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Anorexia Nervosa and Comorbidities

Linking Autism

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Eating Disorders

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Abstract

Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD) are two mental health conditions sharing a series of clinical features. Epidemiological studies have documented that subjects with AN may present ASD and ASD traits more frequently than the general population. Specific studies have discussed the use of psychodiagnostics tools to investigate ASD traits in individuals with AN. Recent research has reported common neuropsychological (i.e., deficits in “Theory of Mind”) and psychopathological (i.e., alexithymia) traits between the two conditions. Finally, ASD traits may impact the interventions to treat AN. This chapter examines the recent literature reporting on the link between AN and ASD, and discusses the implications of this link for the development of new screening and treatment protocols.

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Abbreviations

3di-sv:

3-developmental dimensional and diagnostic interview short version

AdAS:

Adult Autism Subthreshold Spectrum

ADHD:

Attention-Deficit/Hyperactivity Disorder

ADOS-2:

Autism Diagnostic Observation Schedule-2nd Edition

AN:

Anorexia Nervosa

AQ:

Autism Spectrum Quotient

ARFID:

Avoidant/restrictive food intake disorder

ASD:

Autism Spectrum Disorder

BMI:

Body Mass Index

CDC:

Center for Disease Control and Prevention

DSM-5:

Diagnostic and Statistical Manual of Mental Disorders, fifth edition

ED:

Eating Disorders

IQ:

Intelligence Quotient

NDD:

Neurodevelopmental Disorders

OCD:

Obsessive-compulsive Disorder

RRB:

Restrictive and repetitive behaviors and interests

References

  • Adamson J, Kinnaird E, Glennon D et al (2020) Carers’ views on autism and eating disorders comorbidity: qualitative study. BJPsych Open 6(3):e51. https://doi.org/10.1192/bjo.2020.36

    Article  PubMed  PubMed Central  Google Scholar 

  • Alliance NG (2017) National Institute for Health and Care Excellence. Eating Disorders: Recognition and Treatment. London

    Google Scholar 

  • Association AP (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington

    Book  Google Scholar 

  • Baron-Cohen S, Leslie AM, Frith U (1985) Does the autistic child have a ‘theory of mind’? Cognition 21:37–46

    Article  CAS  PubMed  Google Scholar 

  • Baron-Cohen S, Wheelwright S, Skinner R et al (2001) The autism spectrum quotient; evidence for Asperger syndrome/high functioning autism, male and female, scientists and mathematicians. J Autism Dev Disord 31:5–17. https://doi.org/10.1023/a:1005653411471

    Article  CAS  PubMed  Google Scholar 

  • Baron-Cohen S, Lombardo MV, Auyeung B et al (2011) Why are autism spectrum conditions more prevalent in males? PLoS Biol 9(6):e1001081

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chiang HM, Carter M (2008) Spontaneity of communication in individuals with autism. J Autism Dev Disord 38(4):693–705. https://doi.org/10.1007/s10803-007-0436-7

    Article  PubMed  Google Scholar 

  • D’Cruz A-M, Ragozzino M, Mosconi MW et al (2013) Reduced behavioral flexibility in autism spectrum disorders. Neuropsychology 27:152–160

    Article  PubMed  PubMed Central  Google Scholar 

  • Dell’Osso L, Gesi C, Massimetti E et al (2017) Adult autism subthreshold spectrum (AdAS): validation of a questionnaire investigating subthreshold autism spectrum. Compr Psychiatry 73:61–83

    Article  PubMed  Google Scholar 

  • Dell’Osso L, Carpita B, Gesi C et al (2018) Subthreshold autism spectrum disorder in patients with eating disorders. Compr Psychiatry 81:66–72

    Article  PubMed  Google Scholar 

  • Demartini B, Nisticò V, Bertino V et al (2021) Eating disturbances in adults with autism spectrum disorder without intellectual disabilities. Autism Res. https://doi.org/10.1002/aur.2500

  • Galmiche M, Déchelotte P, Lambert G, Tavolacci MP (2019) Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr 109(5):1402–1413

