ADHD and eating behaviour: strategies against binge eating, food noise and impulse eating.

Introduction

Many people with ADHD suffer not only from typical ADHD symptoms such as difficulty concentrating, impulsiveness and increased emotional reactivity. Studies show that this constellation of symptoms significantly increases the likelihood of developing an eating disorder in the course of one's life – especially binge eating disorder. This interaction has a negative impact on several levels: those affected increasingly lose control over their eating behaviour, develop a disturbed sense of hunger and satiety, and fall into a vicious cycle of short-term reward through eating and long-term discomfort.

Binge eating disorders in ADHD can significantly impair everyday life, promote the development of overweight or obesity, and cause lasting deterioration in psychological well-being. It is particularly alarming that many sufferers have severely reduced self-esteem, which is further exacerbated by repeated binge eating and subsequent feelings of shame and guilt.

Scientific studies suggest that several mechanisms are intertwined: the impulsivity typically associated with ADHD makes it difficult to consciously control eating behaviour, while impaired emotion regulation leads to eating being used as a short-term strategy for coping with stress. At the same time, neurobiological characteristics in the dopaminergic reward system reinforce the need for quick, intense stimuli that food – especially high-calorie foods – can provide.

What it's all about:

• why these connections exist,

• how to recognise symptoms early on, and

• which therapeutic approaches help normalise eating behaviour and successfully regulate impulsive eating.

ADHD and binge eating disorder: Why binge eating and eating disorders are common in ADHD

Many people with ADHD suffer not only from typical ADHD symptoms such as difficulty concentrating, impulsivity and increased emotional reactivity. Studies show that this combination of symptoms significantly increases the likelihood of developing an eating disorder later in life – especially binge eating disorder. This interaction has a negative impact on several levels: those affected increasingly lose control over their eating behaviour, develop a disturbed sense of hunger and satiety, and fall into a vicious cycle of short-term reward through eating and long-term discomfort.

Binge eating disorders in ADHD can significantly impair everyday life, promote the development of overweight or obesity, and cause lasting deterioration in psychological well-being. It is particularly alarming that many sufferers have severely reduced self-esteem, which is further exacerbated by repeated binge eating and subsequent feelings of shame and guilt.

Scientific studies suggest that several mechanisms interact: the impulsiveness typically associated with ADHD makes it difficult to consciously control eating behaviour, while impaired emotion regulation leads to eating being used as a short-term strategy for coping with stress. At the same time, neurobiological characteristics in the dopaminergic reward system reinforce the need for quick, intense stimuli that food – especially high-calorie foods – can provide.

In this article, you will learn why these connections exist, how to recognise symptoms early on and which therapeutic approaches can help normalise eating behaviour and successfully regulate impulsive eating. We provide you with well-founded information, specific recommendations and references to specialised support services. It is worth reading on to find sustainable ways out of the vicious circle of ADHD and binge eating.

What is binge eating disorder?

Binge eating disorder is the most common eating disorder and is characterised by recurrent binge eating. Those affected consume large amounts of food within a short period of time without feeling hungry. This is often followed by unpleasant feelings of fullness, shame and negative emotions.

Unlike bulimia nervosa, people with binge eating disorder do not induce vomiting after binge eating. This significantly increases the risk of overweight and obesity.

Typical symptoms include:

• Loss of control when eating

• Consuming large amounts of food in a short period of time

• Regularly recurring binge eating

• Emotional distress after binge eating

What is the link between ADHD and eating disorders?

Adults with ADHD have a significantly increased risk of eating disorders, especially binge eating disorder. Research shows that people with ADHD are twice as likely to suffer from impulsive eating behaviour as people without ADHD.

Reasons for this close connection include:

• Increased impulsivity

• Difficulty regulating emotions

• Increased need for immediate reward

• Problems with feelings of hunger and satiety

Why do people with ADHD often develop binge eating disorder?

The combination of impulsivity, emotional dysregulation and reward seeking makes people with ADHD prone to binge eating. Eating has a short-term calming effect and increases dopamine release in the brain, which has a pleasant effect.

However, in the long term, binge eating, feelings of shame and weight gain reinforce each other, creating a vicious cycle that can severely impair self-esteem.

What is food noise and what role does it play in ADHD and binge eating disorder?

Food noise describes the constant, intrusive thoughts about food, meals or snacks – regardless of whether you are actually hungry. Typical thoughts include: ‘What could I eat next?’, ‘I really need a snack right now.’ or ‘Maybe I'll just go to the fridge.’

Food noise is particularly pronounced in ADHD. The reasons for this are:

• Impulsivity, which makes it difficult to suppress spontaneous thoughts

• Emotional dysregulation, which reinforces the desire for quick rewards through food

• Reward seeking in the dopaminergic system, which leads to food being experienced as a short-term mood booster

Food noise contributes significantly to the development and maintenance of binge eating. Constantly thinking about food increases the likelihood of impulsive eating – often without physical hunger. This develops into a vicious circle: the more often food noise is translated into eating behaviour, the more firmly the pattern becomes established in the brain. The aim of therapy is to actively reduce food noise by:

• stabilising regular meals,

• introducing alternative reward strategies (e.g. exercise, music, social contact),

• practising mindful eating in order to perceive feelings of hunger and satiety more clearly again.

