID: Inattentiveness or distraction can lead some people with ADHD to miss meals or forget about eating all together. They may also eat very quickly and choke during their meals, which can cause the type of trauma that sparks more restrictive eating.

All told, people with ADHD are almost four times more likely to have an eating disorder than those without the condition, according to some research. [4] But unfortunately, these disordered eating patterns may be missed during treatment, as therapy teams tend to focus on addressing other aspects of ADHD.

ARFID and ADHD Connections

Aside from the general impact ADHD can have on disordered eating patterns, there are some commonalities shared between ARFID and ADHD specifically.

People with ADHD are more likely than the general population to struggle with mood disorders, including depression and a number of anxiety disorders. Likewise, a connection has been drawn between anxiety disorders and ARFID, particularly in the role anxiety plays in a person’s restricting of certain foods.

And the way ADHD is treated can also have an impact on sustaining or developing symptoms of ARFID.

Attention deficit hyperactive disorder is commonly treated with some class of stimulant. And while these types of medications can ease ADHD symptoms, they can complicate eating disorder treatment, as they tend to suppress appetite. For people with avoidant/restrictive food intake disorder, skipping meals often becomes more common while taking this class of ADHD medication. [5]

Still, there is much more to learn about the connections between these two conditions. As ARFID is so newly pathologized, most existing research focuses on the previous understanding of the condition, as feeding disorder of infancy and early childhood. This means the long-term effects of ARFID, and its possible connections to ADHD, remain relatively unknown within the mental health community.

Finding Help for ARFID and ADHD

If you or a loved one is struggling with concurrent ARFID and ADHD, it’s important to reach out for help. The health consequences of these conditions, if left untreated, can become severe, and possibly lead to other disordered behaviors or eating problems.

People with avoidant/restrictive food intake disorder frequently deal with a number of nutritional challenges, including electrolyte abnormalities, which can lead to serious issues or concerns with heart health. Bone density is another common ARFID symptom. [6]

And certain aspects of ADHD can serve to exasperate these concerns, particularly if you’re receiving a form of stimulant medication to help treat symptoms.

Still, a careful treatment plan, which can include medication, nutritional education, and therapy to help improve focus or other behavioral issues tied to ADHD, can help you rebuild your health and get you back on track to a healthier life.

References

1. Coglan L, Otasowie J. (2019). Avoidant/restrictive food intake disorder: What do we know so far? BJPsych Advances; 25(2):90-98.
2. Zimmerman J, Fisher M. (2017). Avoidant/Restrictive Food Intake Disorder (ARFID). Current Problems in Pediatric and Adolescent Health Care; 47(4): 95-103.
3. Olivardia R. (2022, October 5). The ADHD-Eating Disorders Link. ADDitude. Accessed July 2022.
4. Reinblatt SP. (2015). Are Eating Disorders Related to Attention Deficit/Hyperactivity Disorder? Current Treatment Options in Psychiatry; 2(4): 402–412.
5. Pennell A, Couturier J, Grant C, Johnson N. (2016). Severe Avoidant/Restrictive Food Intake Disorder and Coexisting Stimulant Treated Attention Deficit Hyperactivity Disorder. International Journal of Eating Disorders; 49(11):1036-1039.
6. Nitsch A, Knopf E, Manwaring J et al. (2021). Avoidant/Restrictive Food Intake Disorder (ARFID): Its Medical Complications and Their Treatment—an Emerging Area. Current Pediatrics Reports; 9:21–29.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated on April 6, 2023
Published on EatingDisorderHope.com