Do Emotion Dysregulation, Alexithymia and Personality Dimensions Explain the Association Between Attention-Deficit/Hyperactivity Disorder and Binge Eating Among Bariatric Surgery Candidates?

Abstract

Background: Addictive-like eating and attention-deficit/hyperactivity disorder (ADHD) are both common among persons seeking treatment for severe obesity. Given that ADHD and addictive-like eating, especially binge eating (BE) and food addiction (FA), are both strongly associated with personality dimensions and emotion dysregulation, it is possible emotional and personality characteristics contribute to the link between addictive-like eating behaviors and ADHD in people with severe obesity. This study aimed to investigate the psychological factors associated with BE and FA in bariatric surgery candidates, and to explore the mediational role of emotional factors (emotion dysregulation and alexithymia) and personality dimensions in the association between ADHD and BE.Method: Two hundred and eighty-two (n = 282) bariatric surgery candidates were recruited during the systematic preoperative psychiatric assessment (University Hospital of Tours, France). We assessed significant BE (Binge Eating Scale), probable adult ADHD (Wender Utah Render Scale and Adult ADHD Self-Report Scale), FA (Yale Food Addiction Scale 2.0, YFAS 2.0), emotion dysregulation (Difficulties in Emotion Regulation Scale-16), alexithymia (Toronto Alexithymia Scale-20) and personality dimensions (Big Five Inventory). Mediation analyses were performed using the PROCESS macro for IBM SPSS Statistics 22.Results: Prevalence of probable adult ADHD, significant BE and FA were 8.2, 19.1, and 26.6%, respectively. Participants who screened positive for addictive-like eating showed higher prevalence of probable adult ADHD, as well as higher scores on adult and childhood ADHD symptoms. They also reported lower conscientiousness, but higher emotion dysregulation, higher alexithymia, and higher neuroticism. Only BE (as opposed to FA) was also associated with lower scores on agreeableness and openness. Analysis of the association between adult ADHD and BE suggests that emotion dysregulation, conscientiousness, agreeableness, and neuroticism are total mediators and alexithymia a partial mediator.Conclusion: Our findings suggest a significant association between ADHD and addictive-like eating among bariatric surgery candidates, and also suggest a significant role of emotion dysregulation and personality dimensions in this association. For individuals with ADHD and obesity, eating may be a way to cope with negative emotions, potentially increasing the risk for addictive-like eating behavior.

Relationships between alexithymia and food addiction: The Finnish version of Yale Food Addiction Scale and preliminary test of its psychometric properties

“… El Archi et al (2021) have reported a higher alexithymia level in obese patients who were diagnosed as having food addiction, which is in line with the result of group comparison in our study. However, this association did not survive in the logistic regression analysis when adjusting for anxiety symptoms, suggesting that alexithymia had a relatively weak relation to the presence of food addiction compared to symptom levels of food addiction.…”

“…It has been further suggested that alexithymia is linked to hypothalamic–pituitary–adrenal (HPA) axis dysfunction ( Alkan et al, 2013 ), which may account for the role of alexithymia in addictions. Based on limited evidence, obese patients with food addiction seem to have more difficulties in emotion regulation and a higher level of alexithymia ( El Archi et al, 2021 ). Nevertheless, research on associations between alexithymia and food addiction remains scarce.…”

The efficacy of a transdiagnostic emotion regulation skills training in the treatment of binge‐eating disorder—Results from a randomized controlled trial

“…In the attempt to derive such treatments from evidence‐based theories on BED, several authors have argued that BE might be seen as a dysfunctional way of avoiding undesired affective states such as anger/frustration, anxiety, sadness/depressed mood, disappointment, or loneliness (Dingemans et al, 2017; Fairburn et al, 2003; Heatherton & Baumeister, 1991; Kenardy et al, 1996; Peterson et al, 2020; Safer et al, 2009). Evidence for this hypothesis comes from numerous retrospective self‐report studies in which individuals suffering from BED reported negative mood to be a significant antecedent of BE (Arnow et al, 1992; Binford et al, 2004; Bruce & Agras, 1992; Masheb & Grilo, 2006; Mitchell et al, 1999; Tachi et al, 2001; Zeeck et al, 2011), from cross‐sectional studies showing BE to be associated with perceived deficits in ER (Prefit et al, 2019; Whiteside et al, 2007) and from self‐report studies indicating that deficits in ER mediate the association between antecedents of BE and BE (El Archi et al, 2021; Kukk & Akkermann, 2020; Shakory et al, 2015). Further evidence comes from prospective field studies demonstrating that undesired affective states predict subsequent BE (Dl et al, 2001; Greeno et al, 2000; Hilbert & Tuschen‐Caffier, 2007; Munsch et al, 2012; Stein et al, 2007; Wild et al, 2007) and from ecological momentary assessment (EMA) studies in which arguably dysfunctional emotion regulation (ER) strategies, such as rumination or repetitive negative thinking, predict subsequent binge eating (Svaldi et al, 2019) and other eating disorder symptoms (Sala et al, 2019), whereas the use of arguably adaptive ER strategies, such as reappraisal, acceptance or self‐compassion, predict subsequent abstinence (Svaldi et al, 2019).…”