A structured daily routine with consciously set meal times helps to significantly reduce food noise and regain control over one's own eating behaviour.

How do binge eating disorder, bulimia and anorexia differ?

Binge eating disorder involves binge eating without subsequent vomiting.

Bulimia (bulimia nervosa) involves binge eating followed by compensatory measures such as self-induced vomiting or excessive exercise.

Anorexia nervosa, on the other hand, is characterised by restrictive eating behaviour and severe underweight. Compared to other eating disorders, obesity and psychological distress are particularly pronounced in binge eating disorder.

What are the symptoms of binge eating disorder in ADHD?

The following symptoms indicate a possible combination of ADHD and binge eating disorder:

• Recurrent binge eating despite lack of hunger

• Feeling full and discomfort after eating

• Feelings of shame, guilt or self-deprecation

• Difficulty controlling the amount of food consumed

• Increased impulsivity when eating

Adults with ADHD also report disturbed feelings of hunger and satiety as well as pronounced emotional eating patterns.

How are binge eating disorder and ADHD diagnosed?

The diagnosis involves several steps:

• Detailed interview to record binge eating and ADHD symptoms

• Use of specific questionnaires and diagnostic criteria

• Exclusion of other disorders (e.g. anorexia nervosa)

Early, thorough diagnosis is important in order to initiate appropriate treatment measures and prevent complications such as severe obesity.

What forms of treatment are recommended?

The following measures are considered particularly effective for treating binge eating disorder in combination with ADHD:

• Cognitive behavioural therapy (focusing on impulsivity and eating behaviour)

• Psychotherapy to address emotional dysregulation

• Nutritional counselling to normalise meal structure and food quantities

• Medication (e.g. stimulants or ADHD medication, tailored to the situation)

• Participation in group therapy specifically for binge eating disorder

Medication support: Lisdexamfetamine as a treatment option

A newer therapeutic option is medication with lisdexamfetamine. Originally developed as a medication for ADHD, lisdexamfetamine has also been shown to be effective in studies for binge eating disorder. According to a report in the Deutsches Ärzteblatt, lisdexamfetamine significantly reduced the number of weekly binge eating episodes in clinical trials. Patients showed better control over their eating behaviour and a decrease in impulsive binge eating episodes during treatment.

Lisdexamfetamine is thought to work by influencing the dopaminergic and noradrenergic systems, which play a role in both ADHD and binge eating disorder. However, treatment should always be individualised and take into account the possible risks and side effects.

Simple recipes for a structured diet

Protein-packed breakfast:

2 eggs, scrambled with spinach and tomatoes

• 1 slice of wholemeal bread

• 1 handful of berries

Quick lunch:

• Quinoa salad with chickpeas, cucumber, bell pepper and lemon-olive oil dressing

Snack for in between meals:

• Natural yoghurt with chia seeds and a handful of nuts

Dinner:

• Grilled chicken fillet with broccoli and sweet potato purée

Simple recipes for a structured diet

Nutrition strategy for ADHD and binge eating disorder – at a glance:

Meal Sample dish Goal

Breakfast Scrambled eggs with spinach, wholemeal bread, berries Protein-rich base, stabilise blood sugar

Lunch Quinoa salad with chickpeas and vegetables Slow-digesting carbohydrates, increase fibre

Snack Natural yoghurt with chia seeds and nuts Small, balanced snack

Dinner Grilled chicken fillet, broccoli, sweet potato purée Nutrient-rich main meal, keeps you feeling full for longer

Important principles:

• Every meal should contain protein + fibre + healthy fats.

• Regular meal times (every 3-4 hours) help to reduce food noise.

• Drink plenty of water to support concentration and body awareness.

What can those affected do to reduce impulsive eating?

Practical recommendations:

• Plan regular, balanced meals

• Practise mindful eating (be aware of feelings of hunger and satiety)

• Regulate negative emotions in other ways (e.g. exercise, relaxation techniques)

• Document eating behaviour to identify patterns

• Seek help if the first signs of an eating disorder appear

Are there specialised clinics for ADHD and eating disorders?

Yes, some facilities specialise in the treatment of binge eating disorders and ADHD. Here, patients benefit from interdisciplinary approaches that normalise eating behaviour, improve emotional regulation and strengthen mental and physical health.

Why early help is so important

Untreated binge eating disorder not only worsens self-esteem and body image, but also increases the risk of physical complications such as overweight, obesity or colon and rectal cancer.

Targeted treatment can reduce weight gain, stabilise eating behaviour and improve quality of life. Early support from therapists can be crucial in stopping negative developments.

Summary: Key points at a glance

• Binge eating disorder is the most common eating disorder and particularly affects people with ADHD.

• Impulsivity, emotional dysregulation and reward seeking promote binge eating.

• Early diagnosis and targeted therapy (e.g. behavioural therapy) significantly improve the prognosis.

• Regular meals, mindfulness and emotion regulation help to reduce impulsive eating.

• Specialised clinics offer comprehensive treatment concepts.