The association between ADHD and eating disorders/pathology in adolescents: A systematic review

Carol Curtin, Sherry L. Pagoto, Eric Mick

Division of Behavioral and Preventive Medicine, University of Massachusetts Medical School, Worcester, USA.
Family Medicine & Community Health, E.K. Shriver Center, University of Massachusetts Medical School, Waltham, USA.
Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, USA.

DOI: 10.4236/ojepi.2013.34028                

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD), one of the most common neurodevelopmental conditions of childhood, is associated with high rates of mood and behavioral disorders. Preliminary evidence suggests that ADHD may also be associated with eating disorders (ED) or eating pathology (EP). This systematic review synthesizes the extant published literature on this association among youth ages 12-21 years. Methods: Literature searches were performed using Medline, Ovid/Psych Info, Google Scholar, and via manual inspection of bibliographies. Cross-sectional, case-control, and prospective studies published in English with sample sizes larger than 50, participant ages 12-21 years, and assessed ADHD and ED or EP, were considered for review. Case reports, feeding, and drug studies were excluded. Results: Preliminary searches yielded 337 articles; eight articles met inclusion/exclusion criteria. Two studies documented an association between ADHD and ED, and three studies found an association between ADHD and EP. Youth with ADHD were nearly 3 to 6 times more likely to develop an ED than youth without ADHD, and were also more likely to have higher rates of EP, body dissatisfaction, and desire to lose weight/ drive for thinness. Impulsivity was predictive of EP, and ADHD youth with co-occurring mood/behavioral disorders and punitive parental relationships were at higher risk. Conclusions: Five of eight studies documented an association between ADHD and ED or EP in adolescents. Future research is needed to confirm and refine further these findings. The findings have clinical implications, including the inclusion of ED/EP in screening and anticipatory guidance efforts. Evaluating whether medical management of ADHD may be efficacious in preventing and/or treating ED/EP is also warranted.

