Stimulant Use in the Context of Eating Disorder Treatment: A Case Study of a Patient With Co-Occurring ADHD and an Eating Disorder

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of developing eating disorders (EDs) compared to the general population. Methylphenidate is a common first-line pharmacological treatment for ADHD and has been explored for symptom interruption in bulimia nervosa (BN); however, its use and efficacy in individuals with comorbid ADHD and restrictive eating pathology, such as anorexia nervosa (AN), remain underexplored. This case study presents a 28-year-old female who initially presented to eating disorder services with BN, was later diagnosed with ADHD, and subsequently re-diagnosed with AN. The patient was treated with a combination of methylphenidate alongside outpatient psychological therapy and participation in a Day Services group programme. While in Day Services, the patient restored 2.2 kg (4lb 9oz); however, the patient remained medically underweight at discharge. EDE-Q scores demonstrated a downward trend in cognitive eating disorder symptoms; however, the patient felt this was not reflective of her mental state. The case examines the interaction between ADHD and co-occurring ED symptomatology, illustrating how pharmacological management of one condition may inadvertently maintain or exacerbate the other. The case highlights a divergence between psychological improvement on self-report measures and persistent underweight status and disordered behaviours, raising questions about the interaction between ADHD pharmacotherapy and eating disorder outcomes.