• April 7, 2024

ADHD and Eating Disorders: Episode 51

Today, we’re joined by the wonderful Johanna Badenhorst and will be taking a deep dive into all things ADHD and […]

Today, we’re joined by the wonderful Johanna Badenhorst and will be taking a deep dive into all things ADHD and eating disorders.

Johanna is a mother of two young boys, an educational developmental psychologist and director of Holistic Wellness Psychology. She has a profound passion for neurodivergence, and perinatal mental health. 

Like many women, Johanna had a late diagnosis of ADHD after many decades assuming that her food hyperfixations, never actually sticking to any routine, and a cupboard full of random hobbies was everyone’s reality. Her own lived experience with ADHD has fueled her dedication to advocate for neurodivergent women. 

Before we get started, we always like to ask every guest one question: what is something that most people don’t know about you?

The thing that probably not many people know is that I have a huge obsession with cults. Of course not being in one, but just listening to podcasts and watching documentaries about the setups of cults. I find the intricacy so interesting, and find the psychology behind it all so fascinating. 

There’s various good podcasts. I really liked the recent one that has been released on Netflix as well called Twin Flames, but also the podcast on Twin Flames is really good. That kind of got me interested in it, either last year or the year before they released that. 

Q1. Can we start by getting a little bit of a brief overview of ADHD? What are the different types, and what are some of the symptoms that people experience?

ADHD stands for attention deficit hyperactivity disorder. Some also refer to it as ADD as well, though we’ve kind of moved away from that definition/name. This is because we now say that people with ADHD are either the inattentive type, the hyperactive type, or combined. 

This means the symptoms are slightly different between those different types. For example, the DSM-5 diagnostic manual, says that the different symptoms for the inattentive type can include things like disorganisation, being inattentive, struggling to focus, and forgetfulness.

The hyperactivity type can be motor and verbal. But for many people, what doesn’t get captured so much, is also the hyperactivity of the restless mind, too. Unfortunately, there’s also elements of rejection sensitivity, which aren’t actually part of the diagnostic criteria. Or things like time-blindness, or certain addictive behaviours, and emotional dysregulation.

It can be really difficult to diagnose women with ADHD, as many of the symptoms are more masked in females, and diagnostic criteria is very much based around the symptoms in males. That’s why so many women get diagnosed so much later in life, because we’re just really good at masking. 

Unfortunately, that’s the same with autism, too, which can be really comorbid with ADHD. 

That’s some of the main symptoms and that of ADHD, that at least are in the diagnostic manual. But there’s many more than that. Like I said, it doesn’t actually capture the experience of many people with ADHD.

Q2. Can you tell us a little bit more about the link between ADHD, disordered eating, and eating disorders?

We know that with eating disorders and ADHD, there’s a huge comorbidity. Everything has been more refined over the last couple of decades in terms of the various types of different eating disorders. 

At the same time we are learning more and more about ADHD, and the links between the neurological pathways, and how they activate is actually quite similar to those people with eating disorders. So, there’s a lot of cross-over there.

For example, things at play for people with binge eating, is the kind of pathway that also gets activated when people with ADHD are self soothing, or seeing that dopamine. Eating can be a very pleasurable thing for many people, and for those with ADHD particularly, it’s even more so. 

It can be problematic if there is also the impulsiveness that comes with that. Also, there’s interceptive difficulties that people with ADHD experience because they don’t really focus on their body cues as much. It doesn’t set people up with ADHD that well – to manage and set limits around eating like it is with other people.

Q3. Would you mind chatting a bit more about interoception? What that is, and what it looks like?

Interoception awareness is something that all humans have, but those with neurodivergence, particularly ADHD, have less awareness. For example, around hunger cues, or our cues to go to the toilet. 

So if you are familiar with that experience, or have ADHD yourself, you may not be paying attention to whether you’re hungry, or not realise that you’re hungry until you’re ravenous – it kind of goes 0 to 100.

It is more of an experience for those people with ADHD, and it’s something you can definitely work on by bringing in more mindfulness, but it’s not as automatic as it is for neurotypical people.

Q4. Something that comes up a lot with clients is the idea of eating for emotional regulation – would you mind telling a bit more about that?

