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Adams KL, Mandy W, Catmur C, Bird G. Potential mechanisms underlying the association between feeding and eating disorders and autism. Neurosci Biobehav Rev 2024; 162:105717. [PMID: 38754718 DOI: 10.1016/j.neubiorev.2024.105717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
There is a reliable association between autism and Feeding and Eating Disorders. Concerningly, where these two conditions co-occur, clinical outcomes of Feeding and Eating Disorders are significantly worse, and treatment less effective, than when the Feeding and Eating Disorders occur in neurotypical individuals. Problematically, the reason for the association between autism and Feeding and Eating Disorders is poorly understood, which constrains advances in clinical care. This paper outlines several possible mechanisms that may underlie the observed association and suggests ways in which they may be empirically tested. Mechanisms are split into those producing an artefactual association, and those reflecting a genuine link between conditions. Artefactual associations may be due to conceptual overlap in both diagnostic criteria and measurement, Feeding and Eating Disorders causing transient autistic traits, or the association being non-specific in nature. A genuine association between autism and Feeding and Eating Disorders may be due to common causal factors, autism directly or indirectly causing Feeding and Eating Disorders, and Feeding and Eating Disorders being a female manifestation of autism.
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Affiliation(s)
- Kiera Louise Adams
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - William Mandy
- Division of Psychology and Language, University College London, London, UK
| | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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2
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Gray IE, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Cognitive and emotional empathy in acute and remitted anorexia nervosa: a systematic review. Front Psychiatry 2024; 15:1385185. [PMID: 38855647 PMCID: PMC11157095 DOI: 10.3389/fpsyt.2024.1385185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background Impairments in empathy are well established in anorexia nervosa (AN). It is unclear, however, whether these deficits only occur in the acute phases of AN due to neurocognitive impacts of starvation (often referred to as context-dependent, or state-like), or if deficits remain once remission has been achieved (trait-like). This debate is commonly referred to as the 'state vs trait' debate. Objective This systematic review aims to summarise existing literature regarding empathy in AN, and to investigate whether empathy deficits in AN are state- or trait-based. Method A total of 1014 articles were identified, and seven articles remained after the screening process. These seven articles, comparing empathy across three groups (acute AN, remission of AN, and non-clinical controls), were evaluated and summarised in accordance with PRISMA guidelines. Articles were required to have included all three groups and report on either cognitive empathy and/or emotional empathy. Results The majority of studies were of satisfactory quality. The results identified were inconsistent, with few articles lending some support to the 'state' hypothesis and others producing nonsignificant results. Conclusions There is minimal literature comparing empathy in acute and remission phases of AN. While there were some inconsistencies in included articles, some data indicate that there may be slight improvements to emotional and cognitive empathy following recovery of AN. Further research is needed to better enrich knowledge regarding the role of state vs trait with regard to neurocognitive difficulties experienced by individuals with AN. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335669, identifier CRD42022335669.
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Affiliation(s)
- Indigo E. Gray
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
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3
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McEnaney E, Ryan C. Improving the Objective Measurement of Alexithymia Using a Computer-Scored Alexithymia Provoked Response Questionnaire with an Online Sample. J Pers Assess 2024:1-11. [PMID: 38422394 DOI: 10.1080/00223891.2024.2320417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
The study and measurement of alexithymia - a trait marked by difficulty identifying and describing feelings - can be improved by incorporating objective measures to supplement self-report scales. The Alexithymia Provoked Response Questionnaire (APRQ) is an observer-rated alexithymia tool that shows promise yet can be time-consuming to administer. The present study aimed to assess the feasibility of computer administration and scoring of the APRQ. Further, the APRQ's association with verbal IQ and emotional vocabulary use was examined, as was the relationship between the APRQ and the self-report Bermond-Vorst Alexithymia Questionnaire-B (BVAQ-B). Adult participants (n = 366), including a proportion gathered through purposive sampling, participated in an online study. Inter-rater reliability measures indicated that computerized scoring of the APRQ is as reliable as human scoring, making the measure scalable for use with large samples. Alexithymia levels were independent of two measures of verbal IQ. Correlational analyses indicated overlap in alexithymia as measured by the APRQ and most of the subscales of the BVAQ-B. The APRQ, as an objective measure, may capture deficits in emotional awareness independent of self-insight.
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Affiliation(s)
- Emma McEnaney
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Christian Ryan
- School of Applied Psychology, University College Cork, Cork, Ireland
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4
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Schröder SS, Danner UN, Spek AA, van Elburg AA. Exploring the intersection of autism spectrum disorder and eating disorders: understanding the unique challenges and treatment considerations for autistic women with eating disorders. Curr Opin Psychiatry 2023; 36:419-426. [PMID: 37781983 DOI: 10.1097/yco.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Autistic women struggle with high levels of both autistic eating behaviours and disordered eating behaviours , which might make them particularly vulnerable to develop eating disorders. Research investigating the presence and characteristics of eating disorders in autistic women is however limited, as is research examining the role of autism in the treatment and recovery of an eating disorder in autistic women. RECENT FINDINGS The link between autism and eating disorders has mainly been investigated from the field of eating disorder research, with studies finding an overrepresentation of autism or autistic traits in eating disorders populations. Findings also suggest that autism or autistic traits are associated with a more serious presentation of the eating disorders, including a higher chance of a chronic course of the eating disorders. Most studies however lack comprehensive autism assessments, making it difficult to determine the actual prevalence of autism and its role in women with eating disorders. SUMMARY Autistic women with an eating disorder seem to suffer from more complex eating disorders and seem to not benefit from current treatment modalities. This could be partly related to specific autism characteristics such as sensory sensitivities, which are not being considered by current treatment protocols. Future research needs to shed light on what underlies the eating behaviours of autistic women with an eating disorder, in order to help to adapt current treatment modalities to meet the unique needs of these women.
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Affiliation(s)
- Sabrina S Schröder
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
| | - Annelies A Spek
- Autism Expert Center, Goyergracht Zuid 39, Eemnes, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
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5
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Nimbley E, Golds L, Sharpe H, Gillespie-Smith K, Duffy F. Sensory processing and eating behaviours in autism: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2022; 30:538-559. [PMID: 35737818 PMCID: PMC9545673 DOI: 10.1002/erv.2920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of this study was to assess the relationship between sensory processing and a broad range of eating behaviours across the lifespan. METHODS Five electronic databases of published and unpublished quantitative studies were systematically searched, evaluated for risk of bias and synthesised according to identified eating outcomes. RESULTS Across 25 studies, there was consistent evidence of a relationship between sensory processing and a range of eating behaviours. There was early evidence for the particular role of taste/smell sensitivities, as well as hypersensitivities, although future research is needed looking at different sensory patterns and modalities. There was also tentative evidence to suggest this relationship extends across development. DISCUSSION Study findings are discussed in relation to implications for sensory-based eating and feeding interventions and the development of eating disorders. Methodological and conceptual limitations are discussed and suggestions for future research are made to address these limitations. A broader investigation of multi-sensory issues and clearly defined eating behaviours, including disordered eating in clinically diagnosed samples, will allow for a more comprehensive and robust understanding of the relationship between sensory processing and eating behaviours in autism.