Keywords

ADHD; Adolescents; Eating Disorders; Eating Pathology

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ferguson, J.H. (2000) National institutes of health consensus development conference statement: Diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). Journal of the American Academy of Child & Adolescent Psychiatry, 39, 182-193. http://dx.doi.org/10.1097/00004583-200002000-00018
[2]	American Psychiatric Association (1994) Statistical manual of mental disorders. American Psychiatric Association, Washington DC.
[3]	Swanson, S.A., Crow, S.J., Le Grange, D., Swendsen, J. and Merikangas, K.R. (2011) Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry, 68, 714. http://dx.doi.org/10.1001/archgenpsychiatry.2011.22
[4]	Pritts, S.D. and Susman, J. (2003) Diagnosis of eating disorders in primary care. American Family Physician, 67, 297-304.
[5]	Biederman, J., Monuteaux, M.C., Mick, E., et al. (2006) Psychopathology in females with attention-deficit/hyper-activity disorder: A controlled, five-year prospective study. Biological Psychiatry, 60, 1098-1105. http://dx.doi.org/10.1016/j.biopsych.2006.02.031
[6]	Spencer, T.J., Biederman, J. and Mick, E. (2007) Attention-deficit/hyperactivity disorder: Diagnosis, lifespan, comorbidities, and neurobiology. Journal of Pediatric Psychology, 32, 631-642. http://dx.doi.org/10.1093/jpepsy/jsm005
[7]	Fischer, M., Barkley, R.A., Smallish, L. and Fletcher, K. (2002) Young adult follow-up of hyperactive children: Self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD. Journal of Abnormal Child Psychology, 30, 463-475. http://dx.doi.org/10.1023/A:1019864813776
[8]	Mannuzza, S., Klein, R.G., Bessler, A. and Malloy, P. (1993) Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50, 565-576. http://dx.doi.org/10.1001/archpsyc.1993.01820190067007
[9]	Barkley, R.A. (1997) Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65. http://dx.doi.org/10.1037/0033-2909.121.1.65
[10]	Davis, C., Levitan, R.D., Smith, M., Tweed, S. and Curtis, C. (2006) Associations among overeating, overweight, and attention deficit/hyperactivity disorder: A structural equation modelling approach. Eating Behavior, 7, 266-274. http://dx.doi.org/10.1016/j.eatbeh.2005.09.006
[11]	Ivan, I., Azarbad, L., Corsica, J. and Hood, M. (2009) Does binge eating mediate the relationship between ADHD characteristics and obesity severity. Obesity, 17, S286.
[12]	Guerrieri, R., Nederkoorn, C. and Jansen, A. (2007) The interaction between impulsivity and a varied food environment: Its influence on food intake and overweight. International Journal of Obesity, 32, 708-714. http://dx.doi.org/10.1038/sj.ijo.0803770
[13]	Nederkoorn, C., Guerrieri, R., Havermans, R., Roefs, A. and Jansen, A. (2009) The interactive effect of hunger and impulsivity on food intake and purchase in a virtual supermarket. International Journal of Obesity, 33, 905-912. http://dx.doi.org/10.1038/ijo.2009.98
[14]	Dawe, S. and Loxton, N.J. (2004) The role of impulsivity in the development of substance use and eating disorders. Neuroscience & Biobehavioral Reviews, 28, 343-351. http://dx.doi.org/10.1016/j.neubiorev.2004.03.007
[15]	Downs, S.H. and Black, N. (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiological Community Health, 52, 377-384. http://dx.doi.org/10.1136/jech.52.6.377
[16]	Livingston, J.D., Milne, T., Fang, M.L. and Amari, E. (2012) The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107, 39-50. http://dx.doi.org/10.1111/j.1360-0443.2011.03601.x
[17]	Biederman, J., Ball, S.W., Monuteaux, M.C., Surman, C.B., Johnson, J.L. and Zeitlin, S. (2007) Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. Journal of Developmental and Behavioral Pediatrics, 28, 302-307. http://dx.doi.org/10.1097/DBP.0b013e3180327917
[18]	Gau, S.S., Ni, H.C., Shang, C.Y., et al. (2010) Psychiatric comorbidity among children and adolescents with and without persistent attention-deficit hyperactivity disorder. Australian & New Zealand Journal of Psychiatry, 44, 135-143. http://dx.doi.org/10.3109/00048670903282733
[19]	Mikami, A.Y., Hinshaw, S.P., Arnold, L.E., et al. (2010) Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD. International Journal of Eating Disorders, 43, 248-259.
[20]	Mikami, A.Y., Hinshaw, S.P., Patterson, K.A. and Lee, J.C. (2008) Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder. Journal of Abnormal Psychology, 117, 225-235. http://dx.doi.org/10.1037/0021-843X.117.1.225
