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How can you help my daughter with ADHD and binge eating?

A case study answer based on an email I received from a parent:


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, one to 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.


  • 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).


  • I would teach your daughter self-acceptance, body neutrality, reduce shame and guilt and build up her self-worth.

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