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For a long time, studies of eating disorders have indicated that the disorders are not just tied to food consumption abnormalities alone. However, it is until recently that researchers focused more on researching complex psychological, physiological, and cultural attachments of afflictions, for instance, binge eating disorders. Extended researches of other aspects that are tied to eating disorders have indicated that eating disorders are tied to attention deficits and self-awareness (Davis, Levitan, Smith, Tweed, & Curtis, 2006). This literature review considers whether eating disorders are connected to ADHD and poor self-awareness that is influenced by ethnic and cultural differences answering two questions:

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1. Are eating disorders connected to Attention Deficit Hyperactivity Disorder (ADHD)?

2. Are eating disorders connected to poor self-awareness influenced by ethnic and cultural differences?

Attention Deficit Hyperactivity Disorder is a type of disorder that has characteristics that include inattention, hyperactivity, and impulsiveness. The disease is one of the most common psychiatric disorders that are diagnosed in childhood with multiple symptoms. As recent research indicated, patients who have ADHD are more vulnerable to changes during their growth and development. Growth and weight changes that occur in patients, who are diagnosed with ADHD are normally explained in connection to the use of stimulants, which in most cases are the medication used for treatment of the disorder. However, studies indicate that growth and weight changes that occur among these changes can happen because of the disorder itself as opposed to the treatment medication. Predictions that were made to explain lower tendency of obesity in children with ADHD because of their increased activity levels were contradicted in the sense that children were found to have higher levels of BMI, signs of over-eating, and high percentage of body fat (Waring & Lapane, 2008). However, it is significant to point out that not many studies have concentrated on assessing prevalence of overweight children who have other developmental disorders, such as ADHD.

Eating disorders are one of the most occurring and serious classification of psychiatric disorders that include bulimia nervosa, anorexia nervosa, binge eating disorders, and other eating disorders that have not been defined (ENDOS). According to available research studies, at least 70 percent of adults that are diagnosed with ADHD have at least one psychiatric case (Nazar et al., 2008).

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Are Eating Disorders Connected to (Attention Deficit Disorder) ADHD?

Patients, who have eating disorders and ADHD exhibit common characteristics such as low self-esteem, deficits in attention, and varied degrees of impulsivity. These deficits lead to overconsumption of food, binge eating, and eating without hunger. Research studies show that eating disorders are linked to cognitive and emotional deficits. People who have AN and BN have been found to have difficulties with executive functioning and weaknesses in contextual integration (Talleyrand, 2010). It has also been found that people with BN exhibit a disintegrated response pattern, especially when put in contexts that exposes them to elicitation of negative emotions. On the other hand, patients who have AN exhibit high levels of impaired decision-making and social cognition. These impairments commonly occur in states of acute illnesses and severely impair abilities of judgment and interpersonal interactions. Therefore, eating disorders and other psychiatric conditions, including ADHD, affect or limit the ability of patients to carry out their daily activities in a normal way. Social adjustments of these patients tend to be slow. Their social communication skills are poor and their social networks are limited. Eating disorders are linked to medical and social disabilities of psychiatric disorders that are costly to patients, their families, and the society (Davis, Levitan, Smith, Tweed, & Curtis, 2006).

Girls affected by ADHD are at risk of eating disorders. This is particularly connected to bulimia nervosa. Girls, who have an eating disorder and ADHD experienced higher occurrences of anxiety, mood changes, disruptive behavior disorders, and the onset of menarche at an earlier time than normal girls did. This finding emphasized earlier findings that women with ADHD had an association with eating disorders. This finding was in line with other researches that were conducted earlier showing that ADHD and eating disorders are connected. In cases, where one of these conditions is found, the other must exist in one way or another. It is only in few cases where a case of either ADHD or an eating disorder occurs without symptoms that point at the existence of the other (Biederman, Ball, Monuteaux, Surman, Johnson, & Zeitlin, 2007).

There is strong connection that exists between obesity and ADHD (Davis, Levitan, Smith, Tweed, & Curtis, 2006). The researchers conducted the study that indicated a higher than expected occurrence of ADHD in adults, who were receiving treatment for obesity. This study showed that patients with ADHD responded differently to punishments and rewards as compared to other healthy people. Delayed reward and reduced sensitivity to negative feedback are characteristics of both adolescents and adults that have ADHD. The study shows that recent developments indicate that eating has been used as a reward in treating people with ADHD. Food rewards are used as self-medication, but can be abused. This is because a patient with this condition needs regular rewards to feel good as a way of compensating for the disorder. This proves findings that patients, who have ADHD have association with substance dependence, which in most cases is food. ADHD patients have used food as a source of mood enhancement that is significantly satisfactory. The study used women with ADHD as participants to test eating in response to negative mood and environmental cues. Since deficiency of dopamine in brain reward pathways causes ADHD, patients with ADHD have a higher risk of substance abuse. Therefore, they use highly palatable foods as a therapeutic proxy that act as a reward pathway. This shows the connection of ADHD to eating disorders (Altafas, 2002).