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Affiliation(s)
- Emy Nimbley
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Lisa Golds
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Helen Sharpe
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Fiona Duffy
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK.,NHS Lothian Child and Adolescent Mental Health Services, Royal Edinburgh Hospital, Edinburgh, UK
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6
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Miniati M, Marazziti D, Palagini L. Is Alexithymia the Link Between Anorexia and Autism Spectrum Disorders? CLINICAL NEUROPSYCHIATRY 2022; 19:137-149. [PMID: 35821872 PMCID: PMC9263678 DOI: 10.36131/cnfioritieditore20220302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Alexithymia main features include deficits in empathy, emotion recognition and regulation. Alexithymia has been recently proposed as a potential key to explain the presence of the so-called 'autistic spectrum disorder' signs (ASD), in patients with Anorexia Nervosa (AN). Objective of this review is to summarize current knowledge on the potential role of alexithymia in linking ASD and AN. Method A systematic search has been conducted on PUBMED database of the last 10 years, in accordance with PRISMA Guidelines, applying queries in the 'PubMed Advanced Search Builder'. Results We initially retrieved 18 papers; the final selection has led to seven papers. According to the available studies, alexithymia is widely represented in samples of AN patients and comorbid ASD traits. However, the specific load of alexithymia in AN with ASD features is still in debate, as well as the potential role of interoceptive deficits. We have found several limitations in the reviewed studies, which shared a cross-sectional design, with no comparison between a pre and a post-treatment condition (except for one study), small samples sizes and some heterogeneity of administered instruments. Conclusions the specific load of alexithymia in explaining the link between AN and ASD is still in debate. Interoception deficit has been proposed as having a crucial role. Further research should be devoted to longitudinal studies and not only to cross-sectional observations.
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Affiliation(s)
- Mario Miniati
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Via Roma 67, 56100, Pisa, Italy.,Corresponding author Mario Miniati, M.D., Ph.D. Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64/A, 44121, Ferrara, Italy
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7
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Dingemans AE, Volkmer SA, Mulkens S, Vuijk R, van Rood YR. The obsessive-compulsive spectrum: A network analysis. Psychiatry Res 2022; 308:114351. [PMID: 34979379 DOI: 10.1016/j.psychres.2021.114351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/24/2022]
Abstract
Several studies have shown that obsessive-compulsive disorder (OCD), eating disorders (ED), autism spectrum disorders (ASD) and body dysmorphic disorder (BDD) share obsessive-compulsive (OC) symptoms and often co-occur, which could be seen as indicative of a common etiological basis. In addition, they also appear to have similarities in executive functioning. The present study investigated disorder-specific symptoms and executive functioning as a possible joint factor in individuals with OCD (n=53), BDD (n=95), ED (n=171) and ASD (n=73), and in healthy controls (n=110). The participants completed online questionnaires measuring OCD, ED, ASD and BDD related symptoms as well as executive functioning. The clinical groups were first compared to the healthy controls. Subsequently, a network analysis was performed only with the OC-groups. This network approach assumes that psychopathological disorders are the result of causal symptom interactions. As expected, the healthy controls reported less severe symptoms compared to the OC patient groups. The network analysis suggested that the executive functioning skill set shifting/attention switching and the ASD symptoms, social and communication skills were the most central nodes in the model. Difficulty with cognitive flexibility and social factors are central in OC-spectrum disorders and may be perpetuating factors and thus a relevant focus of treatment.
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Affiliation(s)
| | | | - Sandra Mulkens
- Department of Psychiatry and Neuropsychology, and Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | | | - Yanda R van Rood
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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8
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Anorexia Nervosa and Autism Spectrum Disorder: A Systematic Review. Psychiatry Res 2021; 306:114271. [PMID: 34798485 DOI: 10.1016/j.psychres.2021.114271] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/20/2021] [Accepted: 11/01/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent research has shown a growing interest in exploring the relationship between anorexia nervosa (AN) and autism spectrum disorder (ASD). Both conditions seem to share areas of cognitive, social and behavioural impairment, leading to relevant implications on treatment, especially when they are in comorbidity. This literature review aims to synthesise the latest studies on this topic to investigate the co-occurrence of AN and ASD, suggest future research directions and consider implications for treatment. METHOD Records were systematically (PRISMA guidelines) identified through PubMed, EBSCOhost, Scopus and Web of Science searching. RESULTS Thirteen studies met the eligibility criteria and were therefore included in the review. Results seem to confirm an overrepresentation of ASD symptoms in AN. Only few studies investigated the AN-ASD comorbidity in young people and report slightly lower rates than those conducted with adults. CONCLUSIONS Analysed studies suggest that while the comorbidity seems to exacerbate the severity of the condition, autistic traits appear to be rather stable over time and not related to body weight. Thus, future longitudinal studies and gender- specific assessment tools can help clarify the relationship between the two disorders, examine the onset of ASD symptoms and develop structured guidelines for treatment.
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9
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Kerr-Gaffney J, Hayward H, Jones EJH, Halls D, Murphy D, Tchanturia K. Autism symptoms in anorexia nervosa: a comparative study with females with autism spectrum disorder. Mol Autism 2021; 12:47. [PMID: 34193255 PMCID: PMC8247081 DOI: 10.1186/s13229-021-00455-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Recent research suggests a link between autism spectrum disorder (ASD) and anorexia nervosa (AN). Individuals with AN show high scores on measures of ASD symptoms, relative to individuals without AN, however, there are currently no studies directly comparing women with AN to women with ASD. The aim of the current study was to examine profiles of ASD symptoms in young women in the acute and recovered stages of AN, women with ASD, and typically developing controls (TD), on both self-report and clinical interview measures. Methods Four groups of participants aged 12–30 years were included (n = 218): AN, recovered AN (REC), ASD, and TD. Group differences on the Social Responsiveness Scale, 2nd edition (SRS-2), 10-item Autism Quotient (AQ-10), and the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) were examined. To explore similarities and differences in specific symptom profiles associated with AN and ASD, individual item endorsement on the ADOS-2 was also examined in AN, REC, and ASD. Results Across measures, women with ASD showed the highest scores, and TDs the lowest. Generally, individuals with AN and REC showed intermediate levels of ASD symptoms, scoring between the other two groups. However, AN and ASD did not differ on restricted interests and repetitive behaviour subscales. The ADOS-2 item ‘quality of social response’ adequately discriminated between ASD and non-ASD participants. Limitations A full diagnostic assessment for ASD was not provided for participants with AN/REC, nor were eating disorders assessed in the ASD group. Therefore, some diagnostic overlap between groups is possible. The cross-sectional design is another limitation. Conclusions The results suggest similarities in scores on both self-report and clinical interview measures in AN and ASD. However, individual ADOS-2 item analyses also revealed subtle differences, particularly in reciprocal social interaction. ASD symptoms may be a combination of both state and trait features in AN. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00455-5.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.,Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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10
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Timko CA, Herrington JD, Bhattacharya A, Kuschner ES, Yerys BE. Caregiver Report of Executive Functioning in Adolescent Females With Anorexia Nervosa or Autism Spectrum Disorder. Front Psychol 2021; 11:586264. [PMID: 33633624 PMCID: PMC7899966 DOI: 10.3389/fpsyg.2020.586264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Current literature suggesting a shared endophenotype between individuals with anorexia nervosa (AN) and autism spectrum disorder (ASD) related to executive functioning (EF) has several limitations: performance-based instead of ecologically valid measures of set-shifting are used, lack of comparisons between same-sex groups, and reliance on adult samples only. This was the first study directly comparing female youth with ASD to female youth with AN using an ecologically valid measure of EF. A secondary data analysis combined caregiver-reported EF on the Behavior Rating Inventory of Executive Functioning (BRIEF) for 22 female adolescent youth with AN and 29 female adolescent youth with ASD. EF in each group was compared to population norms, and EF was compared between groups. Compared to population norms, adolescents with AN had elevated scores on shift, initiate, and emotional control scales, and adolescents with ASD had elevated scores on all scales of the BRIEF and were more likely to have scores in the clinical range. There were significant differences between groups on all but three scales. The cognitive profiles and clinical scores of AN females were not comparable to those of ASD females. The findings reveal a clear clinical impairment in females with ASD but not in females with AN. The results do not support the hypothesis of similar real-world EF profiles between these groups. The results encourage further exploration into the similarities and distinctions between these two disorders.
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Affiliation(s)
- C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - John D Herrington
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - Anushua Bhattacharya
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily S Kuschner
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - Benjamin E Yerys
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
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11
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Abstract
There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.
