Editor’s Note: This column contains information about eating disorders.

This column is a part of a series called “I’m hyperfocusing on…”.

I started a new medication for ADHD this weekend, and I came to a shocking realization. By choosing to go on this medication, I’ve chosen to live with life-changing side effects. I’m putting a trigger warning here, as this article deals with topics of eating disorders that might be triggering to some readers.

In a normal body, the brain receives signals of ghrelin when the stomach has been empty for a while. This signal tells the brain that the body is hungry and therefore informs the owner of the body that it needs to eat. There are a few ways this signal can be disrupted. This disruption is what can make eating disorders so difficult to treat, and the longer the response is disrupted, the harder it is to return to a normal hunger response.

In a normal brain, eating after receiving a ghrelin signal allows food to be associated with hunger and is seen as a solution. We don’t even need to think about the fact that food solves hunger. We just know that food is the solution. However, food also provides the brain with a hit of dopamine, the brain’s reward system. In individuals with ADHD, dopamine deficiency is a big source of struggle.

For an ADHD brain, food might be associated with dopamine instead of ghrelin. This is where things start to get tricky with food relationships. Some people end up self-medicating their dopamine deficiency with food, which can lead to a form of binge-eating disorder in which the individual eats even after the body is full.

There’s another side of the spectrum here, in which the brain doesn’t recognize ghrelin at all because it increases so slowly. This is the category that I fall into. I miss out on gradual signals until they become detrimental. I don’t know that I need to pee until it’s almost too late. Sometimes, a large transition in what I’m focused on can help me recognize I need to go. My mom hated that every time she interrupted me doing something to get my help with groceries, I’d go to the bathroom before helping. In fifth grade, I stayed up late one night reading a book. When I finished my book, I realized that I’d wet the bed without even knowing I needed to go. I lied to my mom and told her my cat had peed on me because I was so embarrassed. I was 11 years old.

I also don’t recognize when I’m hungry. This results in a type of eating disorder known as Avoidant Restrictive Food Intake Disorder, or ARFID. On several occasions, I’ve gone so long without eating that I’ve thrown up. Now, whenever I get nauseous, my first thought is “can I remember the last time I ate food?” Nausea is a strong enough signal that I recognize it no matter what I’m doing, thankfully. I typically have about 20 minutes between the nausea starting and when I start to throw up, so I pack up whatever I’m doing and go to the closest dining hall or café to get food. I also keep an applesauce pouch in my bag for something to eat if nausea sets in during a lecture, because I could slip it up under my mask without taking it off. My freshman year, I kept a banana in my coat pocket.

With my new medication, my dopamine receptors are blocked with a molecule that keeps the receptor firing all day. It’s too soon to know exactly how that works in my daily life, but the first thing I’ve noticed is the lack of transitions to give me a moment to think about whether I need to eat or not. I ate a couple donettes before I took my medication Saturday morning, and that was the last thing I put in my mouth all day. After a full day without food, I realized what had happened. As it is, I’ve lost a significant amount of weight in the last month and a half, and losing control over my ARFID is a slope I can’t afford to slip down.

I pulled out my two bento boxes that I bought for college and started on a plan. I decided that by packing a bento box during my end-of-the-day chores, I would have a designated amount of food I would have to eat during the course of the day. It only holds about one meal’s amount of food, but one meal is progress. I’m already equipped with enough information through my dietetics coursework to understand what I need to worry about when packing my bento boxes. That eliminates the need to worry about food during the day. I can grab my bento box and have food ready to go with no concerns as to whether I’m getting enough of each nutrient. My goal is to eat the entire bento box by the end of the day to ensure I’m eating enough.

I packed my Sunday bento box with carrots and cherry tomatoes, an orange, a few blueberries, cheese sticks and some leftover meatballs. I still haven’t felt anything to convince me to eat, but I’ve been able to open it up a few times today and eat some of the food while working on homework, watching TV, and doing other things. As I pack my Monday bento box, I know I can slip it in my nanny bag in the morning and take it to work with me, and in the fall, I can put it in my backpack.

I’ve lived with ARFID for many years as a result of my ADHD. My new medication hasn’t changed that, but my new realization of how close I toe the line has given me a new plan to stay safe. My medication is changing my life, hopefully for the better.