ADHD and self-destructive behaviours: Part 2 of 3

First posted to this site on 27th October 2017

As I said in my blog yesterday, adolescents with ADHD often suffer from low self-esteem and self-harm in different ways as a cry for help in a world they find difficult to understand and find their place in. When ADHD is undiagnosed the combination of normal pubescent issues and those associated with ADHD can be extremely challenging and in addition to self-harm, adolescents often suffer from Eating Disorders- which I’m going to post about today in part two of this series.

Eating disorders

According to several sources, including Anorexia and Bulimia Care, approximately 1.6 million people in the UK suffer from eating disorders and in the US this figure is around 8 million, according to The National Association of Anorexia Nervosa and Associated Disorders. While eating disorders have been recognised for many years, their association with ADHD is relatively new.

The most well-known eating disorders are Anorexia Nervosa, Bulimia Nervosa and Binge-eating Disorder which are all characterised by dietary chaos and sometimes extreme weight control that is harmful to both physical and emotional health and affects many organ systems of the body.

Anorexia Nervosa is characterised by restricting food intake, often to the point of starvation, which can lead to a low, unhealthy body weight as people with Anorexia try to avoid gaining body fat.

Bulimia nervosa is marred by recurrent binge-eating episodes- a person eats a large amount of food in a short period of time and then purges by self-induced vomiting, laxative use, excessive exercise, fasting, or the use of diuretics to prevent weight gain.

Binge-eating Disorder is characterised by binge eating episodes without the purging behaviours that are present in Bulimia.

The link between ADHD and eating disorders is due to multiple factors, and many of the characteristics of ADHD have been shown to influence some disordered eating behaviours.

The three key features of ADHD- inattention, hyperactivity, and impulsivity- could be linked to eating disorders as the binge eating and purging of Bulimia Nervosa can be impulsive. One study I read mentions that people with Anorexia Nervosa and Bulimia Nervosa can show impairments in attention in neuropsychological testing compared to healthy control subjects. Excessive exercising can also be considered as hyperactive or restless behaviour and restlessness at eating times may cause a person to avoid eating out of anxiousness.

Food can also act as self-medication for anxiety, stress, anger, and boredom as the act of eating is stimulating, and food can also be used as an emotional crutch, so when people feel empty emotionally- food can fill that gap. People with ADHD who feel inadequate and incompetent sometimes turn to food as a source of comfort. Eating is used as an unhealthy outlet to take control of their lives. Both binge-eaters and people with ADHD have trouble heeding their internal cues of satiety and hunger.

The risk factors for Anorexia are also more significant for people with ADHD. People with ADHD and Anorexia have said that information about diets and healthy foods leaves them overwhelmed and although individuals with ADHD take an all-or-nothing approach in decision-making, and eat very little, they are obsessed with food. They often read cookbooks and watch food shows an television. A hyperfocus on food may affect people with ADHD as it simplifies their thinking about food.

According to a study in the Journal of Developmental and Behavioural Paediatrics, girls with ADHD are 2.7 times more likely to develop Anorexia Nervosa and 5.6 times more likely to develop Bulimia Nervosa than those without ADHD. Additionally, the Journal of Eating and Weight Disorders reported that 26.7% of severely obese women had ADHD as adults and they reported issues with impulsivity, distractibility, attention and staying focused.

The Journal of Abnormal Psychology linked eating disorders and ADHD with:

pathological eating
desire to lose weight
peer rejection
punitive parenting
disruptive disorders
internalising disorders
externalising disorders
internalising symptoms

Given the serious implications eating disorders can have on people’s bodily organs and the risk of death with some eating disorders, it is important that young people be supported and not judged if they are experiencing difficulties with their eating. Eating disorders are not a “fashion statement” and are rarely influenced by celebrity and it cheapens a very serious condition. As teachers it is important for us to know the serious implications of undiagnosed ADHD and how this can go on to affect children in adolescence.

What to do if your child has low self-esteem, self-harms or has an eating disorder

**If you suspect your child of having problems associated with self-esteem, self-harm or eating disorders it is very important that you seek the appropriate medical advice. While internet sources may give you some ideas, a doctor is a professional and probably comes across these issues frequently, so they will give the best and safest advice. **

Other things which could be tried at home to improve a person’s self-esteem are:

Regular praise when a person has been helpful can be a good introduction to praise. Some people with low self-esteem find it hard to accept praise about their achievements but are more comfortable being thanked for being helpful. When they are more able to accept this praise then praising their achievements could develop.
It is important that a person knows you love them without condition and that even if they have misbehaved.
If low self-esteem is linked to achievement, then setting smaller and more manageable goals can stop a person from feeling so overwhelmed.
Depending on a person’s interests, joining a club or hobby can help their self-esteem as it gives them an opportunity to achieve away from their normal environment in an area they are interested in and meet new people. People with ADHD can often be interested in many different hobbies and make time to settle on one they like.
Growth Mindset training may help with this if it is practised in school. There is lots of information and resources available online to help with Growth Mindset at home- I’ll post links on a later blog.

Criticism

Many people find criticism difficult, whether they have ADHD or not, but for people with low self-esteem, criticism can be even more challenging.

If someone is to accept criticism it needs to be given in a constructive way and finding positive points to balance the criticism helps e.g. saying ‘I loved the way you read the first page. It’s only a couple of words you’re stumbling on. That word is…’

Modelling ways of giving good constructive criticism is more likely to produce constructive criticism from others.

How can you tell if someone is self-harming or has an eating disorder?

Until a person talks to their parents or doctor willingly, detecting self-harm can be difficult as people who self-harm are prone to covering up their scars and teenagers, who are more body conscious are also more likely to cover up.

Scratching or scarring on the upper arms or legs evidence of hidden razor blades or knives should also cause concern.

Loss of weight, secrecy around food, evidence of food storage in bedrooms or frequent overeating followed by long periods in the bathroom could be indicators of eating disorders.

It is important to:

Stay calm and approachable
Listen without judging
Seek professional, medical help

In addition to these upsetting and damaging symptoms of ADHD, the condition is also linked to risky sexual behaviour and inappropriate use of alcohol and drugs, particularly in those who are undiagnosed and who have accompanying conduct disorders. I will take a look at this in tomorrow’s blog.

Sources

http://www.anorexiabulimiacare.org.uk/about/statistics