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Affiliation(s)
- Claire M Brown
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Mark A Stokes
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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12
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Huggins CF, Donnan G, Cameron IM, Williams JH. Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:307-321. [PMID: 33153301 PMCID: PMC7874376 DOI: 10.1177/1362361320964306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LAY ABSTRACT Autistic people are thought to have difficulties with identifying and understanding their own emotions. This is referred to as emotional self-awareness. It is important to study emotional self-awareness as people who are more able to understand their own emotions, whether they are autistic or not, are more able to respond to them appropriately, as well as to identify them in other people. It has not yet been confirmed whether autistic people have difficulties with emotional self-awareness, or if any reported difficulties are actually due to the way in which emotional self-awareness is measured in autistic people. If these difficulties do exist, it is also not known when these difficulties emerge. In this research, we reviewed 47 existing studies that measured emotional self-awareness in autistic and non-autistic adults and children. We also compared studies that measured emotional self-awareness in different ways. We found that autistic adults did seem to have poorer emotional self-awareness compared to their neurotypical peers. However, this was not the case with autistic children of age 12 years and below. Instead, differences in emotional self-awareness only seemed to emerge during adolescence. Moreover, these difficulties seemed to increase with age. These results suggest that difficulties with emotional self-awareness may not be inherent in autism. Instead, they may emerge alongside the greater social and mental health difficulties that are experienced by many autistic people during adolescence. We therefore suggest that it is important to find out more about, and subsequently support, the emotional self-awareness difficulties that autistic adolescents may encounter.
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13
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Barrionuevo BA, Chowdhury AR, Lee JM, Dueker ND, Martin ER, Pericak-Vance MA, Cuccaro M. Family History of Eating Disorder and the Broad Autism Phenotype in Autism. Autism Res 2020; 13:1573-1581. [PMID: 32888262 DOI: 10.1002/aur.2378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/07/2022]
Abstract
Autism features occur frequently among individuals with eating disorders (ED). This co-occurrence is not well understood but there is speculation that select traits (e.g., rigidity) are common to both autism and ED. To explore the co-occurrence of autistic traits and ED features, we used the Simons Simplex Collection (SSC; N = 2,623 families) to test whether first-degree relatives of individuals with autism with a history of ED features had more autism traits, as measured by the Broad Autism Phenotype Questionnaire (BAP-Q), compared to relatives with no history of ED. The frequency of individuals with ED features was 2.2% (N = 57) among mothers, <1% in siblings, and not present in fathers. We restricted our analyses to mothers. Compared to mothers with no history of ED, those with a history of ED had significantly higher scores on the BAP-Q Total Score and each of the three BAP-Q domains. More importantly, when the BAP-Q was used as a classification tool, we found that when compared to mothers with no history of ED, those with a history of ED were most likely to fall into the clinically significant range on the BAP-Q Rigid domain. Our results suggest that a history of ED features among mothers of individuals with autism is associated with the presence of autistic traits. This extends previous work showing a relationship between autism and ED and expands the range of neuropsychiatric traits that have relevance to the BAP among family members of individuals with autism. LAY SUMMARY: Using information from the Simons Simplex Collection we tested whether mothers of individuals with autism with a history of eating disorder had more autism traits (i.e., similar to those in autism but milder) compared to mothers with no history of eating disorder. The most striking difference between the groups was the presence of rigidity in mothers with a history of eating disorder. This extends previous work showing a relationship between autism and eating disorders and suggests the utility of studying eating disorders in future family studies of autism. Autism Res 2020, 13: 1573-1581. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Joycelyn M Lee
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicole D Dueker
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eden R Martin
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret A Pericak-Vance
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Cuccaro
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
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14
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Vuillier L, Carter Z, Teixeira AR, Moseley RL. Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology. Mol Autism 2020; 11:63. [PMID: 32758290 PMCID: PMC7406391 DOI: 10.1186/s13229-020-00364-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/15/2020] [Indexed: 12/14/2022] Open
Abstract
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 sex-specific as well as generic risk factors in autistic and non-autistic men and women.
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Affiliation(s)
- L. Vuillier
- Department of Psychology, Bournemouth University, Poole, UK
| | - Z. Carter
- Department of Psychology, Bournemouth University, Poole, UK
| | - A. R. Teixeira
- Department of Psychology, Bournemouth University, Poole, UK
| | - R. L. Moseley
- Department of Psychology, Bournemouth University, Poole, UK
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15
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Lander R, Heled E, Gur E. Executive functioning and spatial processing in anorexia nervosa: an experimental study and its significance for the allocentric lock theory. Eat Weight Disord 2020; 25:1039-1047. [PMID: 31209765 DOI: 10.1007/s40519-019-00728-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The allocentric lock theory (ALT) suggests that people with eating disorders have difficulties in multisensory integration in two reference frames-egocentric and allocentric, whereby the egocentric, but not allocentric, is impaired. This leads to a distorted body image that contributes to the development and maintenance of the disorder. The current study aimed to explore a facet of the ALT, namely, the visuo-spatial aspect, and its relation to cognitive flexibility in patients with anorexia nervosa (AN). METHODS Fifty-five participants took part in the study: 20 AN patients and 35 controls, matched by age and education. The object perspective taking test (OPTT) and the mental rotation test (MRT), tapping egocentric and allocentric representations, respectively, and a set-shifting task were administered. The brief symptom inventory was used to measure overall levels of distress. RESULTS AN patients showed higher level of distress. They performed poorer on the OPTT and set-shifting task but not on the MRT. The OPTT and MRT were correlated for controls but not for AN patients, while the set-shifting task and body mass index were associated with the OPTT but not with the MRT for the AN patients. CONCLUSIONS The findings support the ALT by demonstrating impaired visual egocentric representations and intact allocentric visual functions in AN patients, with cognitive flexibility associated only with the egocentric frame. Therefore, egocentric frame impairment in AN patients may be influenced by visual perception and cognitive flexibility deficiency. LEVEL OF EVIDENCE Level III: case-control analytic study.
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Affiliation(s)
- Ravid Lander
- Department of Psychology, Ariel University, Ariel, Israel
| | - Eyal Heled
- Department of Psychology, Ariel University, Ariel, Israel. .,Neurological Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel.
| | - Eitan Gur
- Department of Eaing Disorders, Sheba Medical Center, Ramat Gan, Israel
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16
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Saure E, Laasonen M, Lepistö-Paisley T, Mikkola K, Ålgars M, Raevuori A. Characteristics of autism spectrum disorders are associated with longer duration of anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2020; 53:1056-1079. [PMID: 32181530 DOI: 10.1002/eat.23259] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with neuropsychological characteristics such as impairments in central coherence, cognitive flexibility, and emotion recognition. The same features also manifest in autism spectrum disorders (ASD) and have been suggested to be associated with illness prolongation in AN. The purpose of this meta-analysis was to examine whether pronounced neuropsychological characteristics related to ASD are associated with illness duration in AN. METHOD Four databases (Medline, PsycINFO, Scopus, PubMed) were searched for eligible studies. Search terms were (a) "anorexia nervosa" and (b) "cognitive flexibility" or "set-shifting" or "central coherence" or "emotion recognition" or "theory of mind". The final sample consisted of 53 studies. Duration of AN was divided into three categories in order to investigate differences between the groups with varying illness duration. The meta-analysis was performed with Review Manager using a random-effects model. RESULTS Deficits in central coherence, cognitive flexibility, and emotion recognition were pronounced among individuals with prolonged AN compared to those with shorter illness duration. DISCUSSION A prolonged course of AN appears to be associated with underlying neuropsychological characteristics that are also distinctive to ASD. Neuropsychological impairments may lead to prolonged AN, and prolonged illness may contribute to the subsequent "neurological scar effect," further strengthening these impairments.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marja Laasonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.,Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Katri Mikkola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Monica Ålgars
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Åbo Akademi University, Department of Psychology, Åbo Akademi Fakulteten för humaniora psykologi och teologi, Turku, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
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17
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Brown CM, Stokes MA. Intersection of Eating Disorders and the Female Profile of Autism. Child Adolesc Psychiatr Clin N Am 2020; 29:409-417. [PMID: 32169270 DOI: 10.1016/j.chc.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.
