Nadia Micali and Janet Treasure contributed equally to this work.
The authors declare that they have no competing interests.
CR was a project coordinator for the Experienced Carers Helping Others (ECHO) study and carried out data collection, statistical analysis and drafted the manuscript. EB prepared data for analysis. RH was a project coordinator for ECHO, involved in the setup of the ECHO study, carried out data collection and critical appraisal of the manuscript content. EG, PM, SG, and US were involved in the design and setup of the study and contributed to the interpretation of data and critical appraisal of the manuscript content. SG was also Principal Investigator at one of the study recruitment sites. KT contributed to the interpretation of data and critical appraisal of the manuscript content. NM conducted the Development and Well-being Assessment clinician ratings, supervised statistical analysis, contributed to interpretation of data and was involved in revising the manuscript critically for important intellectual content. JT conceived of the study, participated in its design and coordination, contributed to the interpretation of results, and was involved in drafting of the manuscript and revising it critically for important intellectual content. All authors read and approved the final manuscript.
There may be a link between anorexia nervosa and autism spectrum disorders. The aims of this study were to examine whether adolescents with anorexia nervosa have autism spectrum and/or obsessive-compulsive traits, how many would meet diagnostic criteria for autism spectrum disorder, and whether these traits are shared by parents.
A total of 150 adolescents receiving outpatient treatment for anorexia nervosa or subthreshold anorexia nervosa and their parents completed the autism spectrum disorder and eating disorder sections of the Development and Well-being Assessment. Patients also completed the Children Yale-Brown Obsessive-Compulsive Scale and other measures of psychiatric morbidity, and parents completed the short Autism Quotient and Obsessive-Compulsive Inventory Revised.
Adolescents with anorexia nervosa had a below average social aptitude (19% below cut-off) and high levels of peer relationship problems (39% above cut-off) and obsessive-compulsive symptoms (56% above cut-off). Six cases (4%, all females) were assigned a possible (n = 5) or definite (n = 1) diagnosis of autism spectrum disorder. Parental levels of autism spectrum and obsessive-compulsive traits were within the normal range.
This study suggests that adolescents with anorexia nervosa have elevated levels of autism spectrum traits, obsessive-compulsive symptoms, and a small proportion fulfil diagnostic criteria for a probable autism spectrum disorder. These traits did not appear to be familial. This comorbidity has been associated with a poorer prognosis. Therefore, adaptation of treatment for this subgroup may be warranted.
Controlled-trials.com: ISRCTN83003225. Registered on 29 September 2011.
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- An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents
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