    Article  PubMed  Google Scholar 

  • Gillberg C (1983) Are autism and anorexia nervosa related? Br J Psychiatry 142:428

    Article  CAS  PubMed  Google Scholar 

  • Gillberg C, Rastam M (1992) Do some cases of anorexia nervosa reflect autistic-like conditions. Behav Neurol 5:27–32

    Article  CAS  PubMed  Google Scholar 

  • Head AM, McGillivray JA, Stokes MA (2014) Gender differences in emotionality and sociability in children with autism spectrum disorder. Mol Autism 5:19

    Article  PubMed  PubMed Central  Google Scholar 

  • Herpertz-Dahlmann B (2015) Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am 24:177–196

    Article  PubMed  Google Scholar 

  • Huke V, Turk J, Saeidi S et al (2013) Autism spectrum disorders in eating disorder populations: a systematic review. Eur Eat Disord Rev 21:345–351. https://doi.org/10.1002/erv.2244

    Article  PubMed  Google Scholar 

  • Jagielska G, Kacperska I (2017) Outcome, comorbidity and prognosis in anorexia nervosa. Psychiatr Pol 51(2):205–218. https://doi.org/10.12740/PP/64580

    Article  PubMed  Google Scholar 

  • Kerr-Gaffney J, Harrison A, Tchanturia K (2019) Cognitive and affective empathy in eating disorders: a systematic review and meta-analysis. Front Psych 10:102

    Article  Google Scholar 

  • Kinnaird E, Norton C, Tchanturia K (2017) Clinicians’ views on working with anorexia nervosa and autism spectrum disorder comorbidity: a qualitative study. BMC Psychiatry 17:292

    Article  PubMed  PubMed Central  Google Scholar 

  • Kinnaird E, Stewart C, Tchanturia K (2019) Investigating alexithymia in autism: a systematic review and meta-analysis. Eur Psychiatry 55:80–89

    Google Scholar 

  • Koch SV, Larsen JT, Mouridsen SE et al (2015) Autism spectrum disorder in individuals with anorexia nervosa and in their first- and second-degree relatives: Danish nationwide register-based cohort-study. Br J Psychiatry J Ment Sci 206:401–407

    Article  Google Scholar 

  • Lai MC, Lombardo MV, Baron-Cohen S (2014) Autism. Lancet 383:896–910

    Article  PubMed  Google Scholar 

  • Lanzarini E, Pruccoli J, Grimandi I et al (2021) Phonic and motor stereotypies in autism spectrum disorder: video analysis and neurological characterization. Brain Sci 11:431

    Article  PubMed  PubMed Central  Google Scholar 

  • Ledford J, Gast D (2006) Feeding problems in children with autism spectrum disorders. Focus Autism Other Dev Disabl 21:153–166

    Article  Google Scholar 

  • Leppanen J, Sedgewick F, Treasure J, Tchanturia K (2018) Differences in the theory of mind profiles of patients with anorexia nervosa and individuals on the autism spectrum: a meta-analytic review. Neurosci Biobehav Rev 90:146–163

    Article  PubMed  Google Scholar 

  • Lord C, Rutter M, Dilavore PC et al (2012) Autism diagnostic observation schedule, second edition (ADOS-2) manual (part 1) modules 1–4. Western Psychological Services, Torrance

    Google Scholar 

  • Maenner MJ, Shaw KA, Baio J (2020) Prevalence of autism spectrum disorder among children aged 8 years — autism and developmental disabilities monitoring network, 11 sites, United States, 2016. MMWR Surveill Summ 69:1–12. https://doi.org/10.15585/mmwr.ss6904a1

    Article  PubMed  PubMed Central  Google Scholar 

  • Mairs R, Nicholls D (2016) Assessment and treatment of eating disorders in children and adolescents. Arch Dis Child 101:1168–1175

    Article  PubMed  Google Scholar 

  • Mandy W, Tchanturia K (2015) Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Mol Autism 6:6

