This is a thread I’m writing (admittedly) half-enraged, about eating disorders and ADHD, and the challenges in finding providers who will be comfortable treating both.

ADHD and eating disorders coincide a lot more frequently than you might think. Why is this?

For one, people with ADHD struggle with executive function, which they rely on to organize the tasks involved in meal prep and organization.

People with ADHD also struggle with hyperfocus — they can (and they do!) quite literally forget to eat. This can quickly snowball into a restrictive ED.

People with ADHD also struggle with impulse control, which means they’re more prone to compulsive disorders, like (you guessed it) eating disorders, OCD, addiction, etc. This is a common constellation of challenges in this community.

This is sticky territory for clinicians. Because many of the treatments for ADHD involve stimulants, which are known to suppress appetite, many psychiatrists are reluctant to take on clients with ADHD who have a history of disordered eating.

My partner just recently reached out to an ADHD clinic, who told them that unless they could provide discharge papers from ED treatment, and notes from current providers confirming the stability of their recovery, they would not work with a client with an ED history.

The problem is, people with ADHD will have a harder time being considered recovered from their ED if they don’t have their ADHD well-managed… they forget to eat, or struggle to get organized enough to prep meals, resulting in lapses that impact their perceived stability.

This leaves folks with ADHD + EDs in a painful limbo, as they try to recover from an eating disorder WITHOUT the executive function that would allow them to successfully plan and execute meals/snacks throughout the day, and respond quickly to hunger cues.

My personal opinion, as someone who takes Adderall for my ADHD and lives with anorexia, is that it was a blessing to undergo my ED treatment while remaining on stimulants.

This helped me build my recovery WITH THE EXPECTATION that my appetite would likely be suppressed on some level, and I would need to develop tools to deal with that. And I did.

Each person’s ED is unique, so I won’t say that stimulants are right for every person, but what I do think is wrong is to make it next to impossible to access effective treatments without excessive red tape. Even if that client has an eating disorder, active or not.

ED recovery is a long-haul process. And an EXPENSIVE process. Expecting someone with unmanaged, untreated ADHD to recover from an eating disorder without biochemical support is not actually supporting them in their ED recovery… it’s making it much harder.

IMO, it’s acting from a place of bias, assuming that people with EDs can't be trusted to make decisions about their treatment. And this plays into an existing narrative, that everyone with an ED is going to manipulate or deceive their clinicians. Which is simply not true.

Clinicians MUST reevaluate their practices around not prescribing stimulant meds to clients with eating disorders, especially considering the high co-occurrence of ADHD and eating disorders, and the function of working memory in sustaining ED recovery.

Clinicians: When a therapeutic relationship begins with a foundation of MISTRUST and SKEPTICISM, withholding needed treatments based on bias, you are positioning yourself not as your client’s ally, collaborator, and advocate, but as someone they need to outmaneuver.

It's not a healthy therapeutic dynamic. Pitting yourself against your client is why you see clients with oppositional behaviors… YOUR mistrust evokes a defensive reaction and breaks down communication and safety. This is why your clients seem "deceptive."

This isn't talked about nearly enough. I know countless folks with ADHD and EDs who are still, to this day, battling to access effective care. And their recovery is in jeopardy without the tools they need to be optimally functional IN SERVICE of their recovery.

"We can't treat this" shouldn't be the default in psychiatry. "We need to treat this other thing first" shouldn't be the default, either. If you can't find a concurrent treatment that works enough to create a stable foundation, you need to get more creative/get a consult.

When two disorders are feeding into one another, there is no other option than finding a middle path that addresses the feedback loop. ADHD and eating disorders fit this exact description.

Listen to your patients instead of dismissing them out of hand. They're counting on you.

Here's a thread on my partner Peter's experience that's well worth the read, too: https://twitter.com/peterdakota/status/1331369035238240258