多动症与饮食失调：被忽视的关联

大家好，欢迎收听玛丽安·兰德博士的播客，这是一档关于饮食失调康复的节目。本播客旨在帮助您在食物、饮食和身体形象问题上找到内心的平静。我是玛丽安·米勒博士，持证婚姻家庭治疗师、饮食失调治疗师和暴食辅导教练。

Hello, and welcome to Doctor. Maryann Land, an eating disorder recovery podcast. This is a podcast to help you find peace with food, eating, and body image issues. I'm Doctor. Maryann Miller, licensed marriage and family therapist, eating disorder therapist and binge eating coach.

我很高兴能与您分享故事、嘉宾访谈以及许多技巧和策略，以鼓励您并帮助您从食物和身体形象问题中恢复。非常感谢您今天的收听。

I'm thrilled to share with you stories, guest spots and many tips and strategies to encourage you and help you recover from food and body image issues. Thank you so much for listening today.

欢迎来到玛丽安·兰德博士播客，在这里我们通过创伤知情、神经多样性肯定和脂肪积极视角探讨饮食失调康复。我是玛丽安·米勒博士，持证治疗师、神经多样性人士，并致力于帮助您无羞耻地理解自己的饮食故事，即使它不符合主流叙事。今天，我们将讨论注意力缺陷多动障碍（ADHD）与饮食失调，这两种经历常常相伴而行，却在治疗中很少被同时关注。如果您曾感觉与食物的关系混乱、 overwhelming、不一致或难以解释，特别是在ADHD诊断或疑似诊断的背景下，您绝对不是一个人。

Welcome to Doctor. Maryann Land, the podcast where we explore eating disorder recovery through a trauma informed, neurodivergent affirming, and fat positive lens. I'm doctor Maryann Miller, licensed therapist, neurodivergent human, and someone deeply committed to helping you make sense of your eating story without shame even when it doesn't fit the dominant narratives. Today, we're talking about ADHD and eating disorders, two experiences that often travel together yet rarely get addressed together in treatment. If you've ever felt like your relationship with food is chaotic, overwhelming, inconsistent, or inexplicable, especially in the context of an ADHD diagnosis or suspicion of one, you are absolutely not alone.

研究人员终于开始关注我们许多人在临床和个人经历中目睹的现象：ADHD与饮食失调之间存在强烈关联。在2020年的一项荟萃分析中（就像你取一堆研究并提取它们所有最重要的相似之处），研究人员发现ADHD个体患饮食失调的可能性是非ADHD个体的3.8倍。具体来说，ADHD人群中暴食症和神经性贪食症的发生率显著更高。

Researchers are finally catching up to what so many of us have witnessed clinically and personally. There is a strong link between ADHD and eating disorders. In a 2020 meta analysis, which is like you take a bunch of research studies and you take out the most important similarities of all of them. In this meta analysis, researchers found that individuals with ADHD are three point eight times more likely to develop an eating disorder than those without ADHD. To be specific, rates of binge eating disorder and bulimia nervosa are notably higher in people with ADHD.

一些研究表明，高达30%的暴食症患者符合ADHD的诊断标准。而且不仅仅是暴食型障碍。人们越来越认识到ADHD患者也可能进行限制性进食，特别是当感官敏感或执行功能挑战干扰食物获取时。尽管如此，ADHD在饮食失调患者中经常被漏诊，尤其是在女性、有色人种和酷儿群体中。那么为什么会发生这种情况？

Some studies suggest up to thirty percent of individuals with binge eating disorder meet diagnostic criteria for ADHD. And it's not just binge type disorders. There's growing recognition that people with ADHD may also engage in restrictive eating, especially when sensory sensitivities or executive functioning challenges interfere with food access. Despite all this, ADHD is frequently underdiagnosed in people with eating disorders, particularly in women, people of color, and queer folks. So why does this happen?

