Early-onset anorexia nervosa in girls with Asperger syndrome

Abstract

Eating disorders frequently occur in conjunction with autism spectrum disorders, posing diagnostic and therapeutic difficulties. The comorbidity of anorexia nervosa and Asperger syndrome is a significant clinical complication and has been associated with a poorer prognosis. The authors are presenting the cases of an eleven-year-old girl and a five-and-a-half-year-old girl with comorbid eating disorders and Asperger syndrome.

Same behaviours, different reasons: what do patients with co-occurring anorexia and autism want from treatment?

“…Potential mechanisms underlying the relationship between AN and autism could include shared cognitive traits: commonly with research in autism, literature shows that people with AN exhibit problems with rigidity, central coherence, and emotional and social processing that may persist following recovery (Harrison, Mountford, & Tchanturia, 2014;Lang, Lopez, Stahl, Tchanturia, & Treasure, 2014;Katie Lang et al, 2016;Leppanen, Sedgewick, Treasure, & Tchanturia, 2018;Westwood, Lawrence, Fleming, & Tchanturia, 2016;Westwood, Stahl, Mandy, & Tchanturia, 2016). Significantly, heightened autistic traits in people with AN are associated with more severe presentations and poorer treatment outcomes (Nielsen, Anckarsater, Gillberg, Rastam, & Wentz, 2015;Tchanturia, Adamson, Leppanen, & Westwood, 2017;Tchanturia, Larsson, & Adamson, 2016), leading to suggestions that traditional treatment approaches may need to be adapted for this population (Dudova, Kocourkova, & Koutek, 2015;Stewart, McEwen, Konstantellou, Eisler, & Simic, 2017;. Treasure, 2013).…”

“…Treasure, 2013). Although at present there is a lack of research in this area, potential contributors behind these poorer outcomes could reflect the heightened rigidity and difficulties with introspection seen in autism making it difficult for patients to engage in treatment (Dudova et al, 2015). Similarly, autistic people with co-occurring AN could experience factors motivating their ED behaviours that are related to their autism, rather than the traditional shape and weight concerns associated with AN: studies of food selectivity in autistic individuals suggest that factors impacting eating in this population could include sensory sensitivity, a need for routine and difficulties with coordination (Cermak, Curtin, & Bandini, 2010).…”

Clinicians’ views on working with anorexia nervosa and autism spectrum disorder comorbidity: a qualitative study

“…Although only a limited number of patients with AN show ASD traits, understanding the relationship between ASD and AN is crucial because this comorbidity has been related to poorer illness outcomes [ 29 ]. Individuals with high ASD traits have been found to respond more poorly to psychological treatments [ 37 ], with a clinical case study of two children with comorbid AN and ASD suggesting that the rigidity and low introspection characteristic of ASD hindered responses to traditional therapeutic programmes [ 38 ]. Consequently, it has been suggested that individuals with comorbid AN and ASD require adapted or targeted treatment programmes [ 31 , 38 ].…”

“…Individuals with high ASD traits have been found to respond more poorly to psychological treatments [ 37 ], with a clinical case study of two children with comorbid AN and ASD suggesting that the rigidity and low introspection characteristic of ASD hindered responses to traditional therapeutic programmes [ 38 ]. Consequently, it has been suggested that individuals with comorbid AN and ASD require adapted or targeted treatment programmes [ 31 , 38 ]. Treatments such as cognitive behavioural therapy (CBT) have previously been adapted for individuals with ASD and comorbid anxiety or depression [ 39 ].…”

Risk Factors for Unhealthy Weight Gain and Obesity among Children with Autism Spectrum Disorder

“…Additionally, researchers should further elucidate differences in dietary intake within the ASD group based on oral sensitivities, dietary restrictions, and secondary comorbidities (e.g., GI disorders), and take into account age- and possibly sex-related differences. Eating disorders, such as anorexia nervosa, can also impact feeding behaviors and studies have found comorbidities between eating disorders and ASD, specifically among females [55,56]. Studies suggest that specific behavioral phenotypes, such as rigid and repetitive behaviors and social anhedonia, overlap among both conditions [56,57].…”