Yeah, so there is this interaction with the dopamine, and norepinephrine is another one that may be a little less familiar. So, people with ADHD have a tendency to have a depletion of dopamine. There is also another interaction with the norepinephrine that leads to both being more impulsive, or doing activities of dopamine seeking as well.

When we are feeling more dysregulated, we want those quick fixes of kind of feeling better, or numbing ourselves. So we are feeling distress intolerance. And people with ADHD, feel too intolerant to the emotions that they’re experiencing. So the way that they manage that is by self-soothing through eating  or other addictive behaviours. For many, this is alcohol or drugs, but eating is just very similar to that, too – it kind of has that effect.

Especially really high-calorie foods, they are something that is even more pleasurable. That is why people may have a tendency to reach for those kinds of foods, because that gives them a real big dopamine hit. 

But, that crash happens quickly after and so it doesn’t actually “fix” how they’re feeling. However, it does give that pleasure in that moment that is quite short-lasting.

Q5. This reminds me of so many experiences I’ve had with clients. Especially clients that are experiencing these behaviours, but are undiagnosed with ADHD. Then later, they get their diagnosis, and it’s almost like they’ve put glasses on, and everything starts to make sense. 

Have you worked with a lot of people who have a late diagnosis?

Yes – a lot of women, who have finally got to the point where they researched a lot more information, or friends of theirs get diagnosed, and then suddenly, they were like, “I also have a lot of those things”. Or, they come to therapy and are screened for ADHD if they do hear those traits – like bingeing.

I tend to explore ADHD quite often because there is such a high comorbidity with binge eating disorder particularly, or bingeing behaviours. I do recognise that a lot of these people have been struggling with those behaviours for decades – both the symptoms of ADHD as well as issues with relationship with food. 

Q6. So we’ve chatted a bit about interoception and emotional regulation. I was wondering if you had any higher level strategies to help with both of those – for example building that interoceptive awareness, and then some tips around emotional regulation? 

I recognise it’s gonna be so different for every person, but any thoughts you have, or anything you can share, even from your personal experience as well?

In therapy, I do often really encourage people to get a really good awareness around labelling their emotions. 

First of all, I think it is something that we’re not great at as people. A lot of people actually struggle with what’s called alexithymia. Alexithymia is where you actually have a struggle of recognising and labelling emotions. And if people don’t struggle with this, it’s still not something that is necessarily a strength. 

Because as soon as they feel a certain emotion, they kind of have a tendency to want to fix it. And so, by actually slowing down and tuning into our body, and our bodily sensations, and labelling what’s going on, for example where they’re feeling the discomfort. 

Then, you can start practicing just validating that experience, saying things like, “I can notice that discomfort in this area of my body. And I’m just going to take some deep breaths and breathe around that space”.

Building the skill of urge surfing is a big one that I often work with. It’s a skill for many different addictive behaviours that are urges. You can start just working on that mindfulness of – what are thoughts, feelings, and my bodily sensations? Can I uncover that urge, and do the opposite to the urge? For instance, rather than trying to fix it, or soothe myself unhelpfully, can I pause and just sit in this and ride this one out and see how I feel on the other side?

Q7. Do you have any suggestions around that kind of distress tolerance, especially for people with ADHD? 

We know that people with ADHD have low distress tolerance. What that means is that they find it really  insufferable to experience certain heightened emotions. Especially things like frustration, sadness, and those negative emotions are something that they’re often quite intolerant to. 

So, what happens is that there’s that tendency to want to move through it, or numb it as quickly as possible. That’s where that problem arises, as there’s that interaction with the low dopamine. 

And so, instead of wanting to look for a quick dopamine fix, it’s important to learn ways to sit through the emotions. Again, you can do this by slowing down, labelling it, validating it for ourselves instead of wanting to judge it. This allows us to react and respond to our emotions a lot more effectively. 

There’s also little things that you can do that helps distress intolerance, which can just be developing healthier self-soothing habits as well. So for some, it’s nice weighted blanket, sitting down and having a nice cup of tea, and just noticing what your needs are. 

But in the immediate distress, a good one that I often refer to is TIPP. This stands for changing your body temperature, intense exercise, paced breathing, and progressive muscle relaxation. So if you’re feeling a lot of distress in the moment, any one of those things can help you kind of snap out of that, or break that cycle of distress. 

