Emotion dysregulation mediates the independent associations of PTSD and ADHD symptoms with binge eating in adults with ADHD

Attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) are both associated with binge eating (BE). However, it remains unclear whether these associations reflect shared mechanisms or distinct pathways. We investigated whether ADHD symptoms and PTSD symptoms were independent risk factors for BE in outpatients referred for, and subsequently diagnosed with, ADHD. We also examined whether emotion dysregulation mediates the ADHD-BE and the PTSD-BE relationships. In this cross-sectional study, 97 outpatients referred for ADHD assessment and diagnosed with ADHD according to DSM-5 criteria (ADAPT-ADDICT study) were assessed for the following: BE symptoms (Binge Eating Scale), PTSD symptoms (LEC-5, PCL-5), ADHD symptoms (ASRS-18), and emotion dysregulation (DERS-16). We conducted multivariate analyses, including mediational analyses. In multiple linear regression analyses, adult ADHD symptoms (B = .22, 95% CI [.04 to −.41]; 17.9% variance explained) and PTSD symptoms (B = .16, 95% CI [.08 to −.24]; 10.9% additional variance explained) were independently associated with BE. Emotion dysregulation fully mediated the relationship between ADHD symptoms and BE (indirect effect: B = .13, 95% CI [.04 to −.27], p = .011; direct effect: B = .11, 95% CI [−.09 to −.32], p = .24) and partially mediated the relationship between PTSD symptoms and BE (indirect effect: B = .09, 95% CI [.02 to −.22], p = .023; direct effect: B = .30, 95% CI [.09 to −.48], p < .001). In a sample of outpatients referred for and diagnosed with ADHD, both ADHD and PTSD symptoms were independently associated with BE. Emotion dysregulation may help explain the observed associations between ADHD, PSTD and BE symptoms in this population. BE symptoms were common in our sample, and emotion dysregulation and PTSD may represent relevant targets for clinical intervention.