Autism symptoms in anorexia nervosa: a comparative study with females with autism spectrum disorder

Abstract

Background Recent research suggests a link between autism spectrum disorder (ASD) and anorexia nervosa (AN). Individuals with AN show high scores on measures of ASD symptoms, relative to individuals without AN, however, there are currently no studies directly comparing women with AN to women with ASD. The aim of the current study was to examine profiles of ASD symptoms in young women in the acute and recovered stages of AN, women with ASD, and typically developing controls (TD), on both self-report and clinical interview measures. Methods Four groups of participants aged 12–30 years were included (n = 218): AN, recovered AN (REC), ASD, and TD. Group differences on the Social Responsiveness Scale, 2nd edition (SRS-2), 10-item Autism Quotient (AQ-10), and the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) were examined. To explore similarities and differences in specific symptom profiles associated with AN and ASD, individual item endorsement on the ADOS-2 was also examined in AN, REC, and ASD. Results Across measures, women with ASD showed the highest scores, and TDs the lowest. Generally, individuals with AN and REC showed intermediate levels of ASD symptoms, scoring between the other two groups. However, AN and ASD did not differ on restricted interests and repetitive behaviour subscales. The ADOS-2 item ‘quality of social response’ adequately discriminated between ASD and non-ASD participants. Limitations A full diagnostic assessment for ASD was not provided for participants with AN/REC, nor were eating disorders assessed in the ASD group. Therefore, some diagnostic overlap between groups is possible. The cross-sectional design is another limitation. Conclusions The results suggest similarities in scores on both self-report and clinical interview measures in AN and ASD. However, individual ADOS-2 item analyses also revealed subtle differences, particularly in reciprocal social interaction. ASD symptoms may be a combination of both state and trait features in AN.

Examining the relationship between autistic spectrum disorder characteristics and structural brain differences seen in anorexia nervosa

“…Our behavioural results found that the AAN group had increased scores for ADOS-2 domain scores in communication and creativity domains with medium to large effect size compared to HC group, with the WR group in-between. This replicates previous work which has found that individuals with AAN have increased ADOS-2 scores, similar to that of autistic individuals when compared to HC, with WR individuals lying between groups (Kerr-Gaffney et al, 2021). Interestingly, our results demonstrated that WR individuals had increased stereotype and repetitive behaviours (SRB) compared to AAN and HC individuals with a medium effect size.…”

“…A potential reason for this could be the use of self-report questionnaires verses objective interviews. Our study and studies that have used the ADOS-2 have found increased SRB scores (Kerr-Gaffney et al, 2021) compared to studies using self-reported measures (Kerr-Gaffney et al, 2021). As autistic women and men have different repetitive interests (Lai et al, 2015), it may be that current tools are not sensitive enough to pick up differences.…”

“…There has however, been a limited number of studies examining the relationship between autistic spectrum disorder (ASD) characteristics and structural changes seen in individuals with AN. Behavioural evidence suggests that ASD characteristics are over represented in individuals with AN (Kerr-Gaffney et al, 2021;Westwood & Tchanturia, 2017), with individuals with AN scoring similar to women with ASD in social difficulties, restricted interests and repetitive behaviour (Kerr-Gaffney et al, 2021). Structural imagining studies in autistic individuals have show similar alterations to individuals with AN, such as decreased global volume (Ha et al, 2015), decreased regional CT (Pagnozzi et al, 2018) and decreased LGI (Schaer et al, 2013) reported.…”

The Diagnosis and Management of Autism Spectrum Disorder (ASD) in Adult Females in the Presence or Absence of an Intellectual Disability

“…In fact, many women have been identified as autistic following diagnosis of eating disorders [83]. AN and autism have many parallels, with both groups displaying aloofness, rigidity, RRBs, and social impairment [84,85]. Females with anorexia tend to have elevated autistic traits [85,86], thereby making it hard to distinguish whether the displayed phenotypes are part of AN or there is a co-occurrence of autism.…”

“…AN and autism have many parallels, with both groups displaying aloofness, rigidity, RRBs, and social impairment [84,85]. Females with anorexia tend to have elevated autistic traits [85,86], thereby making it hard to distinguish whether the displayed phenotypes are part of AN or there is a co-occurrence of autism. One important distinguishing factor between the two conditions is the quality of social response: difficulties in social reciprocity is prevalent in ASD, while those suffering from AN show little difficulty in understanding social prompts [85,87].…”