    Article  PubMed  PubMed Central  Google Scholar 

  • National Institute for Health and Clinical Excellence (2011) Autism: recognition, referral and diagnosis of children and young people on the autism spectrum (NICE guideline). National Collaborating Centre for Womens and Childrens Health, London

    Google Scholar 

  • Nickel K, Maier S, Endres D et al (2019) Systematic review: overlap between eating, autism spectrum, and attention-deficit/hyperactivity disorder. Front Psych 10:708

    Article  Google Scholar 

  • Nielsen S, Anckarsäter H, Gillberg C, Gillberg C, Råstam M, Wentz E (2015) Effects of autism spectrum disorders on outcome in teenage-onset anorexia nervosa evaluated by the Morgan-Russell outcome assessment schedule: a controlled community-based study. Mol Autism 6:14. https://doi.org/10.1186/s13229-015-0013-4. PMID: 25774282; PMCID: PMC4359566

    Article  PubMed  PubMed Central  Google Scholar 

  • Numata N, Nakagawa A, Yoshioka K et al (2021) Associations between autism spectrum disorder and eating disorders with and without self-induced vomiting: an empirical study. J Eat Disord 9(1):5. https://doi.org/10.1186/s40337-020-00359-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Parmeggiani A (2014) Gastrointestinal disorders and autism. In: Patel VB, Preedy VR, Martin CR (eds) Comprehensive guide to autism. Diet and nutrition in autism spectrum disorders. Springer, London, pp 2035–2046

    Google Scholar 

  • Parmeggiani A, Pruccoli J (2022) Eating Disorders in Infants and Toddlers. In Hidden and Lesser-known Disordered Eating Behaviors in Medical and Psychiatric Conditions (pp. 5–13). Springer, Cham.

    Google Scholar 

  • Perrone A, Aruta SF, Crucitti G (2020) Pervasive refusal syndrome or anorexia nervosa: a case report with a successful behavioural treatment. Eat Weight Disord 26(6):2089–2093

    Article  PubMed  PubMed Central  Google Scholar 

  • Postorino V, Scahill L, De Peppo L et al (2017) Investigation of autism spectrum disorder and autistic traits in an adolescent sample with anorexia nervosa. J Autism Dev Disord 47:1051–1061

    Article  PubMed  Google Scholar 

  • Pruccoli J, Rosa S, Cesaroni CA et al (2021a) Association among autistic traits, treatment intensity and outcomes in adolescents with anorexia nervosa: preliminary results. J Clin Med 10:3605. https://doi.org/10.3390/jcm10163605

  • Pruccoli J, Solari A, Terenzi L et al (2021b) Autism spectrum disorder and anorexia nervosa: an Italian prospective study. Ital J Pediatr 47(1):59. https://doi.org/10.1186/s13052-021-01006-7

  • Rybak A (2015) Organic and nonorganic feeding disorders. Ann Nutr Metab 5:16–22. https://doi.org/10.1159/000381373

    Article  CAS  Google Scholar 

  • Santosh PJ, Mandy WP, Puura K et al (2009) The construction and validation of a short form of the developmental, diagnostic and dimensional interview. Eur Child Adolesc Psychiatry 18:521–524

    Article  PubMed  Google Scholar 

  • Sedgewick F, Kerr-Gaffney J, Leppanen J, Tchanturia K (2019a) Anorexia nervosa, autism, and the ADOS: how appropriate is the new algorithm in identifying cases? Front Psych 10:507

    Google Scholar 

  • Sedgewick F, Leppanen J, Goh F et al (2019b) Similarities and differences in theory of mind responses of patients with anorexia nervosa with and without autistic features. Front Psych 10:318

    Google Scholar 

  • Simonoff E, Pickles A, Charman T et al (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 47:921–929

    Article  PubMed  Google Scholar 

  • Skuse D, Warrington R, Bishop D et al (2004) The developmental, dimensional and diagnostic interview (3di): a novel computerized assessment for autism spectrum disorders. J Am Acad Child Adolesc Psychiatry 43(5):548–558. https://doi.org/10.1097/00004583-200405000-00008