为什么ADHD和饮食失调如此常见地联系在一起，为什么我们在治疗中会错过它？部分问题在于ADHD仍然被刻板印象化为一种仅影响多动男孩的儿童期障碍。这种过时的模型导致了对成年人的大规模漏诊，特别是那些出生时被指定为女性的人。许多人在接受饮食失调治疗后才发现自己患有ADHD，我在我的客户中也发现了这种情况。人们通常因为难以遵循饮食计划而发现自己有ADHD。

Why are ADHD and eating disorders so commonly linked, and why do we miss it in treatment? Part of the problem is that ADHD is still stereotyped as a childhood disorder that only affects hyperactive boys. This outdated model leads to massive underrecognition in adults, especially those assigned female at birth. Many people first discover that they have ADHD after being in eating disorder treatment, And I found that to be the case with my clients too. And people often figure out that they have ADHD because they're struggling to follow meal plans.

他们难以记住进食，努力应对与食物相关的 overwhelming。不幸的是，医疗服务提供者没有对大脑差异产生好奇，这些困难往往被过多地框架为抵抗、回避或缺乏动力。但重要的是要记住，ADHD不仅仅是一个诊断。它是一种基于大脑的差异，影响您处理时间、信息、情绪和感官输入的方式。

They're struggling to remember to eat. They're grappling with managing food related overwhelm. Unfortunately, instead of providers getting curious about brain differences, these difficulties are often too much framed as resistance, avoidance, or lack of motivation. It's important to remember though that ADHD isn't just a diagnosis. It's a brain based difference on how you process time, information, emotions, and sensory input.

而所有这些领域都与食物相关。让我们从执行功能开始说起。餐食规划、采购食材、烹饪以及记得吃饭，都需要决策制定、顺序安排和启动能力的复杂配合。对于患有ADHD的人来说，这些步骤可能令人精疲力尽、不堪重负，甚至感觉根本无法完成。一个看似简单的任务，比如做三明治，可能需要做出六个或十二个不同的决定。

And every one of these areas intersects with food. Let's start with executive functioning. So meal planning, grocery shopping, cooking, and remembering to eat require a complex dance of decision making, sequencing, and initiation. For someone with ADHD, these steps can be exhausting, overwhelming, and actually feel impossible. A task as seemingly simple as make a sandwich might require six different decisions or 12 different decisions.

用什么面包、蛋白质、温度、质地，餐具在哪里，厨房干净吗，我要用什么盘子？我要用盘子吃吗？喝什么饮料？这种认知负荷可能导致关闭或回避行为。结果，许多ADHD患者无意中跳过正餐，之后导致极度饥饿或暴饮暴食。

What bread, protein, temperature, texture, where are the utensils, is this kitchen clean, What plate am I gonna use? Do I eat it on a plate? What drink do I have? And that cognitive load can lead to shutdown or avoidance. As a result, many folks with ADHD unintentionally skip meals, which later sets them up for intense hunger or binge eating.

然后是时间盲视，这是ADHD的另一个核心特征。如果你难以感知时间的流逝，很容易连续几个小时不吃饭，因为你的身体没有意识到已经过了多久。这常常导致所谓的意外限制——你不是刻意限制进食，只是忘记了吃饭。而当你终于进食时，饥饿感会变得强烈、急迫，有时情绪上难以承受。

Then there's time blindness, another core feature of ADHD. If you have a hard time perceiving the passage of time, it's easy to go hours without eating because your body doesn't register how long it's been. It often leads to what some call accidental restriction. You weren't trying to restrict, you just forgot to eat. And then when you finally do eat, your hunger is intense, urgent, and sometimes emotionally overwhelming.

由于我们生活在一个妖魔化失控感的文化中，这可能会陷入内疚和羞耻的恶性循环，加剧饮食失调的模式。内感受——即你感受和解读内部身体信号（如饥饿和饱腹感）的能力——在ADHD中也常受影响。你可能直到为时已晚才感到饥饿信号；可能难以判断何时吃饱；可能无法区分饥饿与焦虑或过度刺激。

And because we live in a culture that demonizes the sense of loss of control, this can spiral into guilt and shame, reinforcing a disordered eating cycle. Interoception, which is your ability to feel and interpret internal body signals like hunger and fullness, is also commonly affected in ADHD. You may not feel hunger cues until it's too late. You may struggle to know when you're full. You may not be able to distinguish between hunger and anxiety or overstimulation.

