Carolyn Piver Dukarm, MD

Eating Disorders

Eating disorders are complicated illnesses that affect millions of individuals every day. The three main eating disorders are commonly known as anorexia nervosa, bulimia, and binge eating disorder.

• Anorexia nervosa involves self-starvation which ultimately leads to a body weight at least 15% below what is considered healthy. Individuals with anorexia have an intense fear of gaining weight and a distorted image of their bodies. No matter what the scale and mirror reveal, they tend to see themselves as “too fat.” Patients with anorexia often report having rituals around eating, and an ability to ignore or deny sensations of hunger. Many are perfectionists. In addition to restricting their food intake, anorexic patients may also binge eat and then purge (see bulimia, below).
• Bulimia involves repetitive binge eating followed by purging, laxative abuse, excessive exercise and/or fasting. Feelings of shame or loss of control frequently accompany the bingeing, which is often done secretly and impulsively. Patients with bulimia often report hoarding food, feeling that they have little or no control over their eating, and are unsure whether they are hungry or full. They are fearful of gaining weight and have a distorted body image.
• Binge eating disorder is similar to bulimia, but without the purging behavior. Most of the other characteristics described under bulimia above apply to binge eating disorder.

Physical symptoms

Symptoms of anorexia can include any or all of the following: weakness, dizziness, fatigue, shortness of breath, chest pain, irregular heart beat, constipation, abdominal pain, and the absence of menstrual periods. Patients with bulimia may experience any or all of the following symptoms: weakness, abdominal pain, constipation, erosion of their dental enamel, swollen glands on the face and neck, and irregular heart beat. This list is not meant to be all inclusive; other symptoms have been reported.

Diagnosing eating disorders

The diagnostic evaluation of an eating disorder includes a complete history and physical examination by an eating disorder specialist or by an interdisciplinary team of specialists with expertise in managing eating disorders. A complete evaluation includes a review of behavioral, emotional and physical symptoms; a physical assessment including height, weight, measurement of vital signs (blood pressure and pulse) and a complete physical exam; as well as laboratory data.

Attention Deficit Disorder (ADD) is a complex biological condition that affects millions of children, adolescents and adults. The core symptoms of ADD (short attention span, distractibility, poor organizational skills, hyperactivity and lack of impulse control) are usually present over a prolonged period of time and begin at an early age. However, for some, especially those without significant hyperactivity, these symptoms may not be evident until later in life when they begin to result in increasing impairment.

Interestingly, many people with ADD also tend to be highly intelligent, creative, and intuitive. This may be one reason that ADD (especially in high-functioning and successful girls and women) goes undiagnosed for long periods of time.

Types of ADD and the associated symptoms

There are two primary types of ADD: inattentive and hyperactive/ impulsive. Some people have both types, or at least symptoms of both types.

Although the hyperactive-impulsive form of ADD is well recognized, the inattentive form of ADD often goes undiagnosed. This disparity may be a result of the absence of physical hyperactivity in the inattentive form of ADD, one of the primary differences between these two subtypes.

In the hyperactive-impulsive subtype of ADD, the presence of hyperactivity may cause significant disruption in school, work, and home environments. In these circumstances, professional consultation is more likely, resulting in earlier diagnosis and treatment. Conversely, it is probable that many individuals with the inattentive form of the disorder remain undiagnosed and are, thus, unaware of treatment options, because the symptoms of distractibility and difficulty sustaining attention are less disruptive to others than the symptoms of hyperactivity.

Diagnosing ADD

The diagnostic evaluation for ADD includes a complete history and physical exam by a specialist with expertise in the diagnosis and treatment of ADD. Different geographic regions vary in which professional disciplines diagnose and treat patients with ADD (i.e., a pediatrician, psychiatrist, psychologist, or neurologist). The evaluation may also include a review of medical and school records, neuropsychological testing, and possibly laboratory tests and radiological imaging. At present, there is no specific diagnostic test for ADD; the diagnosis is made by clinical history and supportive documentation.

Many individuals with eating disorders, specifically bulimia and binge eating disorder, also suffer from attention deficit disorder (ADD). Unfortunately their ADD remains undiagnosed and untreated. Treating core symptoms of ADD such as impulsivity, distractibility, and difficulty paying attention can significantly improve many eating disorder symptoms.

The rationale for using ADD treatment (including stimulants such as methylphenidate and dextroamphetamine or certain nutritional supplements) to manage eating disorder symptoms in individuals with these two co-existing conditions is as follows:

• The symptom of binge eating may result from impulsivity, and therefore decreasing impulsivity through the use of ADD medication could potentially decrease binge eating and purging;
• Decreasing distractibility by utilizing ADD medications decreases the tendency to be constantly distracted by thoughts of food and body image throughout the day;
• The use of ADD medications improves attention and organization and therefore increases the likelihood of following a structured meal plan and becoming aware of internal cues, such as hunger and satiety.
• Additionally, appetite suppression is often observed with the use of stimulants and can result in a decrease in the desire to binge eat. The appetite suppressing effects of stimulants in individuals with bulimia commonly help to control binge eating impulses without affecting normal appetite.

Treating the underlying ADD in these individuals can lead to significant improvement in eating disorder symptoms, thus reducing the risk of significant illness and potential for death in severe cases of eating disorders. In Pieces of a Puzzle: The Link between Eating Disorders and ADD, Dr. Dukarm discusses in detail the overlap between these two disorders, as well as provides a description of the nutritional changes, cognitive interventions, and medication and supplements that encompass a comprehensive treatment plan.

If you've read this far on our website, you may suspect that you have an eating disorder and/or an attention issue. Please contact us to schedule an appointment, or click the link below to take a self-test that will give you more information.

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