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Gender differences of axis I and II comorbidity in subjects diagnosed with attention-deficit hyperactivity disorder as adults

Published online by Cambridge University Press:  18 June 2013

Dan Edvinsson ,
Eva Lindström ,
Kerstin Bingefors ,
Tommy Lewander  and
Lisa Ekselius
Dan Edvinsson*
Affiliation:
Department of Neuroscience and Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
Eva Lindström
Affiliation:
Department of Neuroscience and Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
Kerstin Bingefors
Affiliation:
Department of Pharmacy, Uppsala University, Uppsala, Sweden
Tommy Lewander
Affiliation:
Department of Neuroscience and Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
Lisa Ekselius
Affiliation:
Department of Neuroscience and Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
*
Dan Edvinsson, Department of Neuroscience, Uppsala University, Uppsala University Hospital, Entrance 16, SE-751 85 Uppsala, Sweden. Tel: +46-18-6115231; Fax: +46-18-510656; E-mail: [email protected]
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Abstract

Objective

To investigate gender differences in psychiatric comorbidity patients diagnosed with attention-deficit hyperactivity disorder (ADHD) as adults.

Methods

Interviews about current ADHD symptoms and psychiatric comorbidity on axis I and II (Structured Clinical Interview for DSM-IV axis I and axis II) were conducted in a clinical cohort of 168 patients (78 women, 90 men). Independent information on childhood and current symptoms was collected from parents, partners and patient files.

Results

The lifetime prevalence of psychiatric comorbidity on axis I reached 92%, and current comorbidity, including autism spectrum disorders and Tourette's syndrome, was 47%. Women had a higher lifetime prevalence of mood and eating disorders compared with men, where substance-use disorders were more frequent. Ten per cent of patients fulfilled diagnostic criteria for a personality disorder. When excluding the general diagnostic criteria, 46% of the patients endorsed the specific criteria for at least one personality disorder. Gender differences were identified with predominance of histrionic personality traits in women and conduct disorder in men.

Conclusion

Patients diagnosed with ADHD as adults display an extremely high lifetime axis I comorbidity with a gender-specific pattern similar to the general population. No gender differences were identified with regard to personality disorders; however, an increased prevalence of deviant personality traits was confirmed. This study stresses the importance of evaluating comorbidity among patients diagnosed with ADHD as adults to secure optimal treatment.

Keywords

ADHDadultscomorbiditygender
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 25 , Issue 3 , June 2013 , pp. 165 - 174
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

