Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients



There is some evidence that eating disorders (ED) and Attention-deficit/hyperactivity disorder (ADHD) share common clinical features and that ADHD might contribute to the severity of eating disorders. A greater understanding of how the presence of comorbid ADHD may affect the psychopathological framework of eating disorder seems of primary importance. The aim of our study was to evaluate rates of ADHD in three ED subgroups of inpatients: anorexia nervosa restricting type (AN-R), anorexia nervosa binge-eating/purging type (AN-BP) and bulimia nervosa (BN). The secondary aim was the evaluation of the associated psychological characteristics.


The sample consisted of 73 females inpatients (mean age 28.07 ± 7.30), all with longstanding histories of eating disorder (ED). The presence of a diagnosis of ADHD was evaluated in a clinical interview based on DSM-IV-TR criteria. The following psychometric instruments were used: the eating attitude test (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI-2), the Wender Utah Rating Scale (WURS), the Brown Attention Deficit Disorder Scale (BADDS), the Hamilton scales for Anxiety (HAM-A) and Depression (HAM-D), and the Barrat Impulsivity Scale (BIS-10).


Among the three ED subgroups, 13 patients reported comorbidity with ADHD; three in the AN-R subtype, nine in the AN-BP and one in the BN. The remaining 60 patients (n = 34 AN-R; n = 19 AN-BP; n = 7 BN) presented only a diagnosis of ED. The EAT (p = 0.04) and HAM-A (p = 0.02) mean scores were significantly higher in patients with comorbid ADHD.


In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.

This is a preview of subscription content, log in to check access.


  1. 1.

    Scahill L, Schwab-Stone M (2000) Epidemiology of ADHD in school-age children. Child Adolesc Psychiatr Clin N Am 9(3):541–555 (vii)

    CAS  Article  Google Scholar 

  2. 2.

    Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, De Girolamo G, Haro JM, Karam EG, Lara C, Lepine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R (2007) Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 190:402–409

    CAS  Article  Google Scholar 

  3. 3.

    Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP (2005) Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med 35(6):817–827

    Article  Google Scholar 

  4. 4.

    Simon V, Czobor P, Balint S, Meszaros A, Bitter I (2009) Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry 194(3):204–211. doi:10.1192/bjp.bp.107.048827

    Article  PubMed  Google Scholar 

  5. 5.

    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®), 5th edn. Author, Washington DC

    Google Scholar 

  6. 6.

    Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Klein KL, Price JE, Faraone SV (2006) Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biol Psychiat 60(10):1098–1105. doi:10.1016/j.biopsych.2006.02.031

    Article  PubMed  Google Scholar 

  7. 7.

    Biederman J, Petty CR, Monuteaux MC, Fried R, Byrne D, Mirto T, Spencer T, Wilens TE, Faraone SV (2010) Adult psychiatric outcomes of girls with Attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study. Am J Psychiatry 167(4):409–417. doi:10.1176/appi.ajp.2009.09050736

    Article  PubMed  Google Scholar 

  8. 8.

    Yoshimasu K, Barbaresi WJ, Colligan RC, Voigt RG, Killian JM, Weaver AL, Katusic SK (2012) Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: a population-based birth cohort study. J Child Psychol Psychiatry 53(10):1036–1043. doi:10.1111/j.1469-7610.2012.02567.x

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Nazar BP, Pinna CM, Coutinho G, Segenreich D, Duchesne M, Appolinario JC, Mattos P (2008) Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders. Rev Bras Psiquiatr 30(4):384–389

    Article  Google Scholar 

  10. 10.

    Yates WR, Lund BC, Johnson C, Mitchell J, McKee P (2009) Attention-deficit hyperactivity symptoms and disorder in eating disorder inpatients. Int J Eat Disord 42(4):375–378. doi:10.1002/eat.20627

    Article  PubMed  Google Scholar 

  11. 11.

    Fernandez-Aranda F, Aguera Z, Castro R, Jimenez-Murcia S, Ramos-Quiroga J, Bosch R, Fagundo A, Granero R, Penelo E, Claes L, Sanchez I, Riesco N, Casas M, Menchon J (2013) ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity? BMC Psychiatry 13(1):166. doi:10.1186/1471-244X-13-166

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Farber SK (2009) The comorbidity of eating disorders and attention-deficit hyperactivity disorder. Eat Disord 18(1):81–89. doi:10.1080/10640260903439623

    Article  Google Scholar 

  13. 13.

    Brewerton TD, Duncan AE (2016) Associations between attention deficit hyperactivity disorder and eating disorders by gender: results from the National Comorbidity Survey Replication. Eur Eat Disord Rev 24(6):536–540. doi:10.1002/erv.2468

    Article  PubMed  Google Scholar 

  14. 14.

    Sprafkin J, Gadow KD, Weiss MD, Schneider J, Nolan EE (2007) Psychiatric comorbidity in ADHD symptom subtypes in clinic and community adults. J Atten Disord 11(2):114–124. doi:10.1177/1087054707299402

    Article  PubMed  Google Scholar 

  15. 15.

    Wentz E, Lacey JH, Waller G, Rastam M, Turk J, Gillberg C (2005) Childhood onset neuropsychiatric disorders in adult eating disorder patients. A pilot study. Eur Child Adolesc Psychiatry 14(8):431–437. doi:10.1007/s00787-005-0494-3

    Article  PubMed  Google Scholar 

  16. 16.

