title: The role of impulsivity, inattention and comorbid ADHD in patients with bulimia nervosa.
abstract: BACKGROUND
  Little is known about the contribution of impulsivity, inattention and comorbid attention deficit/hyperactivity disorder (ADHD) in the development and maintenance of bulimia nervosa (BN). In particular, their specific contribution to disordered eating symptoms and whether they have additive effects to the general psychopathological burden remains unclear.
  
  
  METHODS
  Fifty-seven female patients seeking treatment for BN and 40 healthy controls completed diagnostic questionnaires and interviews that investigated: a) ADHD, b) impulsivity, c) eating disorders and d) general psychopathology. Attentional processes and impulsivity were assessed by a comprehensive computer-based neuropsychological battery.
  
  
  RESULTS
  Twenty-one percent of patients with BN met the clinical cut-off for previous childhood ADHD compared to 2.5% of healthy controls. Adult ADHD according to DSM IV was also more prevalent in patients with BN, with an odds ratio of 4.2. Patients with BN and previous childhood ADHD were more impulsive and inattentive than patients with BN alone. These patients also displayed more severely disordered eating patterns and more general psychopathological symptoms compared with those without ADHD. Severity of eating disorder symptoms was better explained by inattentiveness than by either impulsivity or hyperactivity.
  
  
  CONCLUSIONS
  Our data suggest an elevated rate of former childhood and current ADHD-symptoms in treatment-seeking patients with BN. Stronger impulsivity and inattention associated with more severe neuropsychological deficits and eating disorder symptoms indicate an additive risk that is clinically relevant for these patients. Thus, clinicians should identify comorbid patients who might profit from additional ADHD-specific treatments.
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, Aachen, Germany. jseitz@ukaachen.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Seitz
authors.forename: Berrak
authors.initials: B
authors.lastname: Kahraman-Lanzerath
authors.forename: Tanja
authors.initials: T
authors.lastname: Legenbauer
authors.forename: Lea
authors.initials: L
authors.lastname: Sarrar
authors.forename: Stephan
authors.initials: S
authors.lastname: Herpertz
authors.forename: Harriet
authors.initials: H
authors.lastname: Salbach-Andrae
authors.forename: Kerstin
authors.initials: K
authors.lastname: Konrad
authors.forename: Beate
authors.initials: B
authors.lastname: Herpertz-Dahlmann
mesh_terms: D000293:Adolescent; D000328:Adult; D001288:Attention; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D052018:Bulimia Nervosa / Q000453:epidemiology / Q000523:psychology*; D016022:Case-Control Studies; D003071:Cognition; D015897:Comorbidity; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult