۱- Introduction

۲- Methods

۳- Results

۴- Discussion

References

Abstract

Eating disorders and attention deficit/hyperactivity disorder (ADHD) are highly comorbid. The majority of research on this comorbidity has focused on impulsivity, which is a shared vulnerability between ADHD and eating disorders characterized by binge eating. Less is known about which shared factors may contribute to the co-occurrence of other eating disorders (i.e., anorexia nervosa, restricting subtype) and ADHD. Furthermore, little research has focused on other potential overlapping vulnerabilities, though deficits in emotion regulation have been implicated as an additional shared vulnerability. The current study (N = ۳۰۶ undergraduate students) uses path analysis to examine if emotion regulation difficulties and negative urgency (i.e., impulsivity during negative mood state) are unique or shared vulnerabilities for ADHD symptoms (inattention, hyperactivity-impulsivity) and eating disorder symptoms (bulimic symptoms, drive for thinness). Emotion regulation difficulties were uniquely associated with all dimensions of ADHD and eating disorder symptoms, and negative urgency was uniquely associated with global eating disorder symptoms, bulimic symptoms, and drive for thinness. These results suggest that emotion regulation difficulties are a shared vulnerability factor for the development of diverse presentations of ADHD and eating disorder symptoms, and may be an important prevention target. Additionally, our results support a unique relationship between negative urgency and drive for thinness. Future research should examine these associations prospectively and experimentally to determine directionality and inform preventative interventions for ADHD and eating disorders.

Introduction

Eating disorders (EDs) and attention deficit/hyperactivity disorder (ADHD) are frequently comorbid. Prevalence estimates suggest 3%–۷٫۶% of individuals with ADHD have an ED (Bleck & DeBate, 2013; Brewerton & Duncan, 2016), and 11.1%–۳۱٫۶% of individuals with an ED have a diagnosis of ADHD (Nazar et al., 2016; Yates, Lund, Johnson, Mitchell, & McKee, 2009). Beyond the high prevalence of comorbidity, research indicates that the co-occurrence of ADHD and EDs contributes to increased impairment and worse treatment outcomes (Biederman et al., 2007; Nazar et al., 2016). More research is needed to understand the development of these two co-occurring conditions in order to inform prevention efforts. Research on ADHD and EDs has primarily focused on bulimic symptoms and suggests individuals with ADHD are at higher risk for binge eating and purging (Bleck & DeBate, 2013; Bleck, DeBate, & Olivardia, 2015; Davis, Levitan, Smith, Tweed, & Curtis, 2006). Cognitive symptoms, such as drive for thinness (DT; i.e., extreme desire to be thinner, concerns about dieting, and weight gain fears; Garner, Olmstead, & Polivy, 1983) are far less researched. DT is implicated as a core symptom of EDs and precedes ED development (Stice, 2002), and thus represents an important factor to consider in developmental models of EDs. DT is especially important in understanding ADHD and ED comorbidity, as research indicates adolescents with ADHD have higher DT than healthy peers (Mikami et al., 2010; Neumark-Sztainer, Story, Resnick, Garwick, & Blum, 1995). Investigating DT, in addition to bulimic symptoms, may clarify what accounts for the comorbidity of ADHD and EDs not characterized by binge eating and purging behaviors (e.g., anorexia nervosa, restricting subtype). The relationship between ED symptoms and ADHD is theorized to be explained, in part, by impulsivity.