当我们要求ADHD患者凭直觉进食，却不提供支持内感受意识的工具时，我们可能让他们陷入挫折和自我责备。感官敏感是另一个未被充分讨论的重要因素，我喜欢谈论感官敏感，因为我自己就有非常强烈的感官感知之类的问题。强烈的感官敏感。ADHD与感官处理敏感性常常重叠。许多ADHD患者有强烈的食物偏好，不是因为固执或失调，而是他们的神经系统对某些质地、温度或气味高度敏感。

When we ask people with ADHD to eat intuitively without offering tools to support interoceptive awareness, we risk setting them up for frustration and self blame. Sensory sensitivities are another huge undiscussed factor, and I love talking about sensory sensitivities because that's like something that I have is very strong sensory perceptions and stuff like that. Strong sensory sensitivities. ADHD and sensory processing sensitivity often overlap. Many people with ADHD have strong food preferences, not because they're rigid or disordered, but because their nervous systems are finely tuned to certain textures, temperatures, or smells.

如果糊状、湿软或混合食物让人反感，那并非抗拒或态度不好，而是一种感官边界。对某些人来说，反复吃同样的食物不是为了控制，而是在混乱的世界中寻求安全和可预测性，是为了避免决策疲劳。

If mushy, wet, or mixed foods feel revolting, that's not like being resistant or having a bad attitude. That's a sensory boundary. For some, eating the same food over and over isn't about control. It's about safety and predictability in a chaotic world. It's about avoiding decision fatigue.

不幸的是，在不考虑神经多样性的治疗环境中，这种饮食方式常被误解为回避性或失调行为。情绪失调——ADHD的另一个标志——也塑造了饮食模式。你可能通过进食来安抚过度刺激、寻求踏实感或避免不适；也可能在情绪超载时停止进食，尤其是在解离或过度专注于其他事情时。而且由于ADHD常伴随拒绝敏感型不快症， stakes感觉很高。

Unfortunately, this kind of eating is often misunderstood and considered avoidant or disordered in treatment spaces that don't account for neurodivergence. Emotional dysregulation, which is another hallmark of ADHD, also shapes eating patterns. You may eat to soothe overstimulation, to feel grounded, or to avoid discomfort. You may also stop eating during emotional overload, especially if you dissociate or become hyper focused on something else. And because ADHD often comes with rejection sensitivity dysphoria, the stakes feel high.

如果你正在接受康复计划，却感觉自己搞砸了，这种感受可能难以承受。一次看似失败的经历，你的大脑就会告诉你做错了。你永远无法做好这件事。何必再尝试呢？这种非黑即白的思维会让人陷入羞耻的漩涡无法自拔。

If you're in a recovery program and you feel like you've messed up, that might feel intolerable. One perceived failure and your brain tells you're doing it wrong. You'll never get this right. Why even try? This all or nothing thinking can keep people stuck in shame spirals.

遗憾的是，许多标准的饮食障碍治疗方案都围绕常规、刻板和依从性设计。对于患有ADHD的人来说，这感觉就像在为你设置失败陷阱。他们要求你遵循严格的进餐时间表，却没人帮你解决如何记住这些餐食，更不用说落实它们。他们要求你挑战自己的饮食规则，而治疗师却不询问感官过载、执行功能障碍或神经系统失调等问题，以及这些因素最初是如何催生这些规则的。当你真实的ADHD相关困扰被误认为是抗拒或自我破坏时，这会加深羞耻感，让你在一个从未为你的大脑设计的系统中感觉自己是个糟糕的客户。

It is very unfortunate that many standard eating disorder treatments are designed around routine, rigidity, and compliance. And for people with ADHD, that can feel like setting you up to fail. You're told to follow a strict meal schedule, and no one helps you figure out how to remember those meals, let alone make them happen. You're asked to challenge your food rules, and your therapist doesn't ask about sensory overload, executive dysfunction, or nervous system dysregulation, and how those things might be driving those rules in the first place. When your very real ADHD related struggles are mistaken for resistance or self sabotage, it deepens shame, and it makes you feel like a bad client in a system that was never designed for your brain.

