How can you help my daughter with binge eating disorder and ADHD?
Client question series/case study - Q1.
I have been inspired to make blog posts which have been generated from common client and parent requests. This week I have a question posed by a parent with an adult daughter with BED and ADHD. This particular individual is on ADHD medication, finding themselves with a reduced appetite during the day, forgetting to eat during the day, getting hungry in the evening and they have previously had CBT-E through an NHS eating disorder service but that it had not been effective.
Hello, I’m Becky Grace Irwing. I write about women’s mental health, specifically binge eating disorder, eating disorders and systemic and power imbalances as causes of mental health difficulties. I’m a BABCP accredited CBT Therapist working privately and in the NHS with eating disorders. I help women with binge eating issues heal their relationship with food and their body. Please subscribe to support my work, pay for my writing labour time & to read more. You can also find me on Instagram, Tiktok, Facebook and LinkedIn. My website is Becky Grace Therapy.
Key ways I could possibly help your daughter:
I adapt CBT-E for clients with ADHD. The beauty of private practice is that I get to choose the toolkit to help you. CBT-E should be individualised anyway, from 20-40 sessions, but I do incorporate CBT-T and MANTRA within it and I use other toolkits like DBT skills and my coaching skills from previous teaching and nursing career. This means I’m following a protocol but also flexing that protocol where appropriate based on your daughter’s needs. I incorporate body based work where appropriate too, so we may use breathwork or yoga to help connect her to body. ADHDers are very much based in their minds, overthinking, overanalysing.
One of the first rules of any eating disorder treatment (a bit like Fight Club….) is YOU MUST EAT REGULARLY. Three meals per day, three snacks. Even if on ADHD medication and knowing you won’t have much of an appetite, you may have to schedule and plan it in and get some help in doing this and really prioritising it - but initially reducing the portion sizes for now if not hungry (we can look at the specific circumstances individually). This is why your daughter will be hungry in the evenings when the medication wears off. The medication is suppressing her appetite. You may have to schedule reminders in to eat, whatever helps you. ADHDers can also have object impermanence so it needs to be planned and made visual with reminders .e.g. a blackboard/whiteboard visible in your kitchen or other room of the house where they will go past.
Here is a handy science graph to show you why regular eating is so, so important:
We need to aim for this bottom graph to prevent overeating, bingeing or feeling hungry in the evening.
I don’t know what dosage of medication or type your daughter is on, or how long she’s been taking it - I’d suggest a medication review too, where possible and if appropriate as the dosage may/may not need adjusting (again, not medical advice on this page but a suggestion) but I know it is common to not be hungry and therefore forget to eat on ADHD medication such as Elvanse/Vyvanse, and it is used to support adjunctly with binge eating disorder but it’s not going to solve the root issues of the eating disorders.
Having lived with binge eating disorder for 30 years, being in eating disorder recovery for the last 5 years and had an ADHD diagnosis at 35 (currently 38), I hope I have the expert by experience tag down but that I also have clinical experience working with many clients with both eating disorders and ADHD (and autism which there is a close overlap), not just as a CBT Therapist but as a dual qualified Registered Mental Health Nurse. I have worked in CAMHS and in University mental health services too, so I have other toolkits available to me. I have been in the coalface of a variety of NHS, private and third sector services. I look systemically at issues based on that clinical experience and come up with new perspectives based on this.
I’d explore what it means that ‘CBT-E has not been effective’. How would we know it had been effective? What specifically were the expected goals or expectations? CBT-E is meant to be highly individualised. In NHS Talking Therapies, there tends to be a highly manualised, protocol (set structure) for treating different disorders. In secondary care (so NHS eating disorders for moderate to severe difficulties), there should be some more flexibility to this as part of the treatment, or of course privately.
There isn’t a fixed resolution date/time for eating disorders. It’s breaking the cycles of years of conditioning. Regular eating can take up a year to acclimatise to and that is just the behavioural work. I can’t make any promises or guarantees that I can help your daughter (which is why I wrote possibly in the headline) but hopefully you can tell I’m passionate about the work that I do.
I don’t tend to bring my lived experience into session unless it’s relevant, proportionate or appropriate. These sessions are about you but I can 100% tell you people come to me for my lived experience, as I ‘get it’ (not your experience, but a version of it).
Binge eating and ADHD have been my life. How that has looked - my need for extreme behaviours and impulsivity, and high anxiety has wrecked havoc on my life at times, and feeling: shame, guilt, unworthy, unacceptable and unlovable to others has been high and I think is one of the reasons I class myself as a highly sensitive, highly empathic person, always anticipating other peoples’ responses to make myself more pleasing to them (but I don’t do it any more since I have been in recovery). I would teach your daughter self-acceptance, body neutrality, reduce shame and guilt and build up her self-worth.
I hope this helps answer your questions, and at the minute I’m full with clients until the New Year, when I hope to open up more spaces online, or face to face in Wymondham or Norwich, Norfolk. If you would like to join that waiting list - please send me a message on my website.