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Bulimia nervosa patient diagnosed with previously unsuspected ADHD in adulthood: Clinical case report, literature review, and diagnostic challenges

Authors

  • Konstantinos Ioannidis MD, MSc,

    Corresponding author
    1. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
    • Correspondence to: Konstantinos Ioannidis MD, MSc, Liaison Psychiatry, Box 190, Addenbrookes Hospital, Hills Road, Cambridge CB20 QQ, UK. E-mail: ioannik@doctors.org.uk

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  • Jaco Serfontein MB ChB, MRCPsych,

    1. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
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  • Ulrich Müller MD, PhD

    1. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
    2. Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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  • Conflict of interest: U. Müller has been invited to advisory boards and received educational funding from Janssen Cilag and Eli-Lilly, UK; he has received travel expenses and honoraria from the British Association for Psychopharmacology (BAP), Janssen Cilag, Eli-Lilly, Shire, UCB Pharma and the UK Adult ADHD Network (UKAAN) for talks at scientific and educational meetings.

ABSTRACT

There is increasing literature suggesting a link between attention-deficit hyperactivity disorder (ADHD) and eating disorders (EDs), especially bulimia nervosa. ADHD is under-diagnosed in girls and children of high intelligence are typically missed. We identified a case of a 23-year-old woman suffering from severe bulimia nervosa and previously unsuspected ADHD in adulthood; we diagnosed and treated her with extended-release methylphenidate. We performed a literature review on the ADHD and bulimia nervosa comorbidity. We discuss the reasons why her ADHD remained undiagnosed and the difficulties in diagnosing ADHD in patients with EDs. We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:431–436)

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