    Stulz N, Hepp U, Gachter C, Martin-Soelch C, Spindler A, Milos G (2013) The severity of ADHD and eating disorder symptoms: a correlational study. BMC Psychiatry 13:44. doi:10.1186/1471-244X-13-44

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Ptacek R, Kuzelova H, Papezova H, Stepankova T (2010) Attention deficit hyperactivity disorder and eating disorders. Prague Med Rep 111(3):175–181

    CAS  PubMed  Google Scholar 

  18. 18.

    Gruss B, Mueller A, Horbach T, Martin A, de Zwaan M (2012) Attention-deficit/hyperactivity disorder in a prebariatric surgery sample. Eur Eat Disord Rev 20(1):e103–e107. doi:10.1002/erv.1128

    Article  PubMed  Google Scholar 

  19. 19.

    Dalley JW, Mar AC, Economidou D, Robbins TW (2008) Neurobehavioral mechanisms of impulsivity: fronto-striatal systems and functional neurochemistry. Pharmacol Biochem Behav 90(2):250–260. doi:10.1016/j.pbb.2007.12.021

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Mikami AY, Hinshaw SP, Arnold LE, Hoza B, Hechtman L, Newcorn JH, Abikoff HB (2010) Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD. Int J Eat Disord 43(3):248–259. doi:10.1002/eat.20692

    Article  PubMed  Google Scholar 

  21. 21.

    Mikami AY, Hinshaw SP, Patterson KA, Lee JC (2008) Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder. J Abnorm Psychol 117(1):225–235. doi:10.1037/0021-843X.117.1.225

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL, Zeitlin S (2007) Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J Dev Behav Pediatr 28(4):302–307. doi:10.1097/DBP.0b013e3180327917

    Article  PubMed  Google Scholar 

  23. 23.

    Nazar BP, Suwwan R, de Sousa Pinna CM, Duchesne M, Freitas SR, Sergeant J, Mattos P (2013) Influence of attention-deficit/hyperactivity disorder on binge eating behaviors and psychiatric comorbidity profile of obese women. Compr Psychiatry 55(3):572–578. doi:10.1016/j.comppsych.2013.09.015

    Article  PubMed  Google Scholar 

  24. 24.

    Blinder BJ, Cumella EJ, Sanathara VA (2006) Psychiatric comorbidities of female inpatients with eating disorders. Psychosom Med 68(3):454–462

    Article  Google Scholar 

  25. 25.

    Ward MF, Wender PH, Reimherr FW (1993) The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 150(6):885–890

    CAS  Article  Google Scholar 

  26. 26.

    Brown TE (1996) Brown attention-deficit disorder scales manual. The Psychological Corporation, San Antonio

    Google Scholar 

  27. 27.

    Garner DM, Garfinkel PE (1979) The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med 9(2):273–279

    CAS  Article  Google Scholar 

  28. 28.

    Henderson M, Freeman CP (1987) A self-rating scale for bulimia. The ‘BITE’. Br J Psychiatry 150:18–24

    CAS  Article  Google Scholar 

  29. 29.

    Garner DM, Olmsted MP, Polivy J (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 2:15–34

    Article  Google Scholar 

  30. 30.

    Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32(1):50–55

    CAS  Article  Google Scholar 

  31. 31.

    Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    CAS  Article  Google Scholar 

  32. 32.

    Barratt ES (1985) Impulsiveness subtraits: arousal and information processing. In: Spence JT, Izard CE (eds) Motivation, emotion, and personality. Elsevier Science Publishers, North Holland, pp 137–146

    Google Scholar 

  33. 33.

    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (DSM-IV-TR), vol 4. Author, Washington DC (Text Revision ed)

    Google Scholar 

  34. 34.

    Curtin C, Pagoto SL, Mick E (2013) The association between ADHD and eating disorders/pathology in adolescents: a systematic review. OJEpi 3(4):193–202. doi:10.4236/ojepi.2013.34028

    Article  Google Scholar 

  35. 35.

    Cortese S, Bernardina BD, Mouren M-C (2007) Attention-deficit/hyperactivity disorder (ADHD) and binge eating. Nutr Rev 65(9):404–411. doi:10.1111/j.1753-4887.2007.tb00318.x

    Article  PubMed  Google Scholar 

  36. 36.

    Cortese S, Isnard P, Frelut ML, Michel G, Quantin L, Guedeney A, Falissard B, Acquaviva E, Dalla Bernardina B, Mouren MC (2007) Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents. Int J Obesity (2005) 31(2):340–346

    CAS  Article  Google Scholar 

  37. 37.

    Seitz J, Kahraman-Lanzerath B, Legenbauer T, Sarrar L, Herpertz S, Salbach-Andrae H, Konrad K, Herpertz-Dahlmann B (2013) The role of impulsivity, inattention and comorbid ADHD in patients with bulimia nervosa. PLoS One 8(5):e63891. doi:10.1371/journal.pone.0063891

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Fischer S, Smith GT, Cyders MA (2008) Another look at impulsivity: a meta-analytic review comparing specific dispositions to rash action in their relationship to bulimic symptoms. Clin Psychol Rev 28(8):1413–1425. doi:10.1016/j.cpr.2008.09.001

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to L. Sala.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sala, L., Martinotti, G., Carenti, M.L. et al. Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients. Eat Weight Disord 23, 513–519 (2018).

Download citation


  • Anorexia nervosa
  • Bulimia nervosa
  • Eating disorders
  • Attention-deficit/hyperactivity disorder