Background
Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential.
Method
To ...learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine.
Results
We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on “loss of control” eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials.
Discussion
Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research.
Very little is known about the prevalence of ADHD symptoms in Bulimia Nervosa and Binge Eating Disorder and even less in other eating disorders. This knowledge gap is of clinical importance since ...stimulant treatment is proven effective in Binge Eating Disorder and discussed as a treatment possibility for Bulimia Nervosa. The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic.
In total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Chi-square tests were used for categorical variables and Kruskal-Wallis tests for continuous variables.
Almost one third (31.3 %) of the patients scored above the screening cut off indicating a possible ADHD. The highest prevalence rates (35-37 %) were found in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, while Eating Disorder Not Otherwise Specified type 1-4 and Binge Eating Disorder patients reported slightly below average (26-31 %), and Anorexia Nervosa restricting subtype patients even lower (18 %). Presence of binge eating, purging, loss of control over eating and non-anorectic BMI were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses.
There is a high frequency of ADHD symptoms in patients with binge eating/purging eating disorders that motivates further studies, particularly concerning the effects of ADHD medication. The finding that the frequency of ADHD symptoms in anorexia nervosa with binge eating/purging is as high as in bulimia nervosa highlights the need also for this group.
Objective
To explore the influence of recovery from eating disorders (ED) at 1‐year follow‐up on self‐reported attention deficit hyperactivity disorder (ADHD) symptoms in an unselected group of ...patients in a specialized ED clinic.
Methods
Four hundred and eight adult females with an ED were assessed with the World Health Organization adult ADHD Self‐Report Scale‐Screener, and for comorbid psychiatric symptoms at baseline and 1‐year follow‐up. Recovery was registered at follow‐up.
Results
ADHD symptoms decreased between baseline and follow‐up in recovered patients treated for bulimic ED. In not recovered patients, ADHD symptoms were stable. Decreased depressive symptoms were associated to decreased ADHD symptoms at 1‐year follow‐up.
Conclusions
Bulimic ED and ADHD are linked together. This link, although not known in every detail, has clinical implications with possible value for bulimic ED patients. Clinical studies exploring implementation of ADHD treatment strategies for Bulimia Nervosa are recommended.
Highlights
Attention deficit hyperactivity disorder (ADHD) symptoms decreased in patients recovered from eating disorders (ED).
The decrease in ADHD symptoms was limited to patients recovered from bulimic ED.
The results support the need to investigate whether stimulants are effective in treating Bulimia Nervosa.
Objective
To explore the influence of self‐reported Attention Deficit Hyperactivity Disorder (ADHD) symptoms on recovery rate at 1‐year follow‐up in an unselected group of patients in a specialized ...eating disorder (ED) clinic.
Methods
Four hundred forty‐three adult females with an ED were assessed with the ADHD Self‐Report Scale for Adults (ASRS‐screener), and for demographic variables and ED symptoms. Recovery was registered at 1‐year follow‐up.
Results
A high degree of ADHD symptoms at baseline was predictive for nonrecovery of ED at 1‐year follow‐up in patients with loss of control over eating, bingeing, or purging. The presence of inattentive ADHD symptoms was stronger associated with nonrecovery than hyperactive/impulsive symptoms.
Conclusions
A high degree of ADHD symptoms may have a negative impact on recovery in ED. Screening/diagnostic evaluation of ADHD in all loss of control over eating/bingeing/purging ED patients and studies of the effect of implementing ADHD‐treatment strategies in this patient group are recommended.
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