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Underlying Mechanisms and Trajectory of Comorbid ADHD and Eating Disorders: Proposing an Innovative Systems Framework for Informing Research


ADHD and eating disorders are both significant public health issues. Emerging evidence suggests that ADHD and eating disorders may be comorbid resulting in increased severity of associated health issues. Although several hypotheses have been proposed with respect to the underlying mechanisms of the comorbidity, there is a need for a conceptual model, which presents the simultaneous investigation of the trajectory of onset and multiple hypotheses. The current paper proposes an innovative conceptual model that can be used to simultaneously explore hypothesized underlying mechanisms by triangulating current literature with aspects of the biopsychosocial model, life course approach, Risk Regulator Framework, research domain criteria matrix, and the person-environment transaction theory. Designated within the model are proposed pathways that serve to describe how various psychosocial and psychiatric risk regulators and genetic risk factors combine to influence the comorbidity across the lifespan. The proposed conceptual model can provide the foundation for further research regarding comorbid ADHD and eating disorders in addition to translation for use among other comorbid conditions.

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  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.

    Google Scholar 

  • Ball, J., Biederman, S. W., Monuteaux, M. C., Surman, C. B., Johnson, J. L., & 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(4), 302–307.

    Article  PubMed  Google Scholar 

  • Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31(2), 285–293.

    Article  PubMed  Google Scholar 

  • Biederman, J., Petty, C. R., Monuteaux, M. C., Fried, R., Byrne, D., Mirto, T., . . . Faraone, S. V. (2010). Adult Psychiatric Outcomes of Girls With Attention Deficit Hyperactivity Disorder: 11-Year Follow-Up in a Longitudinal Case–control Study. American Journal of Psychiatry, 167(4), 409–417

  • Bleck, J. R., Debate, R. D., & Olivardia, R. (2014). The Co-occurrence of ADHD and Eating Disorders in a Nationally Representative Sample. Journal of Behavioral Health Services & Research, 1–15.

  • Blinder, B. J., Cumella, E. J., & Sanathara, V. A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine, 68(3), 454–462.

    Article  PubMed  Google Scholar 

  • Blum, K., & Noble, E. (2001). Reward deficiency syndrome (RDS): a biogenic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. Paper presented at the Molecular psychiatry

  • Borrell-Carrió, F., Suchman, A. L., & Epstein, R. M. (2004). The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. The Annals of Family Medicine, 2(6), 576–582.

    Article  PubMed  Google Scholar 

  • Caspi, A., & Roberts, B. W. (1990). Personality continuity and change across the life course. Handbook of personality: Theory and research, 300–326.

  • Caspi, A., & Roberts, B. W. (2001). Personality development across the life course: the argument for change and continuity. Psychological Inquiry, 12(2), 49–66.

    Article  Google Scholar 

  • Comings, D. E., & Blum, K. (2000). Reward deficiency syndrome: genetic aspects of behavioral disorders. Progress in Brain Research, 126, 325–341.

    CAS  Article  PubMed  Google Scholar 

  • Cortese, S., B. D., B., & Mouren, M. C. (2007). Attention-deficit/hyperactivity disorder (ADHD) and binge eating. Nutrition Reviews, 65(9), 404–411.

    Article  PubMed  Google Scholar 

  • Cortese S, Angriman, M., Maffeis, C., Isnard, P., Konofal, E., Lecendreux, M., . . . Mouren, M.-C. (2008). Attention-deficit/hyperactivity disorder (ADHD) and obesity: a systematic review of the literature. Critical reviews in food science and nutrition, 48(6), 524–537.

  • Davis, C., Levitan, R. D., Smith, M., Tweed, S., & Curtis, C. (2006). Associations among overeating, overweight, and attention deficit/hyperactivity disorder: a structural equation modelling approach. Eating Behaviors, 7(3), 266–274.

    Article  PubMed  Google Scholar 

  • Elder, G. H., Johnson, M. K., & Crosnoe, R. (2003). The emergence and development of life course theory. Handbook of the Life Course, 3–19.

  • Engel, G. L. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137(5), 535–544.

    CAS  Article  PubMed  Google Scholar 

  • Fernández-Aranda, F., Agüera, Z., Castro, R., Jiménez-Murcia, S., Ramos-Quiroga, J. A., Bosch, R., . . . Claes, L. (2013). ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity? BMC psychiatry, 13(1), 166.

  • Glass, T. A., & McAtee, M. J. (2006). Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Social Science & Medicine, 62(7), 1650–1671.

    Article  Google Scholar 

  • Haines, J., & Neumark-Sztainer, D. (2006). Prevention of obesity and eating disorders: a consideration of schared risk factors. Health Education Research, 21(6), 770–782.

    Article  PubMed  Google Scholar 

  • Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358.

    Article  PubMed  Google Scholar 

  • Insel, T. R., Cuthbert, B. N., Garvey, M. A., Heinssen, R. K., Pine, D. S., Quinn, K. J., . . . Wang, P. S. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167(7), 748–751.

  • Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., . . . Secnik, K. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry, 163(4), 716.

  • LaHoste, G., Swanson, J., Wigal, S., Glabe, C., Wigal, T., King, N., & Kennedy, J. (1996). Dopamine D4 receptor gene polymorphism is associated with attention deficit hyperactivity disorder. Molecular Psychiatry, 1(2), 121–124.

    CAS  PubMed  Google Scholar 

  • Mattos, P., Saboya, E., Ayrão, V., Segenreich, D., Duchesne, M., & Coutinho, G. (2004). Comorbid eating disorders in a Brazilian attention-deficit/hyperactivity disorder adult clinical sample. Revista Brasileira de Psiquiatria, 26(4), 248–250.

