ADHD & Bulimia: Dopamine, Impulsivity, & the Hidden Link to Binge Eating With Kirsten Book, PMHNP-BC

If you have ADHD and struggle with bulimia or binge eating, it may not be about willpower at all. It may be about dopamine, impulsivity, and a nervous system that has been trying to regulate itself the only way it knows how. In this episode of the podcast, I sit down with psychiatric nurse practitioner Kirsten Book to unpack the often-missed connection between ADHD and eating disorders. We move beyond surface-level explanations and into what is actually happening in the brain, including how dopamine dysregulation, executive functioning challenges, and emotional intensity can drive patterns of bingeing, restricting, and purging. ADHD and Bulimia: The Dopamine Connection Kirsten shares her lived experience of recovering from bulimia and being diagnosed with ADHD later in life. She describes how starting ADHD treatment shifted everything. Instead of feeling constantly out of control, she experienced something many people with ADHD and eating disorders rarely feel, which is a pause. A moment to decide what to do next. That shift in impulsivity and regulation can be a turning point in recovery. We break down how ADHD affects dopamine regulation and why the brain begins to seek out stimulation through food. Binge eating, restriction, and purging can all increase dopamine in the short term, which reinforces these patterns even when they create long-term distress. Why ADHD Gets Missed in Eating Disorders Many people, especially girls and women, are never screened for ADHD. Instead, they are diagnosed with anxiety or depression. This episode explores how untreated ADHD can show up as emotional dysregulation, difficulty focusing, chaotic eating patterns, and a constant sense of being overwhelmed. Kirsten explains why comprehensive screening matters and how identifying ADHD can completely change the direction of treatment. When ADHD is addressed directly, many people experience a reduction in binge eating urges and a greater sense of stability with food. Executive Function, Impulsivity, and Eating Patterns ADHD affects the brain’s executive functioning, including planning, organization, and follow-through. This makes consistent eating much harder than it looks from the outside. Skipped meals, irregular eating, and impulsive food choices are not random. They are connected to how the brain manages energy, attention, and motivation. We also talk about interoception and why people with ADHD may feel disconnected from hunger and fullness cues. This disconnection can lead to both undereating and overeating, creating cycles that feel confusing and hard to interrupt. The Role of Dopamine in Binge Eating and Restriction This episode offers a clear explanation of how different eating disorder behaviors interact with dopamine. Binge eating and highly palatable foods can create a surge in dopamine, reinforcing cravings and compulsive eating. Restriction can also increase dopamine in a different way, which helps explain why it can feel rewarding even when it is harmful. Over time, these patterns can change how the brain responds to reward, making it harder to feel regulated without them. Understanding this helps reduce shame and opens the door to more effective, targeted support. ADHD Treatment and Eating Disorder Recovery We talk through how psychiatric medications can support both ADHD and eating disorder recovery. This includes the role of stimulants, SSRIs, and other medications in improving impulse control, emotional regulation, and the ability to follow through with consistent eating. Kirsten also addresses common concerns about medication, especially for parents. She emphasizes the importance of asking questions, understanding risks and benefits, and approaching treatment with openness rather than fear. Medication is not the only tool, but for many people, it creates the stability needed to fully engage in recovery. This Is Not About Willpower If your eating feels chaotic, impulsive, or out of control, there may be more going on beneath the surface. ADHD changes how the brain processes reward, attention, and regulation. When that is not understood, eating disorder behaviors can become a way to cope. You deserve support that looks at the full picture, including your brain, your nervous system, and the ways you have learned to get through the day. Connect With Kirsten Book, PMHNP-BC Kirsten Book is a dual-certified psychiatric mental health nurse practitioner and family nurse practitioner who specializes in working with children, adolescents, and adults navigating eating disorders, ADHD, anxiety, and depression. You can learn more about her work and concierge psychiatric services at her website. She is licensed in California, Illinois, Arizona, and Washington. She is also active on Facebook, and LinkedIn. The best way to reach her directly is via email at Apple & Spotify “Stuck” Isn’t Lazy: Inertia in ADHD, Autism, & Eating Disorder Recovery With Stacie Fanelli, LCSW on Apple & Spotify. Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety on Apple & Spotify. Eating Disorders & ADHD: Neurodivergent-Affirming Recovery With Taylor Ashley, RP @taylorashleytherapy on Apple & Spotify. Work With Dr. Marianne If you are looking for eating disorder support that integrates neurodivergent-affirming care, I offer therapy and coaching for ARFID, binge eating disorder, anorexia, and bulimia. I work with clients across California and Washington, D.C., as well as offer coaching more broadly in the U.S. and worldwide. My approach focuses on sensory needs, nervous system regulation, executive functioning, and building sustainable eating patterns that actually work for your life. You can visit my website drmariannemiller.com to learn more about working with me and explore current offerings, including therapy, coaching, and self-paced programs. Share This Episode on Bulimia and ADHD If this episode resonated with you, share it with someone who needs to hear it and follow the podcast so you do not miss upcoming episodes on ADHD, ARFID, binge eating, and neurodivergent-affirming recovery.