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Affiliation(s)
- Claire M Brown
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Mark A Stokes
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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18
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Meneguzzo P, Collantoni E, Bonello E, Busetto P, Tenconi E, Favaro A. The predictive value of the early maladaptive schemas in social situations in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:318-331. [PMID: 31999048 DOI: 10.1002/erv.2724] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) show an impairment in the recognition and expression of emotions, as well as an increased sensitivity to being socially excluded, and rigid maladaptive schemas. The Cyberball paradigm is a virtual ball-toss game that can simulate social exclusion and inclusion. Our aim is to evaluate how cognitive schemas can influence the perception and the evaluation of the experiences of social inclusion/exclusion. METHODS Thirty-two AN patients and 34 healthy controls completed a psychological evaluation and were randomly assigned to exclusion or overinclusion paradigm of the Cyberball task. RESULTS Patients with AN showed a significantly higher level of maladaptive schemas as well as higher sensitivity to being ostracized by peers in comparison with healthy controls. Regression analyses identified specific significant relation between being ostracized and dependence/incompetence, negativity/pessimism, and self-sacrifice. DISCUSSION Our findings provide evidence that patients with AN may be ineffective in expressing their mood in exclusive and overinclusive social situations. Specific cognitive/temperamental schemas might play a role in the way people communicate their feelings, and they could be considered targets for psychotherapy interventions to improve social interpretation and emotional recognition/communication.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Elisa Bonello
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Paolo Busetto
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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19
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Fornaro M, Sassi T, Novello S, Anastasia A, Fusco A, Senatore I, de Bartolomeis A. Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa. ACTA ACUST UNITED AC 2019; 42:153-161. [PMID: 31691722 PMCID: PMC7115451 DOI: 10.1590/1516-4446-2019-0500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Autistic traits are associated with a burdensome clinical presentation of anorexia nervosa (AN), as is AN with concurrent depression. The aim of the present study was to explore the intertwined association between complex psychopathology combining autistic traits, subthreshold bipolarity, and mixed depression among people with AN. METHOD Sixty patients with AN and concurrent major depressive episode (mean age, 22.2±7 years) were cross-sectionally assessed using the Autism-Spectrum Quotient test (AQ-test), the Hamilton depression scales for depression and anxiety, the Young Mania Rating Scale (YMRS), the Hypomania-Checklist-32 (HCL-32), second revision (for subthreshold bipolarity), the Brown Assessment and Beliefs Scale (BABS), the Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS), and the Eating Disorder Examination Questionnaire (EDE-Q). Cases were split into two groups depending on body mass index (BMI): severe AN (AN+) if BMI < 16, not severe (AN-) if BMI ≥ 16. RESULTS The "subthreshold bipolarity with prominent autistic traits" pattern correctly classified 83.6% of AN patients (AN+ = 78.1%; AN- = 91.3%, Exp(B) = 1.391). AN+ cases showed higher rates of positive scores for YMRS items 2 (increased motor activity-energy) and 5 (irritability) compared to AN- cases. CONCLUSIONS In our sample, depressed patients with severe AN had more pronounced autistic traits and subtly mixed bipolarity. Further studies with larger samples and prospective follow-up of treatment outcomes are warranted to replicate these findings.
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Affiliation(s)
- Michele Fornaro
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Teresa Sassi
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Stefano Novello
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | | | - Andrea Fusco
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Ignazio Senatore
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Andrea de Bartolomeis
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
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20
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Warrier V, Toro R, Won H, Leblond CS, Cliquet F, Delorme R, De Witte W, Bralten J, Chakrabarti B, Børglum AD, Grove J, Poelmans G, Hinds DA, Bourgeron T, Baron-Cohen S. Social and non-social autism symptoms and trait domains are genetically dissociable. Commun Biol 2019; 2:328. [PMID: 31508503 PMCID: PMC6722082 DOI: 10.1038/s42003-019-0558-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
The core diagnostic criteria for autism comprise two symptom domains - social and communication difficulties, and unusually repetitive and restricted behaviour, interests and activities. There is some evidence to suggest that these two domains are dissociable, though this hypothesis has not yet been tested using molecular genetics. We test this using a genome-wide association study (N = 51,564) of a non-social trait related to autism, systemising, defined as the drive to analyse and build systems. We demonstrate that systemising is heritable and genetically correlated with autism. In contrast, we do not identify significant genetic correlations between social autistic traits and systemising. Supporting this, polygenic scores for systemising are significantly and positively associated with restricted and repetitive behaviour but not with social difficulties in autistic individuals. These findings strongly suggest that the two core domains of autism are genetically dissociable, and point at how to fractionate the genetics of autism.
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Affiliation(s)
- Varun Warrier
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
| | - Roberto Toro
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | - Hyejung Won
- Department of Genetics and Neuroscience Center, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Claire S. Leblond
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | - Freddy Cliquet
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | - Richard Delorme
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Ward De Witte
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janita Bralten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Bhismadev Chakrabarti
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Anders D. Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
| | - Jakob Grove
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Centre for Integrative Sequencing, iSEQ, Aarhus University, Aarhus, Denmark
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Thomas Bourgeron
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
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21
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Crespi B, Dinsdale N. Autism and psychosis as diametrical disorders of embodiment. Evol Med Public Health 2019; 2019:121-138. [PMID: 31402979 PMCID: PMC6682708 DOI: 10.1093/emph/eoz021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Humans have evolved an elaborate system of self-consciousness, self-identity, self-agency, and self-embodiment that is grounded in specific neurological structures including an expanded insula. Instantiation of the bodily self has been most-extensively studied via the 'rubber hand illusion', whereby parallel stimulation of a hidden true hand, and a viewed false hand, leads to the felt belief that the false hand is one's own. Autism and schizophrenia have both long been regarded as conditions centrally involving altered development of the self, but they have yet to be compared directly with regard to the self and embodiment. Here, we synthesize the embodied cognition literature for these and related conditions, and describe evidence that these two sets of disorders exhibit opposite susceptibilities from typical individuals to the rubber hand illusion: reduced on the autism spectrum and increased in schizophrenia and other psychotic-affective conditions. Moreover, the opposite illusion effects are mediated by a consilient set of associated phenomena, including empathy, interoception, anorexia risk and phenotypes, and patterns of genetic correlation. Taken together, these findings: (i) support the diametric model of autism and psychotic-affective disorders, (ii) implicate the adaptive human system of self-embodiment, and its neural bases, in neurodevelopmental disorders, and suggest new therapies and (iii) experimentally ground Bayesian predictive coding models with regard to autism compared with psychosis. Lay summary: Humans have evolved a highly developed sense of self and perception of one's own body. The 'rubber hand illusion' can be used to test individual variation in sense of self, relative to connection with others. We show that this illusion is reduced in autism spectrum disorders, and increased in psychotic and mood disorders. These findings have important implications for understanding and treatment of mental disorders.
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Affiliation(s)
- Bernard Crespi
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Natalie Dinsdale
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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22
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Tonacci A, Calderoni S, Billeci L, Maestro S, Fantozzi P, Ciuccoli F, Morales MA, Narzisi A, Muratori F. Autistic traits impact on olfactory processing in adolescent girls with Anorexia Nervosa restricting type. Psychiatry Res 2019; 274:20-26. [PMID: 30776708 DOI: 10.1016/j.psychres.2019.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/03/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
The correct functioning of the chemosensory pathway is pivotal for the attitude towards feeding. In some neuropsychiatric disorders, abnormalities of the sensory processing dramatically affect feeding behavior; however, evidences for an olfactory involvement in Anorexia Nervosa (AN) are still controversial. We administered a complete olfactory testing battery, the Sniffin' Sticks Extended Test, to a cohort of 19 girls with Restrictive Anorexia Nervosa (AN-R) and 19 healthy controls. A battery of questionnaires aiming to evaluate eating attitude, psychopathologic disorders and autistic traits was also administered. No difference was found between the two groups in any of the olfactory tasks. Despite the lack of correlation between olfaction and disease severity, however, olfactory performances were related to autistic traits in anorectic girls (r = -0.489, p = 0.039). Girls with AN-R do not appear to have an impaired olfactory function with respect to controls. However, a possible correlation between olfactory ability and autistic traits was discovered. In light of such findings, the role of possible relations between social functioning-related features and olfactory processing in AN-R is discussed.
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Affiliation(s)
- Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | - Sara Calderoni
- IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | | | | | | | - Maria Aurora Morales
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | | | - Filippo Muratori
- IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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23
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Kerr-Gaffney J, Harrison A, Tchanturia K. Cognitive and Affective Empathy in Eating Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:102. [PMID: 30886590 PMCID: PMC6410675 DOI: 10.3389/fpsyt.2019.00102] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Recent models of eating disorders (EDs) have proposed social and emotional difficulties as key factors in the development and maintenance of the illness. While a number of studies have demonstrated difficulties in theory of mind and emotion recognition, little is known about empathic abilities in those with EDs. Further, few studies have examined the cognitive-affective empathy profile in EDs. The aim of this systematic review and meta-analysis was to provide a synthesis of empathy studies in EDs, and examine whether those with EDs differ from healthy controls (HC) on self-reported total, cognitive, and affective empathy. Methods: Electronic databases were systematically searched for studies using self-report measures of empathy in ED populations. In total, 17 studies were identified, 14 of which could be included in the total empathy meta-analysis. Eight of the 14 studies were included in the cognitive and affective empathy meta-analyses. Results: Meta-analyses showed that while total empathy and affective empathy scores did not differ between those with anorexia nervosa (AN) and HC, those with AN had significantly lower cognitive empathy scores compared to HCs (small effect size). Meta-analyses of Interpersonal Reactivity Index sub-scores revealed that AN had significantly lower Fantasy scores than HC (small effect size), indicating that those with AN have more difficulty in identifying themselves with fictional characters. Only 3 studies examined empathy in those with bulimia nervosa (BN) or binge eating disorder (BED). Conclusions: The lowered cognitive empathy and intact affective empathy profile found in AN is similar to that found in other psychiatric and neurodevelopmental conditions, such as autism spectrum disorder (ASD). These findings add to the literature characterizing the socio-emotional phenotype in EDs. Future research should examine the influence of comorbid psychopathology on empathy in EDs.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, United Kingdom.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, National Eating Disorders Service, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, National Eating Disorders Service, London, United Kingdom.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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24
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Brewer R, Cook R, Cardi V, Treasure J, Catmur C, Bird G. Alexithymia explains increased empathic personal distress in individuals with and without eating disorders. Q J Exp Psychol (Hove) 2018; 72:1827-1836. [DOI: 10.1177/1747021818816051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is often assumed that empathy impairments are common in individuals with eating disorders (EDs), but empirical work has been limited and produced mixed results, making the clinical features and treatment needs of this population difficult to determine. Alexithymia, characterised by difficulties identifying and describing one’s own emotions, frequently co-occurs with EDs and is associated with atypical recognition of, and empathy for, others’ emotions. This study used an existing empathy for pain paradigm to determine whether atypical empathy in EDs stems from co-occurring alexithymia, rather than EDs per se. Empathy (specifically personal distress in response to others’ pain) was assessed in individuals with EDs ( N = 21) and an alexithymia-matched control group ( N = 22). Participants were simultaneously members of a high alexithymia ( N = 16) or low alexithymia ( N = 27) group, allowing the independent contributions of alexithymia and EDs to be determined. Participants judged the laterality of hands and feet in painful and non-painful situations, and the degree of empathic interference on response times was measured. Results indicated that observation of painful stimuli affected task performance in those with high levels of alexithymia more than those with low levels, but no effect of ED diagnosis was observed. These findings suggest that co-occurring alexithymia explains increased empathic personal distress in ED populations. Atypical empathy may therefore not be a core feature of EDs, and interventions aimed at improving empathy-related social functioning may only be necessary for patients who also have alexithymia. These findings emphasise the importance of determining the influence of co-occurring alexithymia when assessing empathy in clinical populations.
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Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Richard Cook
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Valentina Cardi
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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25
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Zegarra-Valdivia JA, Chino-Vilca BN. Social Cognition and Executive Function Impairment in Young Women with Anorexia Nervosa. CLÍNICA Y SALUD 2018. [DOI: 10.5093/clysa2018a16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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26
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Zhou ZC, McAdam DB, Donnelly DR. Endophenotypes: A conceptual link between anorexia nervosa and autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 82:153-165. [PMID: 29239739 DOI: 10.1016/j.ridd.2017.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
The paper, by translating the concept and the two models of endophenotype (EP), strengthens the hypothesis that there exists a linkage between anorexia nervosa (AN) and autism spectrum disorder (ASD). Specifically, the paper synthesizes empirical research that supported the idea that individuals with AN and individuals with ASD share similarities with respect to their neurocognitive EPs and temperament EPs. The paper then introduces an innovative structure to emphasize the subtle difference between neurocognitive EPs and temperament EPs in relation to AN and ASD. This structure constitutes the categorization of the shared neurocognitive EPs to the liability-index model of EP and the shared temperament EPs to the mediational model of EP. The paper argues that the shared neurocognitive EPs under the liability index model of EP are trait markers signaling the effects of genes on the phenotypes of AN and ASD; whereas, the shared temperament EPs under the mediational model of EP are state markers describing the symptomatic status of AN and ASD. The proposition of the paper suggests clinicians and researchers should target the atypical state markers (i.e., temperament EPs) shared between AN and ASD when tailoring environment-based treatments for individuals with AN who exhibit autistic behaviors and individuals with ASD who display disordered eating behaviors or anorexic symptoms.
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Affiliation(s)
- Z C Zhou
- University of Rochester, Department of Counseling and Human Development, 500 Wilson Blvd, Rochester, NY 14627, USA.
| | - D B McAdam
- University of Rochester Medical Center, Strong Center for Developmental Disabilities, Department of Pediatrics, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - D R Donnelly
- University of Rochester, Department of Counseling and Human Development, 500 Wilson Blvd, Rochester, NY 14627, USA
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27
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Investigation of Autism Spectrum Disorder and Autistic Traits in an Adolescent Sample with Anorexia Nervosa. J Autism Dev Disord 2017; 47:1051-1061. [PMID: 28120263 DOI: 10.1007/s10803-016-3023-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to examine the presence of Autism Spectrum Disorder (ASD) in a sample of female adolescents with Anorexia Nervosa (AN) during the acute phase of illness. We also compare the level of autistic traits, social perception skills and obsessive-compulsive symptoms in four groups: AN, ASD, and two gender- and age-matched control groups. Of the 30 AN participants, only three scored above the conventional ADOS-2 threshold for ASD. The AN participants were similar to their controls on autistic trait measures, and to the ASD group on obsessive-compulsive measures, and on theory of mind ability and affect recognition measures. Further longitudinal studies are needed in order to determine the association between these conditions.
