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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00708

Systematic review: Overlap between eating, autism spectrum and attention-deficit/hyperactivity disorder

  • 1Freiburg University Medical Center, Germany

Background: Links between eating disorders (EDs) (e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED)) and the major neurodevelopmental disorders (NDDs) of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. In both ASD and ADHD, these links range from an elevated risk for EDs to common symptomatic overlaps and etiological commonalities with EDs.

Methods: We performed a systematic literature search (through July 2019) with Medline via Ovid for epidemiological data on EDs (AN, BN, and BED) in combination with both ASD and ADHD.

Results: The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN.
The prevalence of ADHD in EDs ranged between 1.6% and 18%. Comorbid ADHD was more often reported in the AN-binge eating/purging subtype and BN than in the AN restrictive subtype. The prevalence of EDs in ADHD ranged between no association and a lifetime prevalence of 21.8% of developing an ED in women with ADHD.

Conclusions: Studies on the prevalence rates of EDs in ADHD and ASD and vice versa are heterogeneous, but they indicate frequent association. While there is growing evidence of clinical overlaps between the three disorders, it remains difficult to determine whether overlapping characteristics (e.g., social withdrawal) are due to common comorbidities (e.g., depression) or are instead primarily associated with EDs and NDDs. Further, prospective studies are required to better understand how these disorders are related and whether ADHD and ASD could be either specific or non-specific predisposing factors for the development of EDs.

Keywords: Autism (ASD), ADHD (Attention Deficit and Hyperactivity Disorder), Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder

Received: 15 Sep 2018; Accepted: 03 Sep 2019.

Copyright: © 2019 Nickel, Maier, Endres, Joos, Maier, Tebartz Van Elst and Zeeck. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Kathrin Nickel, Freiburg University Medical Center, Freiburg, Germany,