Evidence suggests a comorbidity of childhood attention-deficit/hyperactivity disorder (ADHD) and subsequent eating disorders. However, most studies have assessed this comorbidity among patient populations as opposed to nationally representative samples and have not explored differences by subtype of each disorder. The current study aims to investigate the association between both clinical (i.e., diagnosed) and subclinical (i.e., presence of behaviors but not all diagnostic criteria) ADHD and eating disorders via a secondary data analysis of the National Longitudinal Study of Adolescent Health (n = 12,262). Results reveal that those with clinical ADHD are more likely to experience (a) clinical eating disorder, (b) clinical-level binging and/or purging behaviors, and (c) clinical-level restrictive behaviors. Those with subclinical ADHD (both inattentive and hyperactive/impulsive) were more likely to experience subclinical binging and/or purging behaviors but not subclinical restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention of eating disorders and tertiary prevention via patient-specific treatment plans.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
One impulsive symptom, “often interrupts or intrudes on others,” was not included in the original questionnaire. Thus, participants were considered to have hyperactive/impulsive behavior if they reported five or more hyperactive or impulsive symptoms.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing; 2013.
National Institutes of Mental Health. Attention Deficit Hyperactivity Disorder (ADHD): U.S. Department of Health and Human Services. National Institutes of Health;2008.
Visser SN, Danielson ML, Bitsko RH, et al. Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry. 2014;53(1):34–46. e32.
Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012;9(3):490–499.
Haines J, Neumark-Sztainer D. Prevention of obesity and eating disorders: A consideration of shared risk factors. Health Education Research. 2006;21(6):770–782.
Neumark-Sztainer, Wall, Guo, et al. Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? Journal of the American Dietetic Association. 2006;106(4):559.
Neumark-Sztainer, Wall, Haines, et al. Shared risk and protective factors for overweight and disordered eating in adolescents. American Journal of Preventive Medicine. 2007;33(5):359–369.
Swanson SA, Crow SJ, Le Grange D, et al. Prevalence and Correlates of Eating Disorders in Adolescents Results From the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry. 2011;68(7):714–723.
Hudson JI, Hiripi E, Pope Jr HG, et al. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 2007;61(3):348–358.
Stein D, Latzer Y, Merick J. Eating Disorders: From Etiology to Treatment. International Journal of Child Health and Adolescent Health. 2009;2(2):139–151.
Arcelus J, Mitchell AJ, Wales J, et al. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry. 2011;68(7):724.
Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry. 1995;152(7):1073–1074.
National Eating Disorder Association. Health Consequences of Eating Disorders. Retrieved on March 24, 2013 from www.nationaleatingdisorders.org/health-consequences-eating-disorders.
Neumark-Sztainer D. Obesity and eating disorder prevention: an integrated approach? Adolescent medicine (Philadelphia, Pa.). 2003;14(1):159.
Littleton HL, Ollendick T. Negative body image and disordered eating behavior in children and adolescents: what places youth at risk and how can these problems be prevented? Clinical Child and Family Psychology Review. 2003;6(1):51–66.
Neumark‐Sztainer. School‐Based Programs for Preventing Eating Disturbances. Journal of School Health. 1996;66(2):64–71.
U.S. Department of Health and Human Services. Office of Disease Prevetnion and Health Promotion. Healthy People 2020. Washington, DC.
Reba-Harrelson L, Von Holle A, Hamer R, et al. Patterns and prevalence of disordered eating and weight control behaviors in women ages 25–45. Eating and Weight Disorders.2009;14(4):e190.
Biederman J, Ball SW, Monuteaux MC, et al. Are Girls with ADHD at Risk for Eating Disorders? Results from a Controlled, Five-Year Prospective Study. Journal of Developmental and Behavioral Pediatrics.2007;28(4):302–307.
Sobanski E, Brüggemann D, Alm B, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience. 2007;257(7):371–377.
Yates WR, Lund BC, Johnson C, et al. Attention-deficit hyperactivity symptoms and disorder in eating disorder inpatients. International Journal of Eating Disorders. 2009;42(4):375–378.
Fernández-Aranda F, Agüera Z, Castro R, et al. ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity? BMC psychiatry. 2013;13(1):166.
Davis C, Levitan RD, Smith M, et al. Associations among overeating, overweight, and attention deficit/hyperactivity disorder: A structural equation modelling approach. Eating Behaviors. 2006;7(3):266–274.
Bleck J, DeBate RD. Exploring the co-morbidity of attention-deficit/hyperactivity disorder with eating disorders and disordered eating behaviors in a nationally representative community-based sample. Eating Behaviors. 2013;14(3):390–393.
Blinder BJ, Cumella EJ, Sanathara VA. Psychiatric Comorbidities of Female Inpatients With Eating Disorders. Psychosomatic Medicine. 2006;68(3):454–462.