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Dell'Osso L, Gesi C, Massimetti E, Cremone IM, Barbuti M, Maccariello G, Moroni I, Barlati S, Castellini G, Luciano M, Bossini L, Rocchetti M, Signorelli M, Aguglia E, Fagiolini A, Politi P, Ricca V, Vita A, Carmassi C, Maj M. Adult Autism Subthreshold Spectrum (AdAS Spectrum): Validation of a questionnaire investigating subthreshold autism spectrum. Compr Psychiatry 2017; 73:61-83. [PMID: 27918948 DOI: 10.1016/j.comppsych.2016.11.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 01/01/2023] Open
Abstract
AIM Increasing literature has shown the usefulness of a dimensional approach to autism. The present study aimed to determine the psychometric properties of the Adult Autism Subthreshold Spectrum (AdAS Spectrum), a new questionnaire specifically tailored to assess subthreshold forms of autism spectrum disorder (ASD) in adulthood. METHODS 102 adults endorsing at least one DSM-5 symptom criterion for ASD (ASDc), 143 adults diagnosed with a feeding and eating disorder (FED), and 160 subjects with no mental disorders (CTL), were recruited from 7 Italian University Departments of Psychiatry and administered the following: SCID-5, Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale 14-item version (RAADS-14), and AdAS Spectrum. RESULTS The AdAS Spectrum demonstrated excellent internal consistency for the total score (Kuder-Richardson's coefficient=.964) as well as for five out of seven domains (all coefficients>.80) and sound test-retest reliability (ICC=.976). The total and domain AdAS Spectrum scores showed a moderate to strong (>.50) positive correlation with one another and with the AQ and RAADS-14 total scores. ASDc subjects reported significantly higher AdAS Spectrum total scores than both FED (p<.001) and CTL (p<.001), and significantly higher scores on the Childhood/adolescence, Verbal communication, Empathy, Inflexibility and adherence to routine, and Restricted interests and rumination domains (all p<.001) than FED, while on all domains compared to CTL. CTL displayed significantly lower total and domain scores than FED (all p<.001). A significant effect of gender emerged for the Hyper- and hyporeactivity to sensory input domain, with women showing higher scores than men (p=.003). A Diagnosis* Gender interaction was also found for the Verbal communication (p=.019) and Empathy (p=.023) domains. When splitting the ASDc in subjects with one symptom criterion (ASD1) and those with a ASD, and the FED in subjects with no ASD symptom criteria (FED0) and those with one ASD symptom criterion (FED1), a gradient of severity in AdAS Spectrum scores from CTL subjects to ASD patients, across FED0, ASD1, FED1 was shown. CONCLUSIONS The AdAS Spectrum showed excellent internal consistency and test-retest reliability and strong convergent validity with alternative dimensional measures of ASD. The questionnaire performed differently among the three diagnostic groups and enlightened some significant effects of gender in the expression of autistic traits.
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Affiliation(s)
- L Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Barbuti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Maccariello
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Moroni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G Castellini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - M Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - L Bossini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - M Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - M Signorelli
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - E Aguglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - A Fagiolini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - P Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - V Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - A Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - M Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Mansour S, Rozenblat V, Fuller-Tyszkiewicz M, Paganini C, Treasure J, Krug I. Emotions mediate the relationship between autistic traits and disordered eating: A new autistic-emotional model for eating pathology. Psychiatry Res 2016; 245:119-126. [PMID: 27541347 DOI: 10.1016/j.psychres.2016.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/28/2016] [Accepted: 08/06/2016] [Indexed: 01/30/2023]
Abstract
The aim of the study was to assess the extent of overlap between autistic traits, body dissatisfaction and disordered eating and to explore the mediating effects of negative attitudes towards emotional expression and emotion dysregulation. The sample comprised 416 university students (82% females, 17-48 years [M=19.76, SD=3.85]), who completed an online questionnaire assessing eating attitudes and behaviours (including dieting, bulimia and oral control), body dissatisfaction, and autistic traits (including the Autism Quotient [AQ] and its related subscales as well as the Empathising Quotient). Attitudes towards emotional expression and emotion regulation were also assessed. Results revealed that eating pathology correlated highly with all AQ subscales, with the exception of the attention to detail subscale. However, there was no significant relationship between empathising and eating pathology. Path-analyses indicated that emotion dysregulation, but not negative attitudes towards emotional expression, was a significant mediator of the relationship between AQ, body dissatisfaction and eating pathology. Direct relationships were also obtained for the AQ-bulimia and the AQ-oral control paths. Prevention and early intervention programs for eating pathology would likely benefit from addressing abnormalities in emotion processes in individuals who score highly on measures of autistic traits.
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Affiliation(s)
- Salma Mansour
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vanja Rozenblat
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Burwood, Victoria, Australia; Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
| | - Chiara Paganini
- Faculty of Health, University of Tasmania, Tasmania, Australia
| | - Janet Treasure
- King's College London, Institute of Psychiatry and Neuroscience, Department of Psychological medicine, Section of Eating Disorders, United Kingdom
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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30
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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 2016; 46:964-77. [PMID: 26542816 PMCID: PMC4746216 DOI: 10.1007/s10803-015-2641-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interest in the link between Autism Spectrum Disorder (ASD) and Anorexia Nervosa (AN) has led to estimates of the prevalence of autistic traits in AN. This systematic review and meta-analysis assessed the use of the Autism-Spectrum Quotient (AQ) or abbreviated version (AQ-10) to examine whether patients with AN have elevated levels of autistic traits. Seven studies were identified and subsequent meta-analysis indicated that those with AN appear to have significant difficulties of a manner characteristic of ASD, relative to controls. Whilst this analysis supports previous indications of higher prevalence of ASD in AN, the aetiology of these traits remains unclear. Studies using more robust clinical measures of ASD within AN are needed to confirm what self-report measures appear to show.
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Affiliation(s)
- Heather Westwood
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK
| | - Ivan Eisler
- Child and Adolescent Eating Disorders Service, Maudsley Hospital, London, SE5 8AZ, UK
- Department of Psychology, IoPPN, King's College London (KCL), London, UK
| | - William Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Jenni Leppanen
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK
| | - Janet Treasure
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK
| | - Kate Tchanturia
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK.
- Child and Adolescent Eating Disorders Service, Maudsley Hospital, London, SE5 8AZ, UK.
- Ilia State University, Tbilisi, Georgia.
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Tchanturia K, Larsson E, Adamson J. How anorexia nervosa patients with high and low autistic traits respond to group Cognitive Remediation Therapy. BMC Psychiatry 2016; 16:334. [PMID: 27682072 PMCID: PMC5041290 DOI: 10.1186/s12888-016-1044-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/19/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The current study aimed to evaluate group Cognitive remediation therapy (CRT) inpatients with Anorexia Nervosa (AN). We aimed to examine the treatment response of group CRT in AN patients with high or low levels of autistic traits. METHODS Thirty-five in patients with an AN diagnosis received group CRT intervention for 6 sessions in a national eating disorder unit. All participants completed self-report questionnaires on thinking styles and motivation before and after the intervention. RESULTS Patients with low autistic traits had statistically significant medium size effect improvements in self-reported thinking style scales as well as confidence (ability) to change. Patients with high autistic traits showed no statistically significant improvements in any outcome measure. CONCLUSIONS The brief group format CRT intervention improves self-reported cognitive and motivational aspects in people with AN without autistic traits. For patients with higher autistic traits brief group CRT does not improve self-reported cognitive style or motivation. This finding suggests that brief group format CRT might not be the best suited format for individuals with elevated autistic traits and individual or more tailored CRT should be explored.
