As a specialist who works with patients with eating disorders and body dysmorphic disorder (BDD), I’ve noticed that ADHD has a negative impact on body image. There is no mention of the relationship between body image and ADHD in the scientific literature, but there is anecdotal evidence worth considering.
Body image is more than how you think you look in a pair of skinny jeans. It refers to a person’s attitudes, beliefs, and perceptions of their body: how comfortable we feel about our bodies and how attractive we consider ourselves.
Positive body image is associated with healthy eating and sleep patterns, regular exercise, and avoiding bad habits, like smoking. People with positive body image feel appreciated, valued, and worthy of love. Negative body image can lead to restrictive eating, binge eating, purging, and not exercising at all or exercising excessively. It is associated with feeling unattractive and unworthy of love. Poor self-esteem and feelings of inferiority are both causes and consequences of negative body image.
Body Image and ADHD
Frank, 36, is chronically stressed due to ADHD. “The hyperactivity, the problems with following through on projects — it is too much to handle,” he says. ADHD often leads to feeling out of control. There are many unhealthy ways to deal with stress, including hyperfocusing on one’s body image. Frank has struggled with ADHD and also has been diagnosed with BDD, characterized by a preoccupation with an imagined or slight defect in one’s appearance. In Frank’s case, it is his skin.
“I feel like a failure every day because of my ADHD,” he says. “My appearance is the only thing I can control. So I spend a lot of time on improving my skin. I check myself in mirrors constantly to make sure my skin looks smooth and clean. I research skin cleansers when I should be doing work. Having perfect skin is my goal. If I look good, I feel that will make up for my other deficits.”
Edward, 29, is the same in the way ADHD affects his social skills. “I can be socially awkward and turn women off by interrupting them and saying off-the-wall things. I feel that if I look better, people will like me more, regardless of the fact that I can’t carry on a conversation. That is what led to my exercise addiction.”
A person with ADHD can temporarily shut out the world when he focuses on a number on a scale or his appearance in the mirror. Struggling with both ADHD and weight (despite being at a normal, healthy weight), Marisol, 24, says, “I don’t always accurately judge whether I have done a task well or not at work or at home. It is so hard to get through an assignment that it never feels well done. I feel like I am in limbo. But focusing on my weight grounds me. It is about a concrete number, and it is easy to measure where I stand.”
People with ADHD crave instant feedback. Weight, appearance, and body-related behaviors give that to them, although they can become obsessions. Eddie, 17, who has been diagnosed with ADHD, found himself touching his arms a lot while doing homework to see if his biceps were getting bigger. He would get anxious and look at his muscles in the mirror. If he did not like what he saw, he would start lifting weights in his room. Despite being muscular, he perceived himself as looking “puny,” a behavior known as muscle dysmorphia. Meanwhile, his homework — and other important tasks — didn’t get done.
Hyperfocusing on body image is stimulating, something ADHD brains are attracted to. Although not pleasurable, it is more interesting than doing boring, everyday tasks.
Some people with ADHD are so stimulated and distracted by everything else that they pay little or no attention to their body image. This may lead them to ignore early signs of health problems or obesity. Mark, 51, has struggled with obesity since adolescence. He attributes his dramatic weight gain to impulsive eating. Unlike those who think they are more overweight than they are, Mark underestimates his weight. “I hardly think about my body. I know that I eat unhealthy foods, but I don’t realize how much weight I have gained until I go to the doctor and get weighed. I gained 40 pounds in one year! I thought I had lost weight.”