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Evidence has also been documented on strong relationship that exists between ADHD and binge eating disorder. Evidence shows that impulsive and inattentive components of ADHD encourage eating disorders. Cortese et al (2007) suggest that delayed aversion and deficient inhibitory control mechanisms contribute to abnormal eating behaviors. This is because the above conditions manifest in poor planning and result in difficulties in monitoring one’s behavior in an effective way and could lead to overconsumption of food. In addition, deficits in attention and other executive functions could make it difficult for a person with ADHD to follow a regular eating pattern. This could ultimately lead to abnormal eating behaviors. This is because there is a high probability that patients with ADHD can be inattentive to their signs of hunger. thus, they forget to eat when they find other interesting things to do (Cortese et al, 2007).

There is evidence showing the comorbidity between ADHD and childhood obesity. In the western countries, obesity is a problem that is often observed in children. Obesity cases reported in the western world have shown high relationship with ADHD that had been overlooked. This had been overlooked because less externalizing factors in obese children are not noticeable. In addition, obesity tends to cover issues of hyperactivity, while prejudice that has been laid against children with obesity interferes with objective study and interpretation of their behaviors. Thus, behavioral problems are mostly attributed to character issues.

Are Eating Disorders Connected to Poor Self-awareness Influenced by Ethnic and Cultural Differences?

It has also been found that eating disorders are tied to poor self-awareness that is influenced by ethnic identity. Franko et al (2007) acknowledges that, despite the fact that anorexia was originally believed to feature mainly in white European women, research indicates that eating disorders occur in populations that are ethnically and socio-economically diverse (Franko, Becker, Thomas, & Herzog, 2007). Research also shows that people who suffer from eating and weight related issues are less likely to seek help or treatment than non-minority populations. This is because minorities fear that they might be judged by their status. It has been found that occurrence eating disorders in ethnic or cultural diverse groups differ. For instance, DSM-IV diagnoses of eating disorders show that anorexia nervosa (AN) and bulimia nervosa (BN) occur more in Caucasian women than in African American women.

It is also evident that frequency of binge eating occurrences and bulimic symptoms are found in African American women similarly or in higher rates than in other races. Latino and Asian American women have high concerns about weight and are more frequently dissatisfied with their bodies as compared to Caucasian women. The study also indicates that Caucasian women still experience higher eating and weight concerns than women from ethnic minority groups (Talleyrand, 2010). These differences have been found out to be greater when disorders are studied among college participants and are small when community participants are used.

One significant issue that comes up from this discussion is that poor self-awareness influenced by ethnic identity is linked to eating disorders. Gordon et al. (2010) states that cultural body ideals influence eating disorder symptoms. Findings indicate that clinicians do not easily recognize eating disorders in ethnic minorities as compared to white/European women (Gordon, et al., 2010). This might be due to the belief that only white women develop eating disorders and that women from minority groups exhibit lower rates of eating disorder symptoms and body dissatisfaction as compared to white women. Significant differences that occur with respect to eating disorders in terms of ethnic and cultural differences are all tied to cultural body shape ideals that are denied by a specific ethnic or cultural group. Acculturation has also changed the way eating disorders develop. This is because acculturation accelerates acceptance and adoption of body ideals, for instance, concerning eating disorders. This has been clearly manifested by acculturated Latinos and Europeans compared to their counterparts, who are not acculturated (Gordon et al, 2010).

Baillie (2011) states that it is generally believed that western culture emphasizes thinness and this belief is responsible for presence of eating disorders and body dissatisfaction, especially among women. For instance, Asians who are acculturated to western values show little concern with body image and eating problems. On the other hand, those who live in western societies but are tied to their native cultures are at high risk of developing eating disorders. Chinese and Caucasian people do not show differences with respect to body disordered eating and image disturbance (Gordon et al, 2010). This means that western values of ideal body image impose symptoms of disordered eating and body image disturbance in both ethnicities. Despite the fact that there are no differences in eating disorder symptoms and body dissatisfaction, there are differences in terms of body esteem. For instance, Caucasian men and women demonstrated great levels of sexual attractiveness, physical attractiveness than other participants did. Chinese people took up western culture’s attractiveness and its values as a reference point. This shows that self-awareness as influenced by ethnic or cultural identity is connected to eating disorders (Baillie, 2011).

In conclusion, as current research studies show, eating disorders are connected to ADHD. Most patients, who are diagnosed with ADHD have the deficiency of dopamine that serves as a reward mechanism in the brain and makes them use food as a constant reward. ADHD patients display symptoms, such as delayed aversion and inhibitory control mechanism, that contribute to abnormal eating behaviors. This is because they result in poor planning, inattentiveness, and other executive functions that make it difficult for a person to consciously control their eating behavior or have normal eating habits. Eating disorders are also connected to poor self-awareness that is influenced by ethnic or cultural differences. This is seen in African American, Caucasian, and Chinese people. Evidence shows that not enough research has been conducted on the connection of eating disorders and poor self-awareness influenced by cultural and ethnic differences. As such, future research should focus on finding out whether ethnic and cultural body ideals and acculturation contribute to development of eating disorders. In addition, the relationship between eating disorders and obesity has not been researched. This relationship should also be studied.

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