那么，一种神经多样性肯定、创伤知情、ADHD友好的饮食障碍护理方法会是什么样子呢？首先，它会从同情开始。它会认识到你的饮食行为是适应策略，是你的大脑和身体在过度刺激的世界中为生存而发展出来的。与其假设为病态，我们会问：这服务于什么功能？这满足了什么需求？

So what would a neurodivergent affirming, trauma informed, ADHD friendly approach to eating disorder care look like? First, it would begin with compassion. It would recognize that your food behaviors are adaptations, strategies your brain and body have developed to survive in an overstimulating world. Rather than assuming pathology, we'd ask, what function does this serve? What need is this meeting?

从那里，我们可以开始搭建支持框架。这可能意味着将与食物相关的任务分解成更小、更易管理的步骤。如果你有兴趣试试，Goblin Tools这款应用实际上使用人工智能来帮助你做到这一点。有些人说计时器或外部提醒可能有用。我不确定。

From there, we could begin scaffolding support. That might mean breaking food related tasks into smaller, more manageable steps. And the app Goblin Tools, it actually uses AI to help you do that if you're interested in checking it out. Some people say timers or external reminders can be helpful. I don't know.

说实话，我与ADHD患者合作的时间越长，就越发现计时器没那么有用。我发现有用的是身体共伴（body doubling），即与他人同时做事或同时进食，或者通过共同调节（co-regulation）与他人连接，帮助 calming down 你的神经系统并帮助脱敏，从而减少餐间的激活状态。身体共伴再次是指当你与他人一起进食时，也可以是一起做饭。这真的取决于你的需求是什么。所有这些支持都将是感官协调的，我无法强调其重要性。

The longer I work with people with ADHD, I just haven't found timers to be that helpful, to be honest. What I have found helpful is body doubling, doing it at the same time as someone else or eating at the same time as someone else or co regulation to where you connect with someone else to help calm down your nervous system and help desensitize yourself, which reduces activation between meals. And then body doubling is, again, when you're eating with someone else, it could be cooking with someone else. It just really depends on what your needs are. And all of that support would be sensory attuned, and I cannot emphasize the importance of that.

与其推行刻板的膳食多样性观念或将你的食物偏好标记为回避，我们会好奇哪些食物实际上让你的神经系统感到安全、舒适和可耐受。这些情况可能每天都会变化，取决于你感到过度刺激的程度。也许某些质地让你作呕或感到不堪重负。也许你的大脑渴望一成不变，因为新奇事物会过度刺激。这不是违抗。

Instead of pushing a rigid idea of meal variety or labeling your food preferences as avoidance, we'd get curious about what foods actually feel safe, comforting, and tolerable for your nervous system. And those things can change day to day depending on how overstimulated you might feel. Maybe certain textures make you gag or feel overwhelmed. Maybe your brain craves sameness because novelty is overstimulating. That's not defiance.

这是你的身体在寻求调节。一种感官协调的方法会顺应这些需求，而不是与之对抗。我们可能会探索照明、噪音、衣物甚至餐具形状如何影响你的进食体验。我们创建能安抚你的感官、帮助你真正感受到自主权和能动性的进食常规，而不是让你的感官超负荷。因为感到生理上的安全是能够持续滋养自己的核心部分。

It's your body seeking regulation. A sensory attuned approach works with those needs rather than against them. We might explore how lighting, noise, clothing, or even the shape of utensils affect your eating experience. We create eating routines that soothe your senses and help you really feel a sense of autonomy and agency instead of overloading your senses. Because feeling physiologically safe is a core part of being able to nourish yourself consistently.

我们也会从你当前的状态开始，而不是按照治疗手册上说的你应该达到的状态。如果你只有精力准备一份零食，那也是一种胜利。如果你的安全食物是单调乏味的，我们不需要强行剥夺它们。我们完全可以在此基础上开展工作。如果你的饥饿信号不规律，我们可能会采用温和的定时进食作为过渡，不是为了建立规则，而是为了在你身体和大脑重新连接的过程中创造可预测性。

We'd also begin where you are, not where some treatment manual says you should be. If you only have the bandwidth to prep one snack, that's a win. If your safe foods are beige and bland, we don't need to rip those away. We can totally work with them. If your hunger cues are inconsistent, we might use gentle time based eating as a bridge, not for structure, but to create predictability while your body and brain reconnect.