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References

1.American Psychiatric Association. American Psychiatric Association. Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th edn.Washington, DC: American Psychiatric Association, 2000.Google Scholar
2.Polanczyk, G, de Lima, MS, Horta, BL, Biederman, J, Rohde, LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007;164:942–948.CrossRefGoogle ScholarPubMed
3.Koster, I, Schubert, I, Dopfner, M, Adam, C, Ihle, P, Lehmkuhl, G. Children and adolescents with hyperkinetic disorder. Frequency of the claims diagnosis in primary care based on the data of a regional Statutory Health Insurance Sample–Versichertenstichprobe AOK Hessen/KV Hessen (1998–2001). Z Kinder Jugendpsychiatr Psychother 2004;32:157–166.Google ScholarPubMed
4.Angold, A, Erkanli, A, Egger, HL, Costello, EJ. Stimulant treatment for children: a community perspective. J Am Acad Child Adolesc Psychiatry 2000;39:975–984; discussion 84–94.CrossRefGoogle ScholarPubMed
5.Biederman, J, Mick, E, Faraone, SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 2000;157:816–818.CrossRefGoogle ScholarPubMed
6.Kessler, RC, Adler, LA, Barkley, Ret al. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the National Comorbidity Survey Replication. Biol Psychiatry 2005;57:1442–1451.CrossRefGoogle ScholarPubMed
7.Faraone, SV, Biederman, J, Mick, E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006;36:159–165.CrossRefGoogle ScholarPubMed
8.Kessler, RC, Adler, L, Barkley, Ret al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006;163:716–723.CrossRefGoogle ScholarPubMed
9.Fayyad, J, De Graaf, R, Kessler, Ret al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007;190:402–409.CrossRefGoogle ScholarPubMed
10.Edvinsson, D, Bingefors, K, Lindstrom, E, Lewander, T. ADHD-related symptoms among adults in out-patient psychiatry and female prison inmates as compared with the general population. Ups J Med Sci 2010;115:30–40.CrossRefGoogle ScholarPubMed
11.Sobanski, E, Bruggemann, D, Alm, Bet al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 2007;257:371–377.CrossRefGoogle Scholar
12.Friedrichs, B, Wilmar, I, Larsson, H, Larsson, J-O. Coexisting psychiatric problems and stressful life events in adults with symptoms of ADHD – a large Swedish population-based study of twins. J Atten Disord 2012;16:13–22.CrossRefGoogle ScholarPubMed
13.Nylander, L, Holmqvist, M, Gustafson, L, Gillberg, C. ADHD in adult psychiatry. Minimum rates and clinical presentation in general psychiatry outpatients. Nord J Psychiatry 2009;63:64–71.CrossRefGoogle ScholarPubMed
14.Tamam, L, Karakus, G, Ozpoyraz, N. Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: prevalence and clinical correlates. Eur Arch Psychiatry Clin Neurosci 2008;258:385–393.CrossRefGoogle ScholarPubMed
15.Ryden, E, Thase, ME, Straht, D, Aberg-Wistedt, A, Bejerot, S, Landen, M. A history of childhood attention-deficit hyperactivity disorder (ADHD) impacts clinical outcome in adult bipolar patients regardless of current ADHD. Acta Psychiatr Scand 2009;120:239–246.CrossRefGoogle ScholarPubMed
16.McAweeney, M, Rogers, NL, Huddleston, C, Moore, D, Gentile, JP. Symptom prevalence of ADHD in a community residential substance abuse treatment program. J Atten Disord 2010;13:601–608.CrossRefGoogle Scholar
17.Mikami, AY, Hinshaw, SP, Arnold, LEet al. Bulimia nervosa symptoms in the multimodal treatment study of children with ADHD. Int J Eat Disord 2010;43:248–259.CrossRefGoogle ScholarPubMed
18.Khalifa, N, von Knorring, AL. Psychopathology in a Swedish population of school children with tic disorders. J Am Acad Child Adolesc Psychiatry 2006;45:1346–1353.CrossRefGoogle Scholar
19.Miller, TW, Nigg, JT, Faraone, SV. Axis I and II comorbidity in adults with ADHD. J Abnorm Psychol 2007;116:519–528.CrossRefGoogle ScholarPubMed
20.Philipsen, A, Limberger, MF, Lieb, Ket al. Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder. Br J Psychiatry 2008;192:118–123.CrossRefGoogle ScholarPubMed
21.Rosler, M, Retz, W, Retz-Junginger, Pet al. Prevalence of attention deficit-/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates. Eur Arch Psychiatry Clin Neurosci 2004;254:365–371.CrossRefGoogle ScholarPubMed
22.Ginsberg, Y, Hirvikoski, T, Lindefors, N. Attention deficit hyperactivity disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry 2010;10:112.CrossRefGoogle ScholarPubMed
23.Robison, RJ, Reimherr, FW, Marchant, BK, Faraone, SV, Adler, LA, West, SA. Gender differences in 2 clinical trials of adults with attention-deficit/hyperactivity disorder: a retrospective data analysis. J Clin Psychiatry 2008;69:213–221.CrossRefGoogle ScholarPubMed
24.Philipsen, A. Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults. Eur Arch Psychiatry Clin Neurosci 2006;256(Suppl 1):i42–i46.CrossRefGoogle ScholarPubMed
25.Biederman, J, Faraone, SV, Monuteaux, MC, Bober, M, Cadogen, E. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry 2004;55:692–700.CrossRefGoogle Scholar
