The complexity of the interaction between binge-eating and attention

Abstract

Objective To investigate whether binge-eating in patients with eating disorders (EDs) is associated with attentional deficits. Methods We studied ED patients with binge-eating (n = 51), no binge-eating (n = 59) and controls (n = 58). ED patients were assessed following the stabilization of weight and ED pathology. Attention assessment included evaluation of attention deficit hyperactivity disorder (ADHD) diagnosis, the Adult ADHD Self-Report (ASRS) and ADHD Rating Scale-IV-Home Version (ADHD-RS) questionnaires, and attention functioning assessed with neuropsychological tools. The severity of eating-related pathology, depression, anxiety and obsessionality was also monitored. Results Patients with binge-eating showed more ADHD symptomatology on the ADHD-RS compared with non-binge-eating patients. No differences were found between binge-eating and non-binge-eating patients in ADHD diagnosis and neuropsychological functioning. Among the specific ED subtypes, patients with anorexia nervosa binge/purge type (AN-B/P) showed the highest rates of ADHD symptomatology on the ADHD-RS, and were characterized with sustained attention deficits. Conclusion Binge-eating is not associated with attention deficits as measured by objective neuropsychological tools. Nonetheless, it is associated with attentional difficulties as measured with the self-reported ADHD-RS. AN-B/P patients are the only ED category showing objective sustained attention deficits.

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

“…Five studies assessed ADHD in clinical populations of women with ED. High ADHD prevalence was found, especially among women with ED involving binging/purging behavior (AN-BP, EDNOS-BP, BN): from 10.2% to 49.8% [120][121][122][123][124]. However, Halevy-Yosef and colleagues (2019) [122] observed no significant difference in terms of ADHD prevalence between ED patients with BE (16.6%) and those without BE (13.6%) (p = 0.392).…”

“…Six publications involved samples of individuals with ED. They found that ADHD symptomatology and diagnosis were associated with ED, especially binging/purging behaviors such as BN and AN binge/purge subtype, which were related to inattentive symptoms [122][123][124]. However, Halevy-Yosef and colleagues (2019) [122] found no differences in ASRS scores between ED with and without binging/purging behavior after Bonferroni correction.…”

“…Kim and colleagues (2018) [116] found that children with overeating had higher scores on the K-ARS (Korean version of the ADHD rating scale assessing ADHD symptom severity), increasing with frequency of overeating. Egbert and colleagues (2018) and Halevy-Yosef and colleagues (2019) conducted studies with individuals with clinical obesity and clinical ED respectively, and found that ADHD scale scores (Child Behavior Checklist, CBCL and ADHD-RS respectively) were higher in groups with dysregulated eating (56.17, Standard Deviation (SD) = 8.26 vs. 54.42, SD = 6.18, p < 0.05) [113] or binge eating (22.92, SD = 9.78 vs. 19.86, SD = 10.48, p < 0.001) [122]. In the clinical ED sample, further investigations found that severity of ADHD inattention symptoms was greater among binge-eating than non-binge eating individuals and controls (Bonferroni corrected p = 0.0003), and that severity of ADHD hyperactivity/impulsivity symptoms was greater in binge-eating and non-binge eating individuals than in controls (Bonferroni corrected p < 0.01).…”

“…In the clinical ED sample, further investigations found that severity of ADHD inattention symptoms was greater among binge-eating than non-binge eating individuals and controls (Bonferroni corrected p = 0.0003), and that severity of ADHD hyperactivity/impulsivity symptoms was greater in binge-eating and non-binge eating individuals than in controls (Bonferroni corrected p < 0.01). Patients who reported binging/purging behavior scored higher on both inattentive and hyperactivity/impulsivity ADHD subscales [122]. Kurz and colleagues (2017) [125] used a laboratory test meal and found no difference between individuals with ADHD and controls in loss of control overeating, liking for food and desire to eat.…”

“…Some studies corroborated these results through correlation analysis. They found that ADHD severity was positively correlated with objective overeating (r = 0.10, p < 0.05), objective binge eating (r = 0.17, p < 0.01) [113], BN symptoms (r = 0.19, p < 0.0001), emotional overeating (r = 0.31, p < 0.0001) and emotional undereating (r = 0.28, p < 0.0001) [126], and with disordered eating as assessed on scales including the EAT-26 (ED severity, r = 0.53, p < 0.0001), EDE-Q (disordered eating behavior, r = 0.48, p < 0.0001), EDI-2 (impulse regulation and interoceptive awareness subscales, r = 0.65, p < 0.001 and r = 0.66, p < 0.001 respectively) [122].…”