我们也会认可情绪过载和完美主义。许多康复中的ADHD患者对自己非常苛刻，因为他们成长的环境、遭受的误解、标签化，有时甚至是欺凌和羞辱。他们期望把事情做对，因为如果做不对，坏事就会发生。这就是他们大脑和神经系统运作的方式。所以当他们无法做到完美时，就容易陷入恶性循环。

We'd also validate emotional overwhelm and perfectionism. A lot of ADHDers in recovery are deeply hard on themselves because of how they've grown up in the world around them and how misunderstood and labeled and sometimes bullied and shamed they've been. They expect to get it right because if they don't get it right, then bad things happen. That's how their brain and their nervous systems are functioning. And so they can spiral when they can't get it right.

以感官敏感为导向的方式与ADHD患者工作并实现康复，意味着我们要为混乱和不一致留出空间。我们实际上会接纳这一点，并强调其重要性。因为现实是，有些日子会比其他日子更容易，有很多因素会影响这一点，但这绝不意味着你就不值得被关爱。如果你在饮食障碍领域一直感到被忽视，如果你一直在想为什么常规建议对你的大脑不起作用，如果你一直在限制、暴食、羞耻和崩溃之间循环，我想让你知道，你并没有问题。你很可能是在对一个世界、一种文化和一个治疗模式做出反应，而这些都没有考虑到你的大脑如何处理食物、时间和情绪。

Working with ADHDers and recovering from a sensory tuned approach means that we'd make room for messiness, for inconsistency. We'd actually incorporate that and emphasize the importance of having that. Because the reality is that some days will be easier than others, and there's so many factors that can affect that, and none of this makes you less worthy of care. If you've been feeling unseen in the eating disorder spaces, if you've been wondering why the usual advice doesn't work for your brain, if you've been cycling between restriction, binging, shame, and shutdown, I want you to know you are not broken. You're likely responding to a world, a culture, and a treatment model that hasn't accounted for how your brain processes food, time, and emotion.

你不需要独自解决这个问题。我为像你这样的人创建了我的暴食康复会员计划，为那些正在应对不按教科书发展的饮食挣扎的人们，特别是如果你神经多样化、感官敏感，或者仅仅是因为试图修复本不是你的错的问题而感到筋疲力尽。会员计划是一个虚拟的、自定进度的、无羞耻的空间。你会找到实用的工具、富有同情心的支持和

And you don't have to figure this out alone. I've created my binge eating recovery membership for people just like you, people who are navigating eating struggles that don't follow a textbook, especially if you're neurodivergent, sensory sensitive, or just plain old simply exhausted by trying to fix what was never your fault. The membership is a virtual self paced and shame free place. You'll find practical tools, compassionate support, and

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真正理解你的社区。了解更多信息，请访问Maryann医生网站并点击暴食标签。感谢你今天花时间与我在一起。我知道这个话题很重要，如果它触动了你某些脆弱的地方，没关系。你可以慢慢来。

community that actually gets it. Learn more at doctor Maryann Miller and click on the binge eating tab. Thanks for spending this time with me today. I know this was a big one, and if it brought up anything tender, that's okay. You're allowed to move slowly.

你可以选择适合你的部分，舍弃不适合的。无论你何时准备好继续前进，我都会在这里。下次再见，请温柔地照顾好自己。

You're allowed to take what fits and leave what doesn't. I'll be here whenever you're ready to keep going. Until next time, take gentle care.

感谢你和我一起度过这段时光。我是玛丽安·兰德医生。如果你还没有关注我，请在Instagram上关注玛丽安·米勒医生。

Thanks for hanging out with me. I'm Doctor. Maryann Land. If you're not following me already, please do so Doctor. Maryann Miller on Instagram.

如需在饮食、进食和身体形象问题上获得更多支持，请访问drmaryannmiller.com。如果你喜欢这个播客，如果你能关注、评分或评论，我将非常高兴，因为这能帮助更多听众。非常感谢你今天收听。下次在玛丽安·兰德医生的节目中再见。

For further support with food, eating and body image issues, go to drmaryannmiller.com. If you enjoyed this podcast, I'd be thrilled if you gave it a follow or rated or reviewed it as it helps so many more listeners. Thank you so much for listening today. I'll see you next time in Doctor. Maryann Land.