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. 2025 May;30(5):2127-2136.
doi: 10.1038/s41380-024-02825-w. Epub 2024 Nov 14.

The role of co-occurring conditions and genetics in the associations of eating disorders with attention-deficit/hyperactivity disorder and autism spectrum disorder

Gitte Bundgaard Christiansen #  1 , Liselotte Vogdrup Petersen #  2   3 , Hannah Chatwin  1 , Zeynep Yilmaz  1   4   5   6 , Diana Schendel  1   7   8 , Cynthia M Bulik  5   6   9 , Jakob Grove  7   4   10   11 , Isabell Brikell  4   5 , Birgitte Dige Semark  1 , Katrine Holde  1 , Mohamed Abdulkadir  1 , Christopher Hübel  1   12   13 , Clara Albiñana  1   7 , Bjarni Jóhann Vilhjálmsson  1   7   10 , Anders D Børglum  7   4   10 , Ditte Demontis  7   4   10   11   14 , Preben Bo Mortensen  1   7 , Janne Tidselbak Larsen  1   15
Affiliations

The role of co-occurring conditions and genetics in the associations of eating disorders with attention-deficit/hyperactivity disorder and autism spectrum disorder

Gitte Bundgaard Christiansen et al. Mol Psychiatry. 2025 May.

Abstract

Eating disorders (EDs) commonly co-occur with other psychiatric and neurodevelopmental disorders including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); however, the pattern of family history and genetic overlap among them requires clarification. This study investigated the diagnostic, familial, and genetic associations of EDs with ADHD and ASD. The nationwide population-based cohort study included all individuals born in Denmark, 1981-2008, linked to their siblings and cousins. Cox regression was used to estimate associations between EDs and ADHD or ASD, and mediation analysis was used to assess the effects of intermediate mood or anxiety disorders. Polygenic scores (PGSs) were used to investigate the genetic association between anorexia nervosa (AN) and ADHD or ASD. Significantly increased risk for any ED was observed following an ADHD or ASD diagnosis. Mediation analysis suggested that intermediate mood or anxiety disorders could account for 44%-100% of the association between ADHD or ASD and ED. Individuals with a full sibling or maternal half sibling with ASD had increased risk of AN compared to those with siblings without ASD. A positive association was found between ASD-PGS and AN risk whereas a negative association was found between AN-PGS and ADHD. In this study, positive phenotypic associations between EDs and ADHD or ASD, mediation by mood or anxiety disorder, and genetic associations between ASD-PGS and AN and between AN-PGS and ADHD were observed. These findings could guide future research in the development of new treatments that can mitigate the development of EDs among individuals with ADHD or ASD.

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Conflict of interest statement

Competing interests: CMB is an author and royalty recipient from Pearson. DD has received speaker fees from Medici Nordic. The remaining authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1. Hazard ratios for within-individual associations.
A Association between prior ADHD or ASD and subsequent EDs. B Association between prior EDs and subsequent ADHD or ASD.
Fig. 2
Fig. 2. Hazard ratios for within-individual associations between prior ADHD or ASD and subsequent EDs, adjusted for presence of mood disorders and/or anxiety disorders.
Influence of mood and anxiety disorders on risk for ED following ADHD or ASD diagnosis.
Fig. 3
Fig. 3. Proportion of association attributed to the controlled direct effect (CDE).
Results from four-way decomposition mediation analysis with mood and/or anxiety disorders as mediator.
Fig. 4
Fig. 4. Hazard ratios for familial co-aggregation associations.
A Association between relative ADHD and index person ED. B Association between relative ASD and index person ED.
Fig. 5
Fig. 5. Odds ratios for within-individual associations between polygenic scores (PGSs) and diagnoses.
A Associations between AN-PGS and diagnosis of ADHD or ASD, and vice versa. B Associations between ADHD-PGS or ASD-PGS and diagnosis of AN, adjusted for major depressive disorder PGS. C Associations between ADHD-PGS or ASD-PGS and diagnosis of AN with and without lifetime BN. D Associations between AN-PGS and diagnosis of ADHD or ASD, and vice versa. Cohort limited to individuals with European ancestry.
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