Abstract
Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs) and are associated with increased psychopathology and more dysfunctional personality traits. This study aimed to assess if the presence of ADHD symptoms in patients with EDs affects their short and long-term therapy outcome. A total of 136 consecutively treated ED patients were considered in this study. Baseline pre-treatment evaluation included the Adult ADHD Self-Report Scale (ASRS v1.1) for ADHD symptoms and the assessment of eating symptomatology using the Eating Disorders Inventory (EDI-2). Treatment outcome was evaluated in terms of ED symptoms after cognitive behavioral therapy (CBT) and dropout rate during treatment. Furthermore, we evaluated ED symptoms in treatment completers after a follow-up of 8 years on average. Path analyses assessed the potential mediational role of the EDI-2 total score in the relationship between ADHD and treatment outcome. Results showed that baseline symptoms of ADHD indirectly affected treatment outcome after CBT; the ASRS positive screening was related to higher eating symptomatology (standardized coefficient B = 0.41, p = 0.001, 95% CI: 0.26 to 0.55), and the presence of high ED levels contributed to the increase of dropout (B = 0.15, p = 0.041, 95% CI: 0.03 to 0.33) and a worse treatment outcome (B = 0.18, p = 0.041, 95% CI: 0.01 to 0.35). No direct effect was found between the ASRS positive screening with the risk of dropout (B = −0.08, p = 0.375) and worse treatment outcome (B = −0.07, p = 0.414). These results suggest the relevance of identifying specific treatment approaches for patients with ADHD symptoms and severe eating symptomatology.
Highlights
Attention-deficit/hyperactivity disorder (ADHD), which is characterized by symptoms of impulsivity, hyperactivity and inattention, has been described in relation to several psychiatric disorders including eating disorders (EDs) [1,2,3,4]
The first aim of the present study was to evaluate if the initial presence of ADHD symptomatology impacts the therapy outcome after a cognitive behavioral therapy (CBT) treatment for EDs and dropout rate during treatment
No statistical differences between participants selected for the study and those excluded were found for marital status (χ2 = 0.07, p = 0.982), education level (χ2 = 1.03, p = 0.317), socioeconomic status (χ2 = 2.67, p = 0.446), age (T = 1.04, p = 0.300), duration of the eating problems (T = 0.62, p = 0.535), onset of the ED (T = 0.70, p = 0.487), ED-symptom levels (T = 0.52, p = 0.603) and ADHD-symptom levels (T = 0.74, p = 0.462)
Summary
Attention-deficit/hyperactivity disorder (ADHD), which is characterized by symptoms of impulsivity, hyperactivity and inattention, has been described in relation to several psychiatric disorders including eating disorders (EDs) [1,2,3,4]. A recent study examined the genetic factors common to both disorders and observed a stronger genetic association between ADHD and binge-eating behaviors [18]. ADHD symptoms in ED were associated with higher ED symptomatology [19], binge ED subtypes, with greater psychopathology [19,20,21], and increased levels of motor and cognitive impulsivity [22,23], as well as impulsive personality traits [24,25]. To the best of our knowledge, there is only one previous study in female patients with EDs reporting higher ADHD symptoms at baseline as a predictor of non-recovery from eating-related symptomatology one year after treatment, especially for patients with loss of control overeating, bingeing and purging [26]. A high dropout rate (61%) was shown in that study, highlighting the need for future studies examining the impact of ADHD symptoms over dropout rate in EDs treatment
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