    Article  PubMed  Google Scholar 

  • Mikami, A. Y., Hinshaw, S. P., Patterson, K. A., & Lee, J. C. (2008). Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder. Journal of Abnormal Psychology, 117(1), 225–235.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morris, S. E., & Cuthbert, B. N. (2012). Research domain criteria: cognitive systems, neural circuits, and dimensions of behavior. Dialogues in Clinical Neuroscience, 14(1), 29.

    PubMed  PubMed Central  Google Scholar 

  • National Eating Disorder Association. (n.d.). Health Consequences of Eating Disorders. Retrieved on March 24, 2013 from

  • National Institute of Mental Health. (2008). Attention Deficit Hyperactivity Disorder (ADHD). In National Institute of Mental Health (Ed.), (Vol. no. 08–3572): National Institutes of Health.

  • National Institutes of Mental Health. (n.d.). RDoC Constructs. Retrieved September 21, 2013, from - acute_threat

  • Nazar, B. P., Pinna, C., Coutinho, G., Segenreich, D., Duchesne, M., Appolinario, J. C., & Mattos, P. (2008). Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders. Revista Brasileira de Psiquiatria, 30, 384–389.

    Article  PubMed  Google Scholar 

  • Neumark-Sztainer. (2003). Obesity and eating disorder prevention: an integrated approach? Adolescent medicine (Philadelphia, Pa.), 14(1), 159.

  • Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., & Eisenberg, M. (2006). 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, 106(4), 559.

    Article  PubMed  Google Scholar 

  • Neumark-Sztainer, D. R., Wall, M. M., Story, M. T., Haines, J. I., Sherwood, N. E., & Berg, V. D. (2007). Shared risk and protective factors for overweight and disordered eating in adolescents. American Journal of Preventive Medicine, 33(5), 359–369.

    Article  PubMed  Google Scholar 

  • Noble, E. P. (2003). D2 dopamine receptor gene in psychiatric and neurologic disorders and its phenotypes. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 116(1), 103–125.

    Article  Google Scholar 

  • Peebles, R., Hardy, K. K., Wilson, J. L., & Lock, J. D. (2010). Are diagnostic criteria for eating disorders markers of medical severity? Pediatrics, 125(5), e1193–e1201.

    Article  PubMed  PubMed Central  Google Scholar 

  • Poston, W., Ericsson, M., Linder, J., Haddock, C., Hanis, C., Nilsson, T., . . . Foreyt, J. (1998). D4 dopamine receptor gene exon III polymorphism and obesity risk. Eating and weight disorders: EWD, 3(2), 71–77.

  • Quinn, P. (2008). Attention-deficit/hyperactivity disorder and its comorbidities in women and girls: an evolving picture. Current Psychiatry Reports, 10(5), 419–423.

    Article  PubMed  Google Scholar 

  • Reba-Harrelson, L., Von Holle, A., Hamer, R., Swann, R., Reyes, M., & Bulik, C. (2009). Patterns and prevalence of disordered eating and weight control behaviors in women ages 25–45. Eating and Weight Disorders: EWD, 14(4), e190.

    CAS  Article  PubMed  Google Scholar 

  • Smalley, S., Bailey, J., Palmer, C., Cantwell, D., McGough, J., Del'Homme, M., . . . Nelson, S. (1998). Evidence that the dopamine D4 receptor is a susceptibility gene in attention deficit hyperactivity disorder. Molecular psychiatry, 3(5), 427–430.

  • Sobanski, E., Brüggemann, D., Alm, B., Kern, S., Deschner, M., Schubert, T., . . . Rietschel, M. (2007). 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, 257(7), 371–377

  • Striegel‐Moore, R. H., & Franko, D. L. (2003). Epidemiology of binge eating disorder. International Journal of Eating Disorders, 34(S1), S19–S29.

    Article  PubMed  Google Scholar 

  • Swanson, J., Sunohara, G., Kennedy, J., Regino, R., Fineberg, E., Wigal, T., . . . Wigal, S. (1998). Association of the dopamine receptor D4 (DRD4) gene with a refined phenotype of attention deficit hyperactivity disorder (ADHD): a family-based approach. Molecular psychiatry, 3(1), 38–41.

  • U.S. Department of Health and Human Services. (2012). Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC.

  • Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., . . . Blumberg, S. J. (2014). 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, 53(1), 34–46. e32.

  • Wade, T. D., Keski‐Rahkonen, A., & Hudson, J. I. (2011). Epidemiology of eating disorders (pp. 343–360). Third Edition: Textbook in Psychiatric Epidemiology.

    Google Scholar 

  • Wang, G.-J., Volkow, N. D., & Fowler, J. S. (2002). The role of dopamine in motivation for food in humans: implications for obesity. Expert Opinion on Therapeutic Targets, 6(5), 601–609.

    CAS  Article  PubMed  Google Scholar 

  • Wentz, E., Lacey, J., Waller, G., Råstam, M., Turk, J., & Gillberg, C. (2005). Childhood onset neuropsychiatric disorders in adult eating disorder patients. European Child & Adolescent Psychiatry, 14(8), 431–437.

    Article  Google Scholar 

  • Yates, W. R., Lund, B. C., Johnson, C., Mitchell, J., & McKee, P. (2009). Attention-deficit hyperactivity symptoms and disorder in eating disorder inpatients. International Journal of Eating Disorders, 42(4), 375–378.

    Article  PubMed  Google Scholar 

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Correspondence to Jennifer Bleck.

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Bleck, J., DeBate, R., Levin, B.L. et al. Underlying Mechanisms and Trajectory of Comorbid ADHD and Eating Disorders: Proposing an Innovative Systems Framework for Informing Research. Int J Ment Health Addiction 14, 449–458 (2016).

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  • ADHD
  • Binge eating
  • Eating disorders
  • Comorbidity
  • Theory