[21]	Lewinsohn, P.M., Striegel-Moore, R.H. and Seeley, J.R. (2000) Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 1284-1292. http://dx.doi.org/10.1097/00004583-200010000-00016
[22]	Neumark-Sztainer, D., Story, M., Resnick, M.D., Garwick, A. and Blum, R.W. (1995) Body dissatisfaction and unhealthy weight-control practices among adolescents with and without chronic illness: A population-based study. Archives of Pediatrics & Adolescent Medicine, 149, 1330-1335. http://dx.doi.org/10.1001/archpedi.1995.02170250036005
[23]	Yates, W.R., Lund, B.C., Johnson, C., Mitchell, J. and McKee, P. (2009) Attention-deficit hyperactivity symptoms and disorder in eating disorder inpatients. International Journal of Eating Disorders, 42, 375-378. http://dx.doi.org/10.1002/eat.20627
[24]	Yoshimasu, K., Barbaresi, W.J., Colligan, R.C., et al. (2012) Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: A population-based birth cohort study. Journal of Child Psychology and Psychiatry, 53, 1036-1043. http://dx.doi.org/10.1111/j.1469-7610.2012.02567.x
[25]	Cortese, S., Bernardina, B.D. and Mouren, M.C. (2007) Attention-Deficit/hyperactivity disorder (ADHD) and binge eating. Nutrition Reviews, 65, 404-411. http://dx.doi.org/10.1111/j.1753-4887.2007.tb00318.x
[26]	Mattos, P., Saboya, E., Ayrao, V., Segenreich, D., Duchesne, M. and Coutinho, G. (2004) Comorbid eating disorders in a brazilian attention-deficit/hyperactivity disorder adult clinical sample. Revista Brasileira de Psiquiatria, 26, 248-250.
[27]	Wentz, E., Lacey, J.H., Waller, G., Rastam, M., Turk, J. and Gillberg, C. (2005) Childhood onset neuropsychiatric disorders in adult eating disorder patients. A pilot study. European Child & Adolescent Psychiatry, 14, 431-437. http://dx.doi.org/10.1007/s00787-005-0494-3
[28]	Surman, C.B., Randall, E.T. and Biederman (2006) Association between attention-deficit/hyperactivity disorder and bulimia nervosa: Analysis of 4 case-control studies. Journal of Clinical Psychiatry, 67, 351-354. http://dx.doi.org/10.4088/JCP.v67n0303
[29]	Nazar, B.P., Pinna, C.M., Suwwan, R., et al. (2012) ADHD rate in obese women with binge eating and bulimic behaviors from a weight-loss clinic. Journal of Attention Disorders, 28, Epub ahead of print.
[30]	Cortese, S., Isnard, P., Bernardina, B.D. and Mouren, M. (2007) Attention-deficit/hyperactivity disorder, binge eating, and obesity. Journal of Clinical Psychiatry, 68, 976. http://dx.doi.org/10.4088/JCP.v68n0624h
[31]	Nazar, B.P., Pinna, C.M., Coutinho, G., et al. (2008) Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders. Revista Brasileira de Psiquiatria, 30, 384-389. http://dx.doi.org/10.1590/S1516-44462008000400014
[32]	Tregellas, J.R., Wylie, K.P., Rojas, D.C., et al. (2012) Altered default network activity in obesity. Obesity, 19, 2316-2321. http://dx.doi.org/10.1038/oby.2011.119
[33]	Castellanos, F.X., Margulies, D.S., Kelly, A.M.C., et al. (2008) Cingulate-precuneus interactions: A new locus of dysfunction in adult attention-deficit/hyperactivity disorder. Biological Psychiatry, 63, 332. http://dx.doi.org/10.1016/j.biopsych.2007.06.025
[34]	Fassbender, C., Zhang, H., Buzy, W.M., et al. (2009) A lack of default network suppression is linked to increased distractibility in ADHD. Brain Research, 1273, 114-128. http://dx.doi.org/10.1016/j.brainres.2009.02.070
[35]	Cortese, S., Isnard, P., Frelut, M.L., et al. (2007) Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents. International Journal of Obesity, 31, 340-346. http://dx.doi.org/10.1038/sj.ijo.0803400
[36]	Dukarm, C.P. (2005) Bulimia nervosa and attention deficit hyperactivity disorder: A possible role for stimulant medication. Journal of Women’s Health, 14, 345-350. http://dx.doi.org/10.1089/jwh.2005.14.345
[37]	Drimmer, E.J. (2003) Stimulant treatment of bulimia nervosa with and without attention-deficit disorder: Three case reports. Nutrition, 19, 76-77. http://dx.doi.org/10.1016/S0899-9007(02)01045-6
[38]	Schweickert, L.A., Strober, M. and Moskowitz, A. (1997) Efficacy of methylphenidate in bulimia nervosa comorbid with attention-deficit hyperactivity disorder: A case report. International Journal of Eating Disorders, 21, 299-301. http://dx.doi.org/10.1002/(SICI)1098-108X(199704)21:3<299::AID-EAT11>3.0.CO;2-W
[39]	Lena, S., Chidambaram, U., Panarella, C. and Sambasivan, K. (2001) Cognitive factors in anorexia nervosa: A case history. International Journal of Eating Disorders, 30, 354-358. http://dx.doi.org/10.1002/eat.1097
[40]	Rucklidge, J.J. (2010) Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America, 33, 357. http://dx.doi.org/10.1016/j.psc.2010.01.006