Attention-deficit/hyperactivity disorder in adults with eating disorders: prevalence, clinical correlates, and personality profiles

Eating disorders (EDs) are chronic psychiatric conditions emerging often in adolescence and frequently associated with psychiatric comorbidities. Attention-deficit/hyperactivity disorder (ADHD) persists into adulthood and may share dimensions with EDs, including impulsivity and emotional regulation differences. This study assessed ADHD prevalence among adults with EDs and characterized associated clinical, behavioral, and personality features. Treatment-seeking adults with EDs (restrictive or binge-purge subtypes of anorexia nervosa, bulimia nervosa, binge-eating disorder) were included in this cross-sectional study at Esquirol Hospital, France (June 2020-September 2023). ADHD screening used the ADHD Self-Report Scale (ASRS v1.1) with confirmation by the Diagnostic Interview for ADHD (DIVA 2.0). Participants completed assessments of impulsivity (BIS-11), body dissatisfaction (BSQ-34), personality (TCI), physical activity (GPAQ), and substance use (Fagerström, AUDIT, CAST). Among 120 participants (median age 26.0 [20.8–37.2] years; 95.8% female), more than half (n = 61) had ADHD, with only 2 previously diagnosed. ADHD participants had more psychiatric comorbidities, higher smoking and alcohol use, elevated impulsivity (BIS-11) and body dissatisfaction (BSQ-34), but similar physical activity (GPAQ). On the TCI, ADHD participants showed distinct personality profiles with greater reward dependence and self-transcendence, whereas non-ADHD participants scored higher in self-directedness. Logistic regression identified bulimia nervosa as most strongly associated with ADHD, whose prevalence was higher in binge-eating disorder versus anorexia. ADHD is highly prevalent in adults with EDs, particularly bulimic and binge-eating phenotypes, and is associated with impulsivity, body dissatisfaction, and distinct personality traits. These findings support ADHD screening and integrated treatments targeting impulsivity and attentional dysregulation. Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, and binge-eating disorder, are serious mental health conditions that often occur alongside other psychiatric disorders. Attention-deficit/hyperactivity disorder (ADHD) is characterized by difficulties with attention, impulsivity, and self-regulation and may share some features with EDs. This study examined the prevalence of ADHD in 120 adults receiving treatment for EDs in a specialized hospital in France. ADHD was assessed using a screening questionnaire followed by a diagnostic interview. More than half of the participants (51%) met diagnostic criteria for ADHD, although only two had previously been diagnosed. ADHD was more common in individuals with bulimia nervosa and binge-eating disorder than in those with anorexia nervosa. Participants with ADHD showed higher levels of impulsivity, greater body dissatisfaction, more psychiatric comorbidities, and higher tobacco and alcohol use. They also displayed specific personality traits related to reward sensitivity and self-regulation. These findings suggest that ADHD may be underrecognized in adults receiving treatment for EDs and support routine ADHD screening, particularly among patients with bulimia nervosa and binge-eating disorder.