Research Article: The complexity of the interaction between binge-eating and attention

Date Published: April 24, 2019

Publisher: Public Library of Science

Author(s): Roni Halevy-Yosef, Eytan Bachar, Lilach Shalev, Yehuda Pollak, Adi Enoch-Levy, Eitan Gur, Abraham Weizman, Daniel Stein, Sarah E. Medland.


To investigate whether binge-eating in patients with eating disorders (EDs) is associated with attentional deficits.

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.

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.

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.

Partial Text

The association between eating disorders (EDs) and attention deficit hyperactivity disorder (ADHD) is a subject of great interest in recent years [1,2]. Epidemiological studies show elevated rates of ADHD in ED patients, specifically in patients with binge-eating [3,4,5,6]. Second, elevated rates of disordered eating and EDs, primarily bulimia nervosa (BN), have been found in patients with ADHD in comparison with normal controls [7,8,9]. Third, case reports of patients with comorbid BN and ADHD show beneficial effects of psychostimulants in reducing the rate and severity of binge/purge behaviors and in increasing personal control over eating [10,11].

The aim of the present study was to investigate whether attention deficits are associated with binge-eating in patients with EDs. In line with our first hypothesis, we found that in comparison to controls, patients with and without binge-eating reported a higher frequency of ADHD-RS-hyperactivity/impulsivity and combined ADHD-RS symptoms, as well as of ED and comorbidity-related symptoms. However, in contrast to our second hypothesis, although patients with binge-type EDs reported more difficulties on the ADHD-RS-inattention and combined ADHD-RS scales than patients with non-binge EDs and controls, we did not find significant between-group differences in the neuropsychological attention assessment.




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