Disordered eating behaviours and autistic traits—Are there any associations in nonclinical populations? A systematic review

Christensen, Stephanie Stensbjerg; Bentz, Mette; Clemmensen, Lars; Strandberg‐Larsen, Katrine; Olsen, Else Marie

doi:10.1002/erv.2627

Cited by 25 publications

(34 citation statements)

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“…We scrutinized the relationship between autistic traits and eating psychopathology with a focus on one putative mediating factor that might hypothetically serve as a risk factor for ED in autistic people and those with high autistic traits: levels of alexithymia. We corroborated the relationship between autistic traits and eating psychopathology which has been previously observed with these same measures [32][33][34][35][36], but three new findings are of especial interest. These include (a) a complete or partially mediating role of alexithymia as reflected in TAS-20 scores, notably the difficulty identifying emotions aspect, in the relationship between autistic traits and eating psychopathology; (b) the influence of several other variables on this relationship, including sex, anxiety, and depression; and (c) the divergence between self-report (TAS-20) and performance-based (LEAS) measures of alexithymia.…”

Section: Discussionsupporting

confidence: 88%

“…Though ASC and AN are indeed dissociable, a substantial body of literature supports their common cooccurrence. In non-clinical populations, autistic traits and eating disorder symptomatology rise in tandem significantly correlated [32][33][34][35][36]. Research involving individuals with anorexia has revealed elevated autistic traits or symptomatology appear across a range of measurement tools, including screening questionnaires (such as the Autism-Spectrum Quotient (AQ) [37]) [7,[38][39][40][41][42][43][44][45], clinical interviews [46], and autism diagnostic tests [6,47], and this consistent elevation in autistic symptomatology suggests disproportionate representation of ASC in this population [5,6,48,49] 2 .…”

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confidence: 99%

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Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

et al. 2020

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Background: Autistic people are disproportionately vulnerable to anorexia nervosa and other eating disorders (ED), and within the general population, autistic traits correlate with ED psychopathology. A putative mechanism which may underpin this heightened risk is alexithymia, a difficulty identifying and describing emotional states which is observed in both autism and ED. In two experiments with independent non-clinical samples, we explored whether alexithymia might mediate the heightened risk of eating psychopathology in individuals high in autistic traits. Methods: Our first experiment used the PROCESS macro for SPSS to examine relationships between alexithymia (measured by the Toronto Alexithymia Scale (TAS-20)), autistic traits (autism quotient (AQ)), and eating psychopathology (Eating Attitudes Test (EAT-26)) in 121 participants. Our second experiment (n = 300) replicated and furthered this analysis by examining moderating effects of sex and controlling for anxiety and depression as covariates. We also included an additional performance-based measure of alexithymia, the Levels of Emotional Awareness Scale (LEAS). Results: Study 1 suggested that TAS-20 scores mediated the relationship between heightened autistic traits and eating psychopathology. Replication and further scrutiny of this finding, in study 2, revealed that this mediation effect was partial and specific to the female participants in this sample. The mediation effect appeared to be carried by the difficulty identifying feelings subscale of the TAS-20, even when depression and anxiety were controlled for. LEAS scores, however, were not significantly related to autistic traits or eating psychopathology. Limitations: Cross-sectional data prevents any conclusions around the direction and causality of relationships between alexithymia, autistic traits, and eating psychopathology (alongside depression and anxiety), necessitating longitudinal research. Our non-clinical sample was predominantly Caucasian undergraduate students, so it remains to be seen if these results would extrapolate to clinical and/or autistic samples. Divergence between the TAS-20 and LEAS raises crucial questions regarding the construct validity of these measures. Conclusions: Our findings with respect to autistic traits suggest that alexithymia could partially explain the prevalence of ED in autistic people and may as such be an important consideration in the pathogenesis and treatment of ED in autistic and non-autistic people alike. Further research with clinical samples is critical to explore these ideas. Differences between men and women, furthermore, emphasize the importance of looking for sexspecific as well as generic risk factors in autistic and non-autistic men and women.

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confidence: 88%

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Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

et al. 2020

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“…Previous studies have also shown that higher schizophrenia PRS are associated with poorer social understanding and greater irritability, 25 domains that appear to be impaired in individuals with eating disorders 26,27 and could therefore represent intermediate phenotypes shared by these conditions. Although the majority of the literature has focused on anorexia nervosa, 28 a recent systematic review has shown that those with broader disordered eating behaviours 26 also show deficits in social cognition, and greater autistic traits. To date, these studies have been solely conducted cross-sectionally, 26 making it difficult to infer whether these cognitive deficits traits emerge before or after the onset of eating disorders.…”

Section: Comparisons With Previous Literature and Interpretation Of Tmentioning

confidence: 97%

Polygenic risk for schizophrenia, disordered eating behaviours and body mass index in adolescents

et al. 2019

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BackgroundRecent studies suggest psychotic and eating disorders can be comorbid and could have shared genetic liability. However, this comorbidity has been overlooked in the epidemiological literature. AimsTo test whether polygenic risk scores (PRS) for schizophrenia are associated with disordered eating behaviours and body mass index (BMI) in the general population. MethodUsing data from the Avon Longitudinal Study of Parents and Children and random-effects logistic and linear regression models, we investigated the association between PRS for schizophrenia and self-reported disordered eating behaviours (binge eating, purging, fasting and excessive exercise) and BMI at 14, 16 and 18 years. ResultsOf the 6920 children with available genetic data, 4473 (64.6%) and 5069 (73.3%) had at least one disordered eating and one BMI outcome measurement, respectively. An s.d. increase in PRS was associated with greater odds of having binge eating behaviours (odds ratio, 1.36; 95% CI 1.16-1.60) and lower BMI (coefficient, −0.03; 95% CI, −0.06 to −0.01). ConclusionsOur findings suggest the presence of shared genetic risk between schizophrenia and binge eating behaviours. Intermediate phenotypes such as impaired social cognition and irritability, previously shown to be positively correlated in this sample with schizophrenia PRS, could represent risk factors for both phenotypes. Shared genetic liability between binge eating and schizophrenia could also explain higher rates of metabolic syndrome in individuals with schizophrenia, as binge eating could be a mediator of this association in drug-naïve individuals. The finding of an association between greater PRS and lower BMI, although consistent with existing epidemiological and genetic literature, requires further investigation. Declaration of interestNone.

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“…These primary research publications can later be included in epidemiological systematic reviews or meta‐analyses, which are based on structuring and synthesizing the available empirical evidence in order to answer a specific research question. For example, the publication that compiles previously published results for the association of disordered eating behaviours and autistic traits in nonclinical populations (Christensen, Bentz, Clemmensen, Strandberg‐Larsen, & Olsen, 2019), or the study measuring the effectiveness of contingency management in the treatment of Anorexia nervosa patients (Ziser et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Null hypothesis significance tests, a misleading approach to scientific knowledge: Some implications for eating disorders research

Granero

Treasure

Claes

et al. 2020

Euro Eating Disorders Rev

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Disordered eating behaviours and autistic traits—Are there any associations in nonclinical populations? A systematic review

Abstract: The existing literature indicates concurrent associations between specific autistic-like behaviours and problematic eating behaviours in nonclinical samples across ages. Large prospective longitudinal studies are needed for insight into the temporal order of these associations.

Cited by 25 publications

References 51 publications

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

Polygenic risk for schizophrenia, disordered eating behaviours and body mass index in adolescents

Null hypothesis significance tests, a misleading approach to scientific knowledge: Some implications for eating disorders research

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