Rethinking Eating Disorders, ADHD, and the Patterns Beneath the Surface

The Question That Keeps Coming Up

I’ve been sitting with a question lately—one I don’t know if we’ve fully answered yet in the clinical world:

Is it that medications like Vyvanse help reduce binge eating as a side effect…
or could it be that, for some individuals, we’ve been missing the diagnosis—and treatment—of ADHD?

The Woman Who “Has It All Together”

Let me tell you about a type of woman I often work with. You might recognize her or know someone like her…..

She’s the one people often say, “I don’t know how you do it all.” She’s admired for how much she carries and how consistently she shows up—for her kids, her work, her relationships. From the outside, she seems to have it all together. She might be running a business or managing a household…or both. She keeps things moving. She gets things done. She’s often described as high-functioning, driven… and maybe even a little intense.

She’s incredibly capable on the outside, and yet quietly overwhelmed on the inside.

But if you slow down and really listen, there’s layers underneath that.

Her brain doesn’t shut off easily. Sleep can feel inconsistent or forced. There’s a constant internal movement—thoughts stacking, jumping, looping. Anxiety is often the label that gets applied, and sometimes it fits. But sometimes it doesn’t fully explain what’s happening.

And then there are the patterns that don’t quite fit neatly into one diagnosis.

Eating that feels hard to regulate—not all the time, but in waves. Periods where something in her system seems to override intention. Moments where the pull toward food feels urgent, automatic, almost like it’s serving a purpose beyond hunger.

Not because she doesn’t know what to do.

But because something in her system is trying to regulate.

You might also notice this in other areas. A difficulty slowing down. A tendency to stay in motion. Trouble stopping once she starts something—whether it’s working, organizing, scrolling, or even trying to rest. From the outside, it can look like productivity or drive. From the inside, it often feels like restlessness that never quite settles.

And often, somewhere along the way, she’s been given a diagnosis.

Anxiety.
Maybe depression.
Sometimes an eating disorder.

All of which may be accurate.

But maybe not always complete.

When the Diagnosis Isn’t Wrong… Just Incomplete

Research has been slowly catching up to something many clinicians are starting to notice in real time: ADHD, especially in women, doesn’t always look the way we were taught to expect. Article

It’s not always the child who couldn’t sit still in class. In fact, many women with ADHD were never identified early because they were NOT the ones disrupting class. They typically had A’s and B’s on their report cards with something like…. “Talks too much,” in the side column .

So maybe she learned to overcompensate. To overperform. To internalize the chaos and present as capable. By the time they reach adulthood, what often gets noticed isn’t inattention or impulsivity, but anxiety, overwhelm, and burnout.

Layered into that, we’re also seeing consistent overlap with other conditions. ADHD has been associated with higher rates of eating disorders, particularly those involving bingeing and purging, as well as substance use and patterns of dysregulation that can look like entirely separate diagnoses. When you begin to look at these patterns side by side, they don’t always appear unrelated—they often share underlying threads of impulsivity, reward sensitivity, and difficulty with regulation.

Which begins to shift the lens.

Not: “Why can’t she control this?”
But: “What is her system trying to manage?”

What Happens When We Look Through a Different Lens

This is where the work of Jennifer L. Gaudiani offers an important perspective.

In Sick Enough 2, she reflects:

“I’ve become convinced over the years that doing better with identifying and treating ADHD will reduce the development of and persistence of eating disorders.”

That statement alone invites us to reconsider what we may be overlooking when it comes to disordered eating.

She describes patients with long-standing, complex eating disorders who were later prescribed stimulant medications—not initially for their eating disorder, but for other reasons—that experienced meaningful shifts.

One patient, who had previously been viewed as engaging in excessive exercise during treatment, came to understand that what she had been experiencing was not a conscious effort to burn calories, but a deep, internal restlessness—an inability to feel settled in her own body.

When stimulant medication was introduced, that restlessness quieted.

Another patient described the experience as “putting on glasses for the first time,” where her thoughts became clearer, her mood more stable, and her ability to engage with daily life more consistent. What stood out just as much was how quickly those gains were disrupted when she could not access her medication, highlighting how significant the shift in regulation had been.

Gaudiani notes that many of these individuals share a similar profile: intelligent, driven, often successful in structured environments, and frequently overlooked when it comes to ADHD—particularly women. When eating disorders develop, the focus understandably turns toward treating the eating behaviors themselves. But in some cases, that focus may not capture the full picture of what is driving those behaviors.

It Might Not Be About Appetite

This is where the conversation around stimulant medications becomes more nuanced.

Because yes, medications like Vyvanse are known to suppress appetite. That is often the first explanation offered when binge eating decreases.

But for many individuals, that explanation feels incomplete.

What they describe instead is a shift in their internal experience. Their thoughts feel more organized. The constant sense of urgency softens. The drive to reach for something—food, caffeine, activity, cleaning, picking—begins to decrease, not because it is being forcibly restricted, but because it is no longer needed in the same way.

When executive functioning improves, when the nervous system feels more regulated, behaviors that once served as coping mechanisms may naturally begin to change. Not disappear entirely, and not without continued work, but shift in intensity, frequency, and meaning.

This is an important distinction, because it moves us away from a purely behavioral model and toward a regulatory one. It invites us to consider that, for some individuals, the behavior was never random—it was adaptive, even if it came with consequences.

When We Start Seeing Patterns Instead of Problems

When you begin to look at these experiences through a body-led lens, patterns start to emerge.

You may notice that urges to binge or purge are not constant, but cyclical. That they intensify during periods of stress, sleep disruption, or hormonal shifts—particularly in the luteal phase, when many individuals experience increased emotional sensitivity, changes in appetite, and reduced stress tolerance.

You may notice that the same person who feels steady and regulated one week feels flooded and reactive the next.

And instead of interpreting that as inconsistency or failure, it begins to look more like physiology.

More like a system responding to internal and external demands.

When someone begins to understand these patterns—when they can track them, anticipate them, and work with them—the experience often shifts from shame to awareness.

Not “what is wrong with me?”

But “what is happening in my system right now?”

The Question That Matters More

So the question becomes less about whether a medication is “treating” the eating disorder directly.

And more about whether we are beginning to better understand the system that the eating disorder has been trying to support.

Because if a behavior has been serving a regulatory function, it makes sense that it would persist until something else can support that same need more effectively.

And when that support is in place—whether through therapy, skill-building, medication, or a combination of approaches—the behavior may no longer need to show up in the same way.

Not because it was forced to stop.

But because it is no longer carrying the same responsibility.

Bringing It All Back Together

What I find myself returning to is not a definitive answer to my question… but a shift in how we hold the question.

For a long time, many of these behaviors have been framed through the lens of willpower, discipline, or pathology alone. And while eating disorders are serious, complex, and deserving of thoughtful care, there may also be value in widening the lens just enough to consider what else is happening underneath.

When ADHD goes unrecognized—particularly in women who have learned to compensate, perform, and push through—it does not disappear. It often reshapes itself into patterns that are more socially acceptable on the outside, but internally exhausting to maintain. Over time, the body and brain may begin to rely on whatever tools are available to create moments of relief, stimulation, or grounding.

Food can become one of those tools. So can movement, caffeine, work, or constant activity.

Not as a failure of self-control, but as an attempt—however imperfect—to regulate an overwhelmed system.

And when we begin to better understand that system—when we support it more directly—we may start to see changes that once felt out of reach.

Not because the behavior was simply taken away.

But because the need for it has changed.