Some of these TIPP strategies could look like:

  • Punching a pillow
  • Putting on some angry or excitable music and dancing to it
  • Blasting the aircon on your face
  • Taking a nice warm shower or bath

Q8. Let’s explore body image for a little bit and really kind of unpack how might my ADHD impact someone’s body image

For people with ADHD, their self-esteem is already typically really quite low. They probably have a tendency to hyper fixate on certain things about their body and the way that they look and present to the world. 

I wonder if the rejection sensitivity comes into play with caring a lot about what other people think of how they behave and look –  as a way to be liked and not rejected. Again, there’s probably not so much research on that side of things. 

Q9. Can I ask quickly, you’ve talked about rejection sensitive and rejection sensitive dysphoria a couple of times. Do you mind explaining it to some of our listeners? Because I think it’s one of those areas that people aren’t as familiar with when it comes to ADHD? 

So like I said, it’s not a diagnostic trait. However, it is something that a lot of people do identify with. It’s that real fixation or rumination about things they may have said or done that may have embarrassed them in conversation. For example, it often revolves around friendships, or doing a presentation and then really ruminating on how people were looking at them whilst they were doing that. 

Q10. Do you have any tips for our listeners on improving their relationship with food and their bodies? 

Typically, I would suggest for them to unfollow unhelpful social media accounts. That’s one big step for getting out of this rabbit hole of really obsessing over certain role models who they may see as someone they want to become because of low self-esteem

So, it’s trying to not compare yourself to those people and seeing your own quirks. Traits are something that you can be proud of, or something that you can act on, because that’s what makes you who you are. 

I’ve seen some great social media accounts out there who are talking about ADHD in such a positive way, and I think following those types of people may be really inspiring. So instead of going for people who may be more neurotypical, and have an unrealistic image – actually following those who made me feel quite relatable and provide really good, neuro-affirming content. 

Q11. You’ve talked a bit about having neuro-affirming influences. So I was wondering, would you be able to describe a little bit about what your neurodiversity-affirming care looks like? Even if someone was to want to work with a psychologist such as yourself? What might that look like? 

You want someone who approaches people in a really open minded way, with a collaborative approach, which is what you’d use for eating disorders as well. 

Someone who is too directive probably doesn’t ‘gel’ that well. So, you want someone who is very respectful that whilst you’re in the face of exploring that, they consider all those different neuro-types and presentations. And, also, they don’t close off to a certain kind of presentation just because maybe at that time, you know, as a professional aren’t completely convinced, but do listen to that person’s story. Because they are only just discovering these things themselves. 

I think really listening intently to their experience, really validating them, what they’re going through, and supporting them on building some of those skills that are typically helpful around emotional regulation. 

Q12. What is one key takeaway you would hope that our listeners leave with from this episode today? You can have more than one if you want.

Having a really supportive team around you, is incredibly helpful. So exploring ways of involving a really good GP, involving dietitians, like yourselves (read our blog on ADHD nutritionist for more), and a psychologist or counsellor, a psychiatrist if you wanted to explore your own ADHD or actually get treatment for it as well, if you are already diagnosed,

We do know that there’s evidence that for eating disorders and for ADHD, that we need to consider the therapeutic side of things, as well as potential medications too, because they both together can be so effective. If, but if the person at least feels that they can explore different treatments with their treatment team, that is what ultimately is the best way to go forward. Whatever feels aligned to them.

And taking that really holistic approach. So, some people find really great things in supplements – and that’s amazing. If you find something that works to both really manage the ADHD, and also the eating difficulties that I think is going to be amazing going forward for you.

 

Thanks so much for an awesome episode Johanna! Where can our listeners find you?

 

Instagram: @holisticwellnesspsychology

Website: https://www.holisticwellnesspsychology.com.au/

Podcast: ADHD Her Way

 

Johanna also sees clients locally in Brisbane, as well as seeing clients via Telehealth all over Australia. 

Kiah has also been interviewed as a guest on the ADHD Her Way Podcast

BOOK IN A FREE DISCOVERY CALL WITH OUR DIETITIANS
 

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