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Peer-reviewedCC BY 4.0Frontiers in Psychiatry

The relationship between impulsive behaviors and adult attention-deficit/hyperactivity disorder symptoms in bipolar disorder

  • Tülay Sati Kirkan1
  • Nazan Dolapoglu2
  1. 1Department of Psychiatry, Faculty of Medicine, Bandırma Onyedi Eylül University
  2. 2Department of Psychiatry, Faculty of Medicine, Balıkesir University
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Abstract

Objective: This study aimed to examine the relationship between impulsivity and adult Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in euthymic patients with Bipolar Disorder (BD) Type I.

Methods: One hundred and eleven outpatients diagnosed with BD Type I according to DSM-5 criteria, scoring ≤7 on the Hamilton Depression Rating Scale (HAM-D) and ≤5 on the Young Mania Rating Scale (YMRS), and in remission for at least two months were included. Impulsivity was assessed with the Barratt Impulsiveness Scale-11 (BIS-11) and ADHD symptoms with the Adult ADHD Self-Report Scale (ASRS). Associations were evaluated with Spearman correlation analysis with Benjamini–Hochberg false discovery rate (FDR) correction, and hierarchical multivariable linear regression. Sensitivity analyses addressed item-content overlap, influential observations, and medication effects.

Results: A strong positive correlation was found between BIS-11 total and ASRS total scores (ρ=0.722; q<0.001); the ASRS Inattention and Hyperactivity-Impulsivity subscales were themselves moderately intercorrelated (ρ=0.600; p<0.001). Only 18.9% of patients scored ≥72 on the BIS-11 (clinically significant range) and 28.8% screened positive on ASRS Part A. In the final regression model, ASRS total score was the strongest independent predictor of BIS-11 total score (B = 0.734; β=0.676; p<0.001), together with Young Mania Rating Scale score (β=0.170; p=0.018; R ² =0.573), an association that strengthened after excluding influential observations and after dichotomization (both p<0.01); variance inflation factors (1.04–2.61) indicated no multicollinearity. Both ASRS subscales remained independent predictors in subscale analysis (Hyperactivity-Impulsivity β=0.436; Inattention β=0.317; both p<0.001). The association persisted after removing shared item content (ρ=0.605; p<0.001), excluding influential observations, and adjusting for treatment regimen.

Conclusion: In euthymic BD Type I patients, self-reported impulsivity showed a strong, independent association with self-reported adult ADHD symptom burden, particularly the hyperactivity-impulsivity dimension, robust across sensitivity analyses. Because ADHD symptoms were assessed only by self-report screening, without a structured diagnostic interview, and because the design is cross-sectional, these findings reflect a symptom-level, not diagnostic, association and do not establish causality. They nonetheless support considering ADHD symptoms in the routine clinical evaluation of euthymic BD Type I patients.

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Cite

BibTeXRIS
BibTeX
@article{kirkan2026relationship,
  title = {{The relationship between impulsive behaviors and adult attention-deficit/hyperactivity disorder symptoms in bipolar disorder}},
  author = {Tülay Sati Kirkan and Nazan Dolapoglu},
  journal = {Frontiers in Psychiatry},
  year = {2026},
  month = oct,
  doi = {10.3389/fpsyt.2026.1916550},
  url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1916550/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The relationship between impulsive behaviors and adult attention-deficit/hyperactivity disorder symptoms in bipolar disorder
AU  - Tülay Sati Kirkan
AU  - Nazan Dolapoglu
PY  - 2026
DA  - 2026/10/09
JO  - Frontiers in Psychiatry
DO  - 10.3389/fpsyt.2026.1916550
UR  - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1916550/full
AB  - Objective: This study aimed to examine the relationship between impulsivity and adult Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in euthymic patients with Bipolar Disorder (BD) Type I.  Methods: One hundred and eleven outpatients diagnosed with BD Type I according to DSM-5 criteria, scoring ≤7 on the Hamilton Depression Rating Scale (HAM-D) and ≤5 on the Young Mania Rating Scale (YMRS), and in remission for at least two months were included. Impulsivity was assessed with the Barratt Impulsiveness Scale-11 (BIS-11) and ADHD symptoms with the Adult ADHD Self-Report Scale (ASRS). Associations were evaluated with Spearman correlation analysis with Benjamini–Hochberg false discovery rate (FDR) correction, and hierarchical multivariable linear regression. Sensitivity analyses addressed item-content overlap, influential observations, and medication effects.  Results: A strong positive correlation was found between BIS-11 total and ASRS total scores (ρ=0.722; q<0.001); the ASRS Inattention and Hyperactivity-Impulsivity subscales were themselves moderately intercorrelated (ρ=0.600; p<0.001). Only 18.9% of patients scored ≥72 on the BIS-11 (clinically significant range) and 28.8% screened positive on ASRS Part A. In the final regression model, ASRS total score was the strongest independent predictor of BIS-11 total score (B = 0.734; β=0.676; p<0.001), together with Young Mania Rating Scale score (β=0.170; p=0.018; R ² =0.573), an association that strengthened after excluding influential observations and after dichotomization (both p<0.01); variance inflation factors (1.04–2.61) indicated no multicollinearity. Both ASRS subscales remained independent predictors in subscale analysis (Hyperactivity-Impulsivity β=0.436; Inattention β=0.317; both p<0.001). The association persisted after removing shared item content (ρ=0.605; p<0.001), excluding influential observations, and adjusting for treatment regimen.  Conclusion: In euthymic BD Type I patients, self-reported impulsivity showed a strong, independent association with self-reported adult ADHD symptom burden, particularly the hyperactivity-impulsivity dimension, robust across sensitivity analyses. Because ADHD symptoms were assessed only by self-report screening, without a structured diagnostic interview, and because the design is cross-sectional, these findings reflect a symptom-level, not diagnostic, association and do not establish causality. They nonetheless support considering ADHD symptoms in the routine clinical evaluation of euthymic BD Type I patients.
SN  - 1664-0640
ER  -