Despite a suggested link between anorexia nervosa (AN) and autism spectrum disorder (ASD), previous studies have used self-report or diagnostic criteria to assess for ASD in AN populations, rather than direct observation of symptom characteristic of ASD. The aim of this study was to use a standardised, clinical assessment of ASD, the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), to investigate the presence of autistic symptoms in a cross-sectional sample of women with AN.
Sixty women were recruited from inpatient or day-patient specialist eating disorder services. Each participant underwent the ADOS-2 assessment and completed a set of self-report questionnaires assessing eating disorder pathology and other psychiatric symptoms. IQ was also assessed.
Fourteen women (23.3%) scored above clinical cutoff for ASD on the ADOS-2. Only eight of these women displayed repetitive or restrictive behaviours, while all 14 had difficulties with social affect. Elevated ASD symptoms were associated with increased alexithymia and obsessive-compulsive symptoms, but not specific eating disorder pathology.
ASD symptoms are over-represented in women with severe AN and appear to be associated with other psychiatric symptoms, which warrant further investigation and consideration in treatment.
APA. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.
Micali N, Hagberg KW, Petersen I, Treasure JL. The incidence of eating disorders in the UK in 2000–2009: findings from the General Practice Research Database. BMJ Open. 2013;3.
Brugha T, Cooper SA, McManus S, Purdon S, Smith J, Scott FJ, Spiers N, Tyrer F. Estimating the prevalence of autism spectrum conditions in adults: extending the 2007 adult psychiatric morbidity survey. The NHS Informaiton Centre; 2012.
Hiller R, Pellicano E. Anorexia and autism—a cautionary note. Psychologist. 2013;26:1.
Mandy W, Tchanturia K. Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Mol Autism. 2015;6.
Bargiela S, Steward R, Mandy W. The experiences of late-diagnosed women with autism spectrum conditions: an investigation of the female autism phenotype. J Autism Dev Disord. 2016;46(10);3281-94.
Yaull-Smith D. Girls on the spectrum. In Communication. National Autistic Society; 2008.
Skuse DH, Mandy W, Steer C, Miller LL, Goodman R, Lawrence K, Emond A, Golding J. Social communication competence and functional adaptation in a general population of children: preliminary evidence for sex-by-verbal IQ differential risk. J Am Acad Child Adolesc Psychiatry. 2009;48:128–37. CrossRefPubMed
Beggiato A, Peyre H, Maruani A, Scheid I, Rastam M, Amsellem F, Gillberg CI, Leboyer M, Bourgeron T, Gillberg C, Delorme R. Gender differences in autism spectrum disorders: divergence among specific core symptoms. Autism Res. 2016; doi: 10.1002/aur.1715.
Lord C, Rutter M, DiLavore PC, Risi S, Gotham K, Bishop SI. Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Manual (Part 1) Modules 1–4. Torrace: Western Psychological Services; 2012.
Ritvo RA, Ritvo ER, Guthrie D, Ritvo MJ, Hufnagel DH, McMahon W, Tonge B, Mataix-Cols D, Jassi A, Attwood T, Eloff J. The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): a scale to assist the diagnosis of autism spectrum disorder in adults: an international validation study. J Autism Dev Disord. 2011;41:1076–89. CrossRefPubMed
Vagni D, Moscone D, Travaglione S, Cotugno A. Using the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) disentangle the heterogeneity of autistic traits in an Italian eating disorder population. Res Autism Spectrum Disord. 2016;32:143–55. CrossRef
NICE. Autism: recognition, referral, diagnosis and management of adults on the autism spectrum. National Institute for Health and Clinical Excellence; 2012.
Westwood H, Eisler I, Mandy W, Leppanen J, Treasure J, Tchanturia K. Using the autism-spectrum quotient to measure autistic traits in anorexia nervosa: a systematic review and meta-analysis. J Autism Dev Disord. 2015.
Keys A, Brožek J, Henschel A, Mickelsen O, Taylor HL: The biology of human starvation.(2 vols). 1950
Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire. Int J Eating Disord. 1994;16:363–70.
Taylor GJ, Bagby RM, Parker JD: Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge University Press; 1999.
Wechsler D. Wechsler Abbreviated Scale of Intelligence—Second Edition (WASI-II). San Antonio: NCS Pearson; 2011.
Kirk RE. Practical significance: a concept whose time has come. Educ Psychol Meas. 1996;56:746–59. CrossRef
Halladay AK, Bishop S, Constantino JN, Daniels AM, Koenig K, Palmer K, Messinger D, Pelphrey K, Sanders SJ, Singer AT, et al. Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority. Mol Autism. 2015;6:36. CrossRefPubMedPubMedCentral
Russell AJ, Murphy CM, Wilson E, Gillan N, Brown C, Robertson DM, Craig MC, Deeley Q, Zinkstok J, Johnston K, et al. The mental health of individuals referred for assessment of autism spectrum disorder in adulthood: a clinic report. Autism. 2015.
Milosavljevic B, Carter Leno V, Simonoff E, Baird G, Pickles A, Jones CR, Erskine C, Charman T, Happe F. Alexithymia in adolescents with autism spectrum disorder: its relationship to internalising difficulties, sensory modulation and social cognition. J Autism Dev Disord. 2016;46:1354–67. CrossRefPubMed
Pinna F, Sanna L, Carpiniello B. Alexithymia in eating disorders: therapeutic implications. Psychol Res Behav Manag. 2015;8:1–15. PubMed
- Clinical evaluation of autistic symptoms in women with anorexia nervosa
- BioMed Central