Untangling ADHD and Trauma in Eating Disorder Treatment
We recently wrote a post about the overlap of ADHD and eating disorders and received a thoughtful response from a reader about the additional intersection of trauma. I wanted to follow up with an additional blog post exploring this.
In eating disorder treatment, getting the full picture of what’s going on with a client is essential for effective care. There are so many complexities to fully understanding an individual’s presentation. For instance, there’s a growing awareness that symptoms of ADHD and trauma often overlap, leading to potential misdiagnoses or incomplete treatment plans. This confusion can be especially significant in the context of eating disorders, where both ADHD and trauma frequently co-occur and can influence disordered eating behaviors in distinct — but sometimes deceptively similar — ways.
The Symptoms Overlap
On the surface, ADHD and trauma can present with remarkably similar features, including:
- Difficulty concentrating or staying present
- Impulsivity or trouble with self-regulation
- Emotional reactivity or mood swings
- Disorganization or forgetfulness
- Sleep disturbances or fatigue
In someone struggling with an eating disorder, these symptoms can become even more pronounced. For example, both a trauma response and ADHD-related impulsivity might look like binge eating. Similarly, zoning out during meals might be dissociation from trauma or inattentiveness due to ADHD. The trauma response can also lead to a “freeze” response which may cause immobilization, loss of hunger cues and inability to eat – similar to when individuals with ADHD become hyper-focused on something and forget to eat.
The Risk of Misattribution
When clinicians or treatment teams attribute all dysregulation or impulsivity to trauma, ADHD may go unrecognized. Conversely, if emotional reactivity and executive function challenges are viewed solely through an ADHD lens, underlying trauma may be overlooked. Misattribution can lead to ineffective interventions — like focusing only on grounding techniques for dissociation without addressing the cognitive challenges of ADHD, or prescribing ADHD medication without treating unresolved trauma.
In eating disorder treatment, this misalignment matters. A client with untreated ADHD may continue to struggle with meal planning, impulsive eating, or emotional regulation — not due to noncompliance or resistance, but because they lack the necessary neurocognitive support. Meanwhile, a client with unprocessed trauma might need a safe, relational approach before cognitive or behavioral tools can be effective.
Why Differentiation Matters in Treatment
Getting the diagnosis right isn’t just about labels — it’s about access to the right interventions. ADHD may require stimulant medication, executive functioning support, and structured routines. Trauma work, on the other hand, often calls for somatic therapies, EMDR, or trauma-informed relational models. In eating disorder recovery, clients may need both — but if one is missed, healing can stall.
This is especially true for those with complex trauma or late-diagnosed ADHD, where a lifetime of masking, invalidation, or misdiagnosis has already taken a toll on self-esteem and trust in the treatment process.
Key Questions for Clinicians
To navigate this complexity, clinicians can ask:
- When did these symptoms first appear? Are they longstanding (suggesting ADHD) or tied to a specific event (suggesting trauma)?
- Does the client have a history of developmental challenges, school difficulties, or early signs of ADHD?
- Is emotional dysregulation primarily reactive to triggers, or more generalized and persistent?
- How does the client respond to structure and routine? Do they benefit from tools that support executive functioning?
- Have both trauma-informed and neurodivergence-informed lenses been used in case conceptualization?
Important Consideration: It Can Be Both
ADHD and trauma are not mutually exclusive. In fact:
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Individuals with ADHD may be at higher risk for experiencing trauma due to impulsivity, poor risk assessment, and social challenges.
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Those with trauma histories may show ADHD-like symptoms, and prolonged trauma exposure in early childhood (complex trauma) can impact brain development in ways that resemble neurodevelopmental disorders.
Assessment Matters
A comprehensive evaluation should include:
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Clinical interviews
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Developmental and trauma histories
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Behavior checklists
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Collateral information from caregivers, teachers, or others
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If possible, structured ADHD or trauma-specific assessment tools
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A Call for Integrated, Curious Care
Ultimately, the overlap between ADHD and trauma is not a reason for confusion — it’s a call for greater nuance and compassion in eating disorder treatment. Providers must remain curious, collaborative, and open to revisiting assumptions. ADHD and trauma are not mutually exclusive, and in fact, many clients live with both. Validating the full scope of their experience creates space for more personalized, empowering, and effective recovery work.