Farber SK. The comorbidity of eating disorders and attention-deficit hyperactivity disorder. Eating Disorders. 2009;18(1):81–89.
Krisanaprakornkit T, Ngamjarus C, Witoonchart C, et al. Meditation therapies for attention-deficit/hyperactivity disorder (ADHD). Cochrane database of systematic reviews. 2010(6):CD006507.
Rader R, McCauley L, Callen E. Current strategies in the diagnosis and treatment of childhood attention-deficit/hyperactivity disorder. American Family Physician. 2009;79(8):657–665.
Dukarm CP. Bulimia Nervosa and Attention Deficit Hyperactivity Disorder: A Possible Role for Stimulant Medication. Journal of Women’s Health. 2005;14(4):345–350.
Kooij J, Burger H, Boonstra A, et al. Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial. Psychological Medicine. 2004;34(06):973–982.
Sokol MS, Gray NS, Goldstein A, et al. Methylphenidate treatment for bulimia nervosa associated with a cluster B personality disorder. The International Journal Of Eating Disorders. 1999;25(2):233–237.
Mikami AY, Hinshaw SP, Arnold LE, et al. Bulimia Nervosa Symptoms in the Multimodal Treatment Study of Children with ADHD. International Journal of Eating Disorders. 2010;43(3):248–259.
Fleming J, Levy L. Eating disorders in women with AD/HD. Gender Issues and AD/HD: Research, Diagnosis and Treatment. Silver Springs, MD: Silver Springs Advantage Books. 2002:411–426.
Cortese S, Bernardina BD, Mouren MC. Attention-deficit/hyperactivity disorder (ADHD) and binge eating. Nutrition Reviews. 2007;65(9):404–411.
Schweickert LA, Strober M, Moskowitz A. Efficacy of methylphenidate in bulimia nervosa comorbid with attention-deficit hyperactivity disorder: A case report. International Journal of Eating Disorders. 1997;21(3):299–301.
Engel SG, Corneliussen SJ, Wonderlich SA, et al. Impulsivity and compulsivity in bulimia nervosa. International Journal of Eating Disorders. 2005;38(3):244–251.
Fahy T, Eisler I. Impulsivity and eating disorders. The British Journal of Psychiatry.1993;162(2):193–197.
Rosval L, Steiger H, Bruce K, et al. Impulsivity in women with eating disorders: Problem of response inhibition, planning, or attention? International Journal of Eating Disorders. 2006;39(7):590–593.
Wiederman MW, Pryor T. Multi-impulsivity among women with bulimia nervosa. International Journal of Eating Disorders. 1996;20(4):359–365.
Wonderlich SA, Connolly KM, Stice E. Impulsivity as a risk factor for eating disorder behavior: Assessment implications with adolescents. International Journal of Eating Disorders. 2004;36(2):172–182.
Harris KM. Design features of add health. Chapel Hill: Carolina Population Center, University of North Carolina at Chapel Hill. Retrieved May 1, 2013 from https://www.cpc.unc.edu/projects/addhealth/data/guides/design%20paper%20WI-IV.pdf . 2011.
Fuemmeler BF, Dedert E, McClernon FJ, et al. Adverse childhood events are associated with obesity and disordered eating: Results from a US population‐based survey of young adults. Journal of traumatic stress. 2009;22(4):329–333.
Conley A, Boardman JD. Weight overestimation as an indicator of disordered eating behaviors among young women in the United States. International Journal of Eating Disorders. 2007;40(5):441–445.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders : DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.
Froehlich TE, Lanphear BP, Epstein JN, et al. Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children. Archives of Pediatrics & Adolescent Medicine. 2007;161(9):857–864.
Jensen PS, Kettle L, Roper MT, et al. Are stimulants overprescribed? Treatment of ADHD in four US communities. Journal of the American Academy of Child & Adolescent Psychiatry. 1999;38(7):797–804.
Wolraich ML, Hannah JN, Baumgaertel A, et al. Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a county-wide sample. Journal of Developmental & Behavioral Pediatrics. 1998;19(3):162.
Coghill D, Seth S. Do the diagnostic criteria for ADHD need to change? Comments on the preliminary proposals of the DSM-5 ADHD and Disruptive Behavior Disorders Committee. European Child & Adolescent Psychiatry. 2011;20(2):75–81.
Stice E, Marti CN, Rohde P. Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology. 2013;122(2):445.
This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from grant P01-HD31921 for this analysis.
Conflict of Interest
The authors have no conflicts of interest to disclose.
About this article
Cite this article
Bleck, J.R., DeBate, R.D. & Olivardia, R. The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample. J Behav Health Serv Res 42, 437–451 (2015). https://doi.org/10.1007/s11414-014-9422-y
- Anorexia Nervosa
- Eating Disorder
- Binge Eating
- ADHD Symptom
- Bulimia Nervosa