Adapting eating disorder treatment for ADHD: clinicians’ perspectives on building structure, harnessing strengths, and negotiating boundaries

TY - JOUR

T1 - Adapting eating disorder treatment for ADHD

T2 - clinicians’ perspectives on building structure, harnessing strengths, and negotiating boundaries

AU - Makin, Lauren

AU - Mondelli, Valeria

AU - Tchanturia, Kate

PY - 2026/8/19

Y1 - 2026/8/19

N2 - Background: ADHD is overrepresented in clinical eating disorder (ED) services, and patients with ADHD present to services with increased ED psychopathology, psychological distress, and functional difficulties. They are also more likely to drop out of treatment and have poorer outcomes. Although previous studies have explored patients with ADHD’s perspectives on their ED and treatment, clinician accounts remain underexplored, despite clinicians shaping recognition, formulation, and treatment adaptation in routine care. This study therefore explored ED clinicians’ perspectives on working with patients with ADHD. Methods: Semi-structured interviews were conducted with 19 multidisciplinary ED clinicians and analysed using reflexive thematic analysis through a neuro-affirming lens. Results: Three themes were developed: (1) ADHD as pervasive life chaos; (2) Harnessing energy, alliance, and creativity; and (3) Navigating service boundaries. Conclusions: Clinicians described ADHD-related disorganisation, reward-seeking, and emotional volatility as underpinning ED behaviours and disrupting therapeutic processes, highlighting the importance of supporting structure and planning during treatment. Strength-based, collaborative, and creative approaches were also emphasised. However, challenges around recognising, diagnosing, and medicating ADHD were particularly salient, highlighting the need for greater collaboration and knowledge exchange between ED and ADHD services, alongside better use of existing multidisciplinary and dual expertise within ED teams.

AB - Background: ADHD is overrepresented in clinical eating disorder (ED) services, and patients with ADHD present to services with increased ED psychopathology, psychological distress, and functional difficulties. They are also more likely to drop out of treatment and have poorer outcomes. Although previous studies have explored patients with ADHD’s perspectives on their ED and treatment, clinician accounts remain underexplored, despite clinicians shaping recognition, formulation, and treatment adaptation in routine care. This study therefore explored ED clinicians’ perspectives on working with patients with ADHD. Methods: Semi-structured interviews were conducted with 19 multidisciplinary ED clinicians and analysed using reflexive thematic analysis through a neuro-affirming lens. Results: Three themes were developed: (1) ADHD as pervasive life chaos; (2) Harnessing energy, alliance, and creativity; and (3) Navigating service boundaries. Conclusions: Clinicians described ADHD-related disorganisation, reward-seeking, and emotional volatility as underpinning ED behaviours and disrupting therapeutic processes, highlighting the importance of supporting structure and planning during treatment. Strength-based, collaborative, and creative approaches were also emphasised. However, challenges around recognising, diagnosing, and medicating ADHD were particularly salient, highlighting the need for greater collaboration and knowledge exchange between ED and ADHD services, alongside better use of existing multidisciplinary and dual expertise within ED teams.

U2 - 10.1186/s40337-026-01740-5

DO - 10.1186/s40337-026-01740-5

M3 - Article

SN - 2050-2974

JO - Journal of Eating Disorders

JF - Journal of Eating Disorders

ER -