My doctor asks, “Is there a record of any eating disorders in your family medical history?” and I start laughing right there in the awkwardly small office, it echoes off the walls until I realize I am an adult and I have to answer. I am twenty one, and recently diagnosed with combination Hyperactive and Inattentive Attention Deficit/Hyperactivity Disorder. My doctor is about to prescribe me a medication for ADHD, and the number one side effect is “loss of appetite (anorexia)”. I am excited now, in this exact moment I have the power to lie, and lose five pounds at least. I gather my composure and say, “My mom would kill me if I ever did that, there is definitely no family history of eating disorders”. Strictly off the record, my mom put me on Weight Watchers at eleven, and every single woman in my family (both sides of the tree) has had at least one eating disorder. The doctor checks something off of a checklist on her laptop and wordlessly sends a prescription for a controlled substance to the pharmacy I used to get baby pictures developed at. I take a deep breath, feeling quite satisfied with myself until she says, “Your BMI isn’t that far off anyway, losing ten pounds would be a good thing”. I cry the entire drive home.
As evidenced by the fact that I was not diagnosed until twenty one, there is a massive gap in the research surrounding ADHD and the way it presents in women. Initial research on the disorder and any relevant medications was done almost exclusively on boys and men, leaving a black hole of information once further research proved that on average it presents far differently in women and girls. However, new studies show that there is a massive comorbidity between ADHD and eating disorders in women. According to one study in The Journal of Behavioral Health Services & Research, “A case–control, longitudinal, family study of girls with ADHD found that those with ADHD were 3.6 times more likely to develop a clinical or subclinical ED and 5.6 times more likely to develop clinical or subclinical [Bulimia Nervosa].” These numbers are scary, not just because they are a reflection of the American psyche, but because this study does not include individuals being medicated for ADHD.
The most commonly prescribed medication for ADHD is Amphetamine, or Adderall. Other medications include Vyvanse, Concerta, Ritalin, and Strattera, all some form of essentially micro-dosed-meth, made to be easily metabolized by my body. The side effects of all of these medications include “loss of appetite (anorexia), weight loss, decreased interest in eating”, which is why they are also at times prescribed to treat Binge Eating Disorders. These side effects only increase the likelihood of an individual developing a clinical or subclinical ED.
Science now has a baseline understanding of how ADHD presents in women, and has proven that untreated ADHD in women has a connection to E.Ds. My question is, why are we still only prescribing medication that lists “weight loss” as the primary side effect? I struggled with ADHD for my entire childhood, constantly told that I was lazy, I lacked willpower, or that my non-stop rambling was incredibly annoying. I was afraid I had the first ever case of super-early-onset-Alzheimers because I couldn’t handle multi-step directions without forgetting something. I was regularly brought to tears out of frustration because my brain couldn’t do what I needed it to. I would get so angry because, “I literally just had my keys where the f*ck did they go?” (they are in my hand). I had debilitating anxiety because I felt like everyone else knew how to get through life, and I was struggling like a fish out of water, with people just watching in disappointment.
Like many other women with untreated ADHD, I developed several different EDs as a way to cope with my anxiety and gain control over something in my life, cycling through them as I moved through middle school, high school, and then college. My eating disorders served as a comfort, like a favorite childhood blanket I could crawl under when life got complicated and scary. It was a routine and habit I could always return to, an empty stomach always eager to greet me with open arms. The ever present grumbling in my gut whispered words of encouragement and fortitude, telling me I can last just a little bit longer. While there was shame, I was always applauded for my weight loss, and somehow the shame dissipates after that.
So back in that doctors office, when I was given the choice to either try a medication that would help me get a handle on my ADHD, or heal my disordered eating, I chose to try the medication. I appreciate the change in my life now that I am medicated, but as I enter yet another season of eating disorder recovery I cannot help but wish I didn’t have to choose.