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Affiliation(s)
- Kate Tchanturia
- King’s College London, Division of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, Beckenham, UK
- Illia State University Tbilisi, Tbilisi, Georgia
| | - Emma Larsson
- King’s College London, Division of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - James Adamson
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, Beckenham, UK
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32
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Raynal P, Melioli T, Chabrol H. Personality profiles in young adults with disordered eating behavior. Eat Behav 2016; 22:119-123. [PMID: 27289047 DOI: 10.1016/j.eatbeh.2016.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/07/2016] [Accepted: 06/01/2016] [Indexed: 12/21/2022]
Abstract
Personality traits are closely related to eating disorders (ED) and might be involved in their development and maintenance. Nevertheless little is known regarding the association between personality traits and disordered eating in subclinical populations. College students answered questionnaires assessing disordered eating behaviors (DEB) and the following personality disorder (PD) traits: schizotypal, autistic, obsessional, borderline and cyclothymic. Participants with DEB (n=101, 87% women) displayed significantly higher scores for several variables including schizotypy, cyclothymic, borderline and obsessional traits compared to other participants (n=378). Cluster analysis in the DEB subsample led to the identification of three groups: 1) a cluster with a high level of traits (HT); 2) a cluster scoring high on schizotypal, borderline and cyclothymic traits (SBC); 3) a cluster with a low level of traits (LT). Symptoms of depression, suicidal ideations, trait anger and obsessive-compulsive symptoms were higher in the HT and the SBC clusters compared to the LT cluster. Given that two thirds of participants suffering from DEB appeared to display a morbid personality profile, it appears of prime importance to take into account PD traits of individuals with DEB.
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Affiliation(s)
- Patrick Raynal
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse, UT2J, France.
| | - Tiffany Melioli
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse, UT2J, France
| | - Henri Chabrol
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse, UT2J, France
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33
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Westwood H, Stahl D, Mandy W, Tchanturia K. 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 2016; 46:1809-1827. [PMID: 27109830 DOI: 10.1017/s0033291716000581] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Difficulties in set-shifting are commonly reported in both autism spectrum disorder (ASD) and anorexia nervosa (AN) populations. Despite this, it is not known whether this cognitive profile persists across different ages, or whether the profiles seen in ASD and AN are comparable. This systematic review and meta-analyses aimed to compare the set-shifting profiles, as measured by the Wisconsin Card Sorting Test (WCST) in adults and younger people with either ASD or AN, relative to healthy controls (HCs) and to statistically compare performance on the WCST between ASD and AN. In all, 24 studies on ASD and 22 studies on AN were identified. In ASD, there were significant differences between the clinical group and HCs, with the ASD group making significantly more perseverative errors, indicating greater difficulty in set-shifting [pooled effect size of d = 0.67, 95% confidence interval (CI) 0.53-0.81, p ⩽ 0.001]. This effect was consistent across the age span. For AN studies, there was a significant difference between adults with AN and HCs (d = 0.52, 95% CI 0.36-0.68, p ⩽ 0.001) but a non-significant effect in child studies (d = 0.25, 95% CI -0.05 to 0.55, z = 1.66, p = 0.096). Meta-regression indicated no effect of diagnosis (AN or ASD) on performance in adult studies but there was a non-significant trend (p = 0.053) towards children with ASD performing worse than children with AN. While difficulties with set-shifting appear to be stable in ASD, there may be differences between children and adults with AN, which warrant further investigation.
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Affiliation(s)
- H Westwood
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - D Stahl
- Department of Biostatistics,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - W Mandy
- University College London,Research Department of Clinical, Educational and Health Psychology,London,UK
| | - K Tchanturia
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
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Ambwani S, Berenson KR, Simms L, Li A, Corfield F, Treasure J. Seeing things differently: An experimental investigation of social cognition and interpersonal behavior in anorexia nervosa. Int J Eat Disord 2016; 49:499-506. [PMID: 26712303 DOI: 10.1002/eat.22498] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Interpersonal difficulties among individuals with anorexia nervosa (AN) may stem in part due to misperceiving social cues. The current study investigated social functioning by comparing interpersonal self-efficacy, perceptions of dominance/submission (i.e., agency) and coldness/warmth (i.e., communion), and hypothetical behavioral reactions among individuals with and without AN. METHOD Seventy-seven women (AN/Other Specified Feeding or Eating Disorder OSFED-AN n = 41, nonclinical comparison group n = 36) completed questionnaires assessing mood symptoms and interpersonal self-efficacy, followed by an experimental video-rating task in which they received critical feedback from job supervisors varying in degrees of agency and communion. RESULTS AN respondents perceived more coldness overall, even after adjusting for differences in depression and anxiety symptoms, and tended to respond with coldness even to videos that they perceived as being warm. However, perceptual accuracies for agency were similar across groups. Interpersonal self-efficacy moderated the relationship between diagnostic status and behavioral responses: among those who felt competent being cold-submissive, AN respondents selected cold-submissive responses more frequently than did the nonclinical comparison group. DISCUSSION Among those with AN symptoms, there may be a tendency toward social perceptual inaccuracies regarding communion and non-complementary cold behavioral responses. Results suggest that improving social perceptions may be a fruitful intervention target for enhancing interpersonal functioning among individuals with AN. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:499-506).
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Affiliation(s)
- Suman Ambwani
- Psychology Department, Dickinson College, Carlisle, Pennsylvania
| | - Kathy R Berenson
- Department of Psychology, Gettysburg College, Gettysburg College, Gettysburg, Pennsylvania
| | - Lea Simms
- Psychology Department, Dickinson College, Carlisle, Pennsylvania
| | - Amanda Li
- Institute of Psychiatry, King's College London, London, United Kingdom
| | - Freya Corfield
- Institute of Psychiatry, King's College London, London, United Kingdom
| | - Janet Treasure
- Institute of Psychiatry, King's College London, London, United Kingdom
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35
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Testing the disgust conditioning theory of food-avoidance in adolescents with recent onset anorexia nervosa. Behav Res Ther 2015; 71:131-8. [DOI: 10.1016/j.brat.2015.06.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 11/18/2022]
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36
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Kästner A, Begemann M, Michel TM, Everts S, Stepniak B, Bach C, Poustka L, Becker J, Banaschewski T, Dose M, Ehrenreich H. Autism beyond diagnostic categories: characterization of autistic phenotypes in schizophrenia. BMC Psychiatry 2015; 15:115. [PMID: 25968177 PMCID: PMC4436160 DOI: 10.1186/s12888-015-0494-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/29/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Behavioral phenotypical continua from health to disease suggest common underlying mechanisms with quantitative rather than qualitative differences. Until recently, autism spectrum disorders and schizophrenia were considered distinct nosologic entities. However, emerging evidence contributes to the blurring of symptomatic and genetic boundaries between these conditions. The present study aimed at quantifying behavioral phenotypes shared by autism spectrum disorders and schizophrenia to prepare the ground for biological pathway analyses. METHODS Specific items of the Positive and Negative Syndrome Scale were employed and summed up to form a dimensional autism severity score (PAUSS). The score was created in a schizophrenia sample (N = 1156) and validated in adult high-functioning autism spectrum disorder (ASD) patients (N = 165). To this end, the Autism Diagnostic Observation Schedule (ADOS), the Autism (AQ) and Empathy Quotient (EQ) self-rating questionnaires were applied back to back with the newly developed PAUSS. RESULTS PAUSS differentiated between ASD, schizophrenia and a disease-control sample and substantially correlated with the Autism Diagnostic Observation Schedule. Patients with ADOS scores ≥12 obtained highest, those with scores <7 lowest PAUSS values. AQ and EQ were not found to vary dependent on ADOS diagnosis. ROC curves for ADOS and PAUSS resulted in AuC values of 0.9 and 0.8, whereas AQ and EQ performed at chance level in the prediction of ASD. CONCLUSIONS This work underscores the convergence of schizophrenia negative symptoms and autistic phenotypes. PAUSS evolved as a measure capturing the continuous nature of autistic behaviors. The definition of extreme-groups based on the dimensional PAUSS may permit future investigations of genetic constellations modulating autistic phenotypes.
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Affiliation(s)
- Anne Kästner
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Martin Begemann
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany. .,DFG Research Center for Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), Göttingen, Germany.
| | - Tanja Maria Michel
- Department of Psychiatry, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Sarah Everts
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Beata Stepniak
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Christiane Bach
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
| | - Luise Poustka
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
| | - Joachim Becker
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany.
| | - Tobias Banaschewski
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
| | - Matthias Dose
- kbo-Isar-Amper-Klinikum Taufkirchen, Taufkirchen (Vils), Germany.
| | - Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str.3, 37075, Göttingen, Germany. .,DFG Research Center for Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), Göttingen, Germany.
