Negative Affectivity and Emotion Dysregulation as Mediators between ADHD and Disordered Eating: A Systematic Review

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with disordered eating, especially addictive-like eating behavior (i.e., binge eating, food addiction, loss of control overeating). The exact mechanisms underlying this association are unclear. ADHD and addictive-like eating behavior are both associated with negative affectivity and emotion dysregulation, which we hypothesized are mediators of this relationship. The purpose of this systematic review was to review the evidence related to this hypothesis from studies assessing the relationship between childhood or adulthood ADHD symptomatology, negative affectivity, emotion dysregulation and addictive-like eating behavior. The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. The literature search was conducted in PubMed and PsycINFO (publication date: January 2015 to August 2020; date of search: 2nd September 2020). Out of 403 potentially relevant articles, 41 were retained; 38 publications reported that ADHD and disordered eating or addictive-like eating behavior were significantly associated, including 8 articles that suggested a mediator role of negative affectivity or emotion dysregulation. Sixteen publications reported that the association between ADHD symptomatology and disordered eating or addictive-like eating behavior differed according to gender, eating behavior and ADHD symptoms (hyperactivity, impulsivity and inattention). We discuss the practical implications of these findings and directions future research.

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

“…These results are consistent with prior studies conducted by Alfonsson et al (2013) and Nielsen et al (2017) with the same population, with estimated ADHD prevalence of 8.3 and 8.6% respectively. Most of the literature reports that disordered eating involving binging/purging behavior is associated with a higher prevalence of ADHD symptomatology, varying between 12 and 37.1% (El Archi et al, 2020).…”

“…Initial support to this hypothesis has been provided in a study reporting that emotion dysregulation may mediate the effects of negative affectivity on BE (Kukk and Akkermann, 2020). Further support comes from a previous review that suggested a mediational role of emotion dysregulation and negative affectivity in the ADHDaddictive-like eating relationship (El Archi et al, 2020), and from a previous study highlighting the mediational role of mood and feelings in the association between inattention symptoms of ADHD and risk of disordered eating (Martin et al, 2020).…”

“…Ziobrowski et al (2018) suggested that the association between ADHD and eating disorder may in part be due to psychiatric comorbidities. Given that ADHD is strongly associated with personality dimensions such as high neuroticism (Nigg et al, 2002) and emotion dysregulation (Corbisiero et al, 2013), and that BE and FA are also associated with emotion dysregulation (Brunault et al, 2016a;Dawes et al, 2016;Benzerouk et al, 2018;Kukk and Akkermann, 2020), emotional eating (Brunault et al, 2016a;Benzerouk et al, 2018) and depression (Gearhardt et al, 2012), we hypothesized that individuals with ADHD may develop more addictivelike eating behavior due to greater emotion dysregulation and negative affectivity (El Archi et al, 2020). Hence, addictivelike eating behavior may be a way for people with ADHD to cope with emotion dysregulation, potentially increasing the risk of BE, FA and severe obesity.…”

Inter-Individual Differences in Food Addiction and Other Forms of Addictive-Like Eating Behavior

“…These seven original studies investigate the factors associated with this phenotype in different contexts: patients seeking treatment for an eating disorder, including anorexia nervosa, bulimia nervosa or binge eating disorder [ 12 , 13 ], patients seeking treatment for obesity (i.e., bariatric surgery candidates) [ 14 ], and non-clinical populations (i.e., persons not directly seeking treatment for these conditions) such as adolescents [ 15 ], female restrained eaters [ 16 ], and persons with weight-related disorders recruited in the general population [ 17 ]. This special issue also present four literature reviews that focus on: neuroimaging of sex/gender differences in obesity, in which FA is prevalent [ 18 ], involvement of the melanocortin system in binge eating, food reward and motivation [ 19 ], association between addictive-like eating behavior and attention-deficit/hyperactivity disorder (ADHD) [ 20 ], and a discussion about the FA concept and its practical implications through four complementary disciplines: addiction medicine, nutrition, health psychology, and behavioral neuroscience [ 21 ].…”

Nutrition in Skin Picking Disorder and Trichotillomania

“…For example, added sugar in a person's diet has been associated with impulsive choices (9), and vitamin deficiencies of E, C, and B12 have been associated with obsessive-compulsive disorder (10). Poor diet (e.g., sugarsweetened beverages, processed foods) coupled with loss of control over eating (e.g., over-eating) have been linked, to a variety of impulsive/compulsive symptoms, such as attentiondeficit hyperactivity disorder (ADHD) and (relatedly) bingeeating (11)(12)(13). BFRBs have impulsive/compulsive features, such as impaired response inhibition and ritualized behaviors, and comorbidities such as obsessive-compulsive disorder and behavioral addictions (14)(15)(16).…”