26.Halmoy, A, Fasmer, OB, Gillberg, C, Haavik, J. Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients. J Atten Disord 2009;13:175–187.CrossRefGoogle ScholarPubMed
27.Rasmussen, K, Levander, S. Untreated ADHD in adults: are there sex differences in symptoms, comorbidity, and impairment? J Atten Disord 2009;12:353–360.CrossRefGoogle ScholarPubMed
28.First, MB, Spitzer, RL, Gibbon, Met al. Structured Clinical Interview for DSM-IV axis I Disorders, Clinical Version (SCID-CV). Washington, DC: American Psychiatric Press Inc., 1996.Google Scholar
29.Leekam, SR, Libby, SJ, Wing, L, Gould, J, Taylor, C. The Diagnostic Interview for Social and Communication Disorders: algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder. J Child Psychol Psychiatry 2002;43:327–342.CrossRefGoogle ScholarPubMed
30.Le Couteur, A, Rutter, M, Lord, Cet al. Autism diagnostic interview: a standardized investigator-based instrument. J Autism Dev Disord 1989;19:363–387.CrossRefGoogle ScholarPubMed
31.Ottosson, H, Bodlund, O, Ekselius, Let al. DSM-IV and ICD-10 personality disorders: a comparison of a self-report questionnaire (DIP-Q) with a structured interview. Eur Psychiatry 1998;13:246–253.CrossRefGoogle ScholarPubMed
32.First, MBGibbon, M, Spitzer, RLet al. Structured Clinical Interview for DSM-IV axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press Inc., 1997.Google Scholar
33.Sprafkin, J, Gadow, KD, Weiss, MD, Schneider, J, Nolan, EE. Psychiatric comorbidity in ADHD symptom subtypes in clinic and community adults. J Atten Disord 2007;11:114–124.CrossRefGoogle ScholarPubMed
34.Cumyn, L, French, L, Hechtman, L. Comorbidity in adults with attention-deficit hyperactivity disorder. Can J Psychiatry 2009;54:673–683.CrossRefGoogle ScholarPubMed
35.Kringlen, E, Torgersen, S, Cramer, V. A Norwegian psychiatric epidemiological study. Am J Psychiatry 2001;158:1091–1098.CrossRefGoogle ScholarPubMed
36.Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593–602.CrossRefGoogle ScholarPubMed
37.Banaschewski, T, Poustka, L, Holtmann, M. Autism and ADHD across the life span: differential diagnoses or comorbidity? Nervenarzt 2011;82:573–581.CrossRefGoogle ScholarPubMed
38.Gargaro, BA, Rinehart, NJ, Bradshaw, JL, Tonge, BJ, Sheppard, DM. Autism and ADHD: how far have we come in the comorbidity debate? Neurosci Biobehav Rev 2010;35:1081–1088.CrossRefGoogle ScholarPubMed
39.Ghanizadeh, A. Factor analysis on ADHD and autism spectrum disorder DSM-IV-derived items shows lack of overlap. Eur Child Adolesc Psychiatry 2010;19:797–798.CrossRefGoogle ScholarPubMed
40.Rommelse, NN, Franke, B, Geurts, HM, Hartman, CA, Buitelaar, JK. Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry 2010;19:281–295.CrossRefGoogle ScholarPubMed
41.Simonoff, E, Pickles, A, Charman, T, Chandler, S, Loucas, T, Baird, G. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 2008;47:921–929.CrossRefGoogle Scholar
42.Research Units on Pediatric Psychiatric Psychopharmacology (RUPP) Autism Network. Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch Gen Psychiatry 2005;62:1266–1274.CrossRefGoogle Scholar
43.Aman, MG, Farmer, CA, Hollway, J, Arnold, LE. Treatment of inattention, overactivity, and impulsiveness in autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2008;17:713–738.CrossRefGoogle ScholarPubMed
44.Handen, BL, Johnson, CR, Lubetsky, M. Efficacy of methylphenidate among children with autism and symptoms of attention-deficit hyperactivity disorder. J Autism Dev Disord 2000;30:245–255.CrossRefGoogle ScholarPubMed
45.Baron-Cohen, S, Scott, FJ, Allison, Cet al. Prevalence of autism-spectrum conditions: UK school-based population study. Br J Psychiatry 2009;194:500–509.CrossRefGoogle ScholarPubMed
46.Khalifa, N, von Knorring, AL. Prevalence of tic disorders and Tourette syndrome in a Swedish school population. Dev Med Child Neurol 2003;45:315–319.CrossRefGoogle Scholar
47.Huang, Y, Kotov, R, de Girolamo, Get al. DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry 2009;195:46–53.CrossRefGoogle ScholarPubMed
48.Lenzenweger, MF, Lane, MC, Loranger, AW, Kessler, RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007;62:553–564.CrossRefGoogle ScholarPubMed
49.Williams, ED, Reimherr, FW, Marchant, BKet al. Personality disorder in ADHD Part 1: assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate. Ann Clin Psychiatry 2010;22:84–93.Google ScholarPubMed
50.Anckarsater, H, Stahlberg, O, Larson, Tet al. The impact of ADHD and autism spectrum disorders on temperament, character, and personality development. Am J Psychiatry 2006;163:1239–1244.CrossRefGoogle ScholarPubMed
51.O'Donnell, ML, Creamer, M, Pattison, P, Atkin, C. Psychiatric morbidity following injury. Am J Psychiatry 2004;161:507–514.CrossRefGoogle ScholarPubMed
52.Moffitt, TE, Caspi, A, Taylor, Aet al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med 2010;40:899–909.CrossRefGoogle ScholarPubMed