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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Koch SV, Larsen JT, Mouridsen SE, Bentz M, Petersen L, Bulik C, Mortensen PB, Plessen KJ. 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 2015; 206:401-7. [PMID: 25657359 DOI: 10.1192/bjp.bp.114.153221] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/21/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical and population-based studies report increased prevalence of autism spectrum disorders (ASD) in individuals with anorexia nervosa and in their relatives. No nationwide study has yet been published on co-occurrence of these disorders. AIMS To investigate comorbidity of ASD in individuals with anorexia nervosa, and aggregation of ASD and anorexia nervosa in their relatives. METHOD In Danish registers we identified all individuals born in 1981-2008, their parents, and full and half siblings, and linked them to data on hospital admissions for psychiatric disorders. RESULTS Risk of comorbidity of ASD in probands with anorexia nervosa and aggregation of ASD in families of anorexia nervosa probands were increased. However, the risk of comorbid and familial ASD did not differ significantly from comorbid and familial major depression or any psychiatric disorder in anorexia nervosa probands. CONCLUSIONS We confirm aggregation of ASD in probands with anorexia nervosa and in their relatives; however, the relationship between anorexia nervosa and ASD appears to be non-specific.
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Affiliation(s)
- Susanne V Koch
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janne T Larsen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svend E Mouridsen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Bentz
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Petersen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cynthia Bulik
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preben B Mortensen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin J Plessen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Calderoni S, Fantozzi P, Balboni G, Pagni V, Franzoni E, Apicella F, Narzisi A, Maestro S, Muratori F. The impact of internalizing symptoms on autistic traits in adolescents with restrictive anorexia nervosa. Neuropsychiatr Dis Treat 2015; 11:75-85. [PMID: 25609969 PMCID: PMC4294691 DOI: 10.2147/ndt.s73235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although previous studies indicated a positive association between restrictive anorexia-nervosa (AN-R) and autistic traits, the potential interference of psychiatric internalizing comorbidity on this association is not yet fully investigated. MATERIALS AND METHODS The aim of this study was to explore autistic traits and internalizing psychopathology in adolescents (age range: 11.7-17.2 years) with AN-R. Twenty-five patients referred to two tertiary-care hospitals were compared to a large control group (N=170) with no differences in age and sex. AN-R patients and controls filled out instruments assessing autistic traits (autism spectrum quotient [AQ]), psychopathology (youth self-report [YSR] 11-18), and eating patterns (eating attitude test [EAT]). In order to disentangle the possible mediating role of internalizing symptoms on autistic traits, two separate control groups (called True and False healthy control, both composed of 25 eating-problem-free participants) were derived from the whole control group on the basis of the presence or absence of internalizing problems in the YSR. RESULTS AN-R patients scored significantly higher on AQ compared to the whole control group and to controls without internalizing problems (True HC), but these differences disappeared when only controls with internalizing problems (False HC) were considered. CONCLUSION Autistic traits in AN-R individuals may have been overestimated and may partly be due to comorbid internalizing symptoms in investigated patients.
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Affiliation(s)
- Sara Calderoni
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Pamela Fantozzi
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Giulia Balboni
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Veronica Pagni
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Emilio Franzoni
- Child Neuropsychiatric Unit, Women, Children and Adolescents Health Department, University Hospital S Orsola-Malpighi, Bologna, Italy
| | - Fabio Apicella
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Antonio Narzisi
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Sandra Maestro
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Filippo Muratori
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy ; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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40
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Kim YR, Kim JH, Kim MJ, Treasure J. Differential methylation of the oxytocin receptor gene in patients with anorexia nervosa: a pilot study. PLoS One 2014; 9:e88673. [PMID: 24523928 PMCID: PMC3921190 DOI: 10.1371/journal.pone.0088673] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/14/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Recent studies in patients with anorexia nervosa suggest that oxytocin may be involved in the pathophysiology of anorexia nervosa. We examined whether there was evidence of variation in methylation status of the oxytocin receptor (OXTR) gene in patients with anorexia nervosa that might account for these findings. Methods We analyzed the methylation status of the CpG sites in a region from the exon 1 to the MT2 regions of the OXTR gene in buccal cells from 15 patients and 36 healthy women using bisulfite sequencing. We further examined whether methylation status was associated with markers of illness severity or form. Results We identified six CpG sites with significant differences in average methylation levels between the patient and control groups. Among the six differentially methylated CpG sites, five showed higher than average methylation levels in patients than those in the control group (64.9–88.8% vs. 6.6–45.0%). The methylation levels of these five CpG sites were negatively associated with body mass index (BMI). BMI, eating disorders psychopathology, and anxiety were identified in a regression analysis as factors affecting the methylation levels of these CpG sites with more variation accounted for by BMI. Conclusions Epigenetic misregulation of the OXTR gene may be implicated in anorexia nervosa, which may either be a mechanism linking environmental adversity to risk or may be a secondary consequence of the illness.
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Affiliation(s)
- Youl-Ri Kim
- Department of Psychiatry, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Jeong-Hyun Kim
- Indang Institute of Molecular Biology, Inje University, Seoul, Republic of Korea
- School of Biological Sciences, Inje University, Gimhae, Republic of Korea
| | - Mi Jeong Kim
- Indang Institute of Molecular Biology, Inje University, Seoul, Republic of Korea
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom
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41
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Tchanturia K, Smith E, Weineck F, Fidanboylu E, Kern N, Treasure J, Baron Cohen S. Exploring autistic traits in anorexia: a clinical study. Mol Autism 2013; 4:44. [PMID: 24220604 PMCID: PMC4176300 DOI: 10.1186/2040-2392-4-44] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/05/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The objectives of this study were to explore associations between autistic traits and self-reported clinical symptoms in a population with anorexia nervosa (AN). Experimental and self-report evidence reveals similarities between AN and autism spectrum condition (ASC) populations in socio-emotional and cognitive domains; this includes difficulties with empathy, set-shifting and global processing. Focusing on these similarities may lead to better tailored interventions for both conditions. METHODS A cross-sectional independent-groups design was employed. Participants with AN (n = 66) and typical controls (n = 66) completed self-report questionnaires including the Short (10-Item) Version Autism Spectrum Quotient (AQ-10) questionnaire (the first time this has been implemented in this population), the Eating Disorder Examination Questionnaire, the Hospital Anxiety and Depression Scale and the Work and Social Adjustment Scale. Group differences and the relationship between autistic traits and other questionnaire measures were investigated. RESULTS The AN group had a significantly higher AQ-10 total score and a greater proportion scored above the clinical cut-off than the control group. Seven out of ten AQ-10 items significantly discriminated between groups. In the AN group, levels of autistic traits correlated with a greater self-reported anxiety and depression and a lower ability to maintain close relationships; however, eating disorder symptoms were not associated with autistic traits. CONCLUSIONS Women with anorexia possess a greater number of autistic traits than typical women. AQ-10 items that discriminated between groups related to 'bigger picture' (global) thinking, inflexibility of thinking and problems with social interactions, suggesting that autistic traits may exacerbate factors that maintain the eating disorder rather than cause the eating disorder directly. Using screening instruments may improve understanding of patients' problems, leading to better tailoring of intervention. We conclude that further investigation of autistic traits in AN could inform new intervention approaches based on joint working between ASC and eating disorder services.
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Affiliation(s)
- Kate Tchanturia
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK.,King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Emma Smith
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - Felicitas Weineck
- King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Eliz Fidanboylu
- King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Nikola Kern
- Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - Janet Treasure
- Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK.,King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Simon Baron Cohen
- Autism Research Centre, Psychiatry Department, Cambridge University, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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