    Article  PubMed  Google Scholar 

  • Smink FR, Van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414

    Article  PubMed  PubMed Central  Google Scholar 

  • Stewart C, McEwen F, Konstantellou A et al (2017) Impact of ASD on treatment outcomes of eating disorders in girls. Eur Eat Disord Rev 25:123–128

    Article  PubMed  Google Scholar 

  • Strober M, Freeman R, Lampert C, Diamond J (2007) The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: evidence from a family study with discussion of nosological and neurodevelopmental implications. Int J Eat Disord. https://doi.org/10.1002/eat.20429

  • Taurines R, Schwenck C, Westerwald E et al (2012) ADHD and autism: differential diagnosis or overlapping traits? A selective review. ADHD Atten Deficit Hyperact Disord 4:115–139

    Article  Google Scholar 

  • Tchanturia K, Adamson J, Leppanen J, Westwood H (2019) Characteristics of autism spectrum disorder in anorexia nervosa: a naturalistic study in an impatient treatment programme. Autism 23:123–130

    Article  PubMed  Google Scholar 

  • Thapar A, Rutter M (2015) Neurodevelopmental disorders. Rutter’s child adolescent psychiatry. Sixth edition. John Wiley & Sons Inc, Chichester, West Sussex; Ames, Iowa, 31–40. https://doi.org/10.1002/9781118381953

  • Thapar A, Cooper M, Rutter M (2017) Neurodevelopmental disorders. Lancet Psychiatry 4:339–346

    Article  PubMed  Google Scholar 

  • Treasure J, Schmidt U (2013) The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 1:13

    Article  PubMed  PubMed Central  Google Scholar 

  • Westwood H, Tchanturia K (2017) Autism spectrum disorder in anorexia nervosa: an updated literature review. Curr Psychiatry Rep 19:1

    Google Scholar 

  • Westwood H, Stahl D, Mandy W, Tchanturia K (2016) The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the Wisconsin card sorting test: a systematic review and meta-analysis. Psychol Med 46:1809–1827

    Article  CAS  PubMed  Google Scholar 

  • Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K (2017a) Alexithymia in eating disorders: systematic review and meta-analyses of studies using the Toronto alexithymia scale. J Psychosom Res 99:66–81

    Google Scholar 

  • Westwood H, Mandy W, Tchanturia K (2017b) The association between symptoms of autism and neuropsychological performance in females with anorexia nervosa. Psychiatry Res 258:531–537

    Google Scholar 

  • Westwood H, Mandy W, Simic M, Tchanturia K (2018) Assessing ASD in adolescent females with anorexia nervosa using clinical and developmental measures: a preliminary investigation. J Abnorm Child Psychol 46(1):183–192. https://doi.org/10.1007/s10802-017-0301-x

    Article  PubMed  Google Scholar 

  • Xu G, Strathearn L, Liu B, Bao W (2018) Corrected prevalence of autism spectrum disorder among US children and adolescents. JAMA 319(5):505

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell‘Età Pediatrica, Centro Regionale per i Disturbi della Nutrizione e dell’Alimentazione in età evolutiva, Bologna, Italy

    Antonia Parmeggiani & Jacopo Pruccoli

  2. DIMEC Dipartimento di Scienze Mediche e Chirurgiche, Bologna, Italy

    Antonia Parmeggiani & Jacopo Pruccoli

Authors
  1. Antonia Parmeggiani
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  2. Jacopo Pruccoli
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Correspondence to Jacopo Pruccoli .

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Editors and Affiliations

  1. School of Life Sciences, University of Westminster, London, UK

    Vinood B. Patel

  2. School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Victor R. Preedy

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Parmeggiani, A., Pruccoli, J. (2023). Anorexia Nervosa and Comorbidities. In: Patel, V.B., Preedy, V.R. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-16691-4_36

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  • DOI: https://doi.org/10.1007/978-3-031-16691-4_36

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  • Print ISBN: 978-3-031-16690-7

  • Online ISBN: 978-3-031-16691-4

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