Binge, Purge, and Wander: Navigating Bulimia and Attention Deficit Hyperactivity Disorder (ADHD)

A 32-year-old woman with no prior medical conditions, but a history of anorexia nervosa (AN) diagnosed in adolescence, was referred for evaluation by an eating disorders (ED) specialist due to worsening bingeing and purging behaviors. Her clinical presentation was characterized by a body mass index (BMI) approaching the underweight range and frequent bingeing and purging episodes occurring twice daily, consistent with a diagnosis of BN. No other medical or psychiatric comorbidities were diagnosed, including mood, anxiety, and substance use disorders, which are often comorbid with ED. However, the patient reported significant difficulties in managing both personal and professional activities, attributing these challenges to impaired concentration. She had difficulty staying focused on tasks and was easily distracted by unrelated thoughts or stimuli. As a result, she often procrastinated on household and self-care tasks. She also reported problems with time management, frequently arriving late to work, struggling to complete assignments on time, and underestimating how long tasks would take. Initial treatment with fluoxetine and cognitive behavioral therapy (CBT) yielded no substantial improvement. Given the presence of symptoms suggestive of attention deficit hyperactivity disorder (ADHD), a one-month trial of lisdexamfetamine (LDX) was initiated. This intervention resulted in a marked reduction in bingeing and purging episodes and a notable improvement in the patient's concentration, thereby enhancing her overall quality of life. The importance of ADHD screening is underscored, particularly for high-functioning adult women who may not present typical symptoms. In this case, a thorough clinical assessment and detailed anamnesis raised suspicion of previously unrecognized ADHD, that may have been present since childhood. Although the literature on the comorbidity of ADHD and BN is limited, this case highlights a potential link between the two conditions. The significant improvement observed following the introduction of psychostimulants supports the hypothesis that untreated ADHD may contribute to the exacerbation of BN symptoms. Further research is essential to clarify the underlying mechanisms and establish a solid scientific basis for future clinical interventions and therapeutic strategies.