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Saure E, Laasonen M, Kylliäinen A, Hämäläinen S, Lepistö-Paisley T, Raevuori A. Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa. J Clin Psychol 2024. [PMID: 38712729 DOI: 10.1002/jclp.23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE In anorexia nervosa (AN), the traits of autism spectrum disorder (ASD) are associated with poor outcomes. However, the subtle nature of these characteristics remains poorly understood. We investigated the in-depth patterns of ASD traits using Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) in women with AN. METHODS Of 28 women with ICD-10 AN, 16 (age 19-30 years) participated in the ADOS-2, a video-recorded, semistructured diagnostic assessment for social communication and interaction and restricted, repetitive behaviors and interests related to ASD. None of the participants had previously been diagnosed with ASD. Other measurements included the Eating Disorder Examination Questionnaire and the Wechsler Abbreviated Scale of Intelligence-IV. RESULTS Five individuals (18% of all, 31% of those assessed) scored above the cutoff for autism in ADOS-2. They had challenges in social communication and interaction, manifesting as sustained difficulties in social relationships and deficits in conversation skills. Few described being frequently misunderstood by others, including in the eating disorder treatment settings. Three individuals showed prominent restricted and repetitive behaviors such as ritual seeking, eating-related routines, sensory sensitivity related to food texture and selective eating, and intense interest in specific topics. The mean duration of AN in women above the cutoff was twice as long compared with those below (12.3 vs. 6.2 years). DISCUSSION The ASD-related characteristics and behavior appear to contribute to the manifestation and duration of AN in a subgroup of women. Among these women, the traits of ASD appear to be mixed with eating disorder symptoms, which should be taken into account in the treatment.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marja Laasonen
- Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Anneli Kylliäinen
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sini Hämäläinen
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tuulia Lepistö-Paisley
- Department of Child Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
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Saure E, Raevuori A, Laasonen M, Lepistö-Paisley T. Emotion recognition, alexithymia, empathy, and emotion regulation in women with anorexia nervosa. Eat Weight Disord 2022; 27:3587-3597. [PMID: 36258146 PMCID: PMC9803740 DOI: 10.1007/s40519-022-01496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Anorexia nervosa (AN) is associated with challenges in recognizing, understanding, and interpreting one's own and other's emotional states, feelings, and thoughts. It is unknown whether difficulties in emotion processing occur independently of common comorbid symptoms of AN and predict acute eating disorder characteristics. We aimed to examine emotion recognition, alexithymia, emotion regulation, and empathy in individuals with AN and to assess whether these predict eating disorder symptoms independently from comorbid symptoms. METHODS Participants included 42 women with AN and 40 healthy control (HC) women between 18-30 years. Basic and complex emotion recognition was assessed with face photos and video clips. Alexithymia, empathy, emotion regulation, and comorbid symptoms (anxiety, depressive, and obsessive-compulsive symptoms and ASD traits) were assessed with self-assessment questionnaires. RESULTS Participants with AN exhibited difficulties in basic and complex emotion recognition, as well as increased alexithymia, decreased empathy, and challenges in emotion regulation when compared to HCs. After controlling for comorbid symptoms, differences remained only in complex emotion recognition. Challenges in emotion recognition were associated with lower body mass index, and increased alexithymia was associated with increased eating disorder symptoms. Increased challenges in emotion regulation were associated with a shorter duration of illness, higher body mass index, and increased eating disorder symptoms. CONCLUSIONS Participants with AN displayed widespread deficit in emotion processing, but only challenges in complex emotion recognition occurred independently from comorbid symptoms. Deficits in emotion processing may contribute to the illness severity and thus could be an important treatment target. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland.
- BABA Center and Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Anu Raevuori
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marja Laasonen
- School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Tuulia Lepistö-Paisley
- Department of Child Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Saure E, Lepistö-Paisley T, Raevuori A, Laasonen M. Atypical Sensory Processing Is Associated With Lower Body Mass Index and Increased Eating Disturbance in Individuals With Anorexia Nervosa. Front Psychiatry 2022; 13:850594. [PMID: 35432034 PMCID: PMC9008215 DOI: 10.3389/fpsyt.2022.850594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/11/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Elevated autism spectrum disorder (ASD) traits are associated with anorexia nervosa (AN). Conversely, eating disturbances, which are core characteristics of AN, are common in ASD. Among individuals with ASD, atypical sensory processing is associated with eating disturbance. Because AN and ASD appear to overlap, it would be crucial to understand whether sensory processing atypicality exist also in AN. Further, it would be essential to find if atypical sensory processing is associated with eating disturbances in individuals with AN, since treatment modifications may be needed. We therefore aimed to examine whether atypical sensory processing is associated with AN and its core characteristics. METHODS Participants of the current study included 42 individuals with AN and 40 healthy controls (HCs). All participants were adult women. Sensory processing, other ASD traits, and eating disorder symptoms were assessed with self-report questionnaires. RESULTS Individuals with AN reported lower registration, decreased sensation seeking, increased sensory sensitivity, and increased sensation avoiding compared to HCs. When analyzing groups with restrictive AN (AN-R) and binge-purge type AN (AN-BP) separately, only individuals with AN-R exhibited decreased sensation seeking, and only those with AN-BP exhibited lower registration. After controlling for body mass index as a covariate, group differences remained significant only in sensory sensitivity between individuals with AN and HCs. Increased atypical sensory processing predicted lower body mass index and increased disordered eating. CONCLUSION Results suggest that sensory processing appears to differ between AN and HC women, and AN subtypes may exhibit distinct sensory processing atypicality. Sensory sensitivity may be stable traits whereas other aspects of atypical sensory processing may be related to acute AN. Atypical sensory processing may contribute to the severity of AN, and thus it is crucial to recognize sensory processing differences when treating individuals with AN.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuulia Lepistö-Paisley
- Child Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marja Laasonen
- Logopedics, Philosophical Faculty, School of Humanities, University of Eastern Finland, Joensuu, Finland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lindström R, Lepistö-Paisley T, Makkonen T, Reinvall O, Nieminen-von Wendt T, Alén R, Kujala T. Atypical perceptual and neural processing of emotional prosodic changes in children with autism spectrum disorders. Clin Neurophysiol 2018; 129:2411-2420. [PMID: 30278390 DOI: 10.1016/j.clinph.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/20/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study explored the processing of emotional speech prosody in school-aged children with autism spectrum disorders (ASD) but without marked language impairments (children with ASD [no LI]). METHODS The mismatch negativity (MMN)/the late discriminative negativity (LDN), reflecting pre-attentive auditory discrimination processes, and the P3a, indexing involuntary orienting to attention-catching changes, were recorded to natural word stimuli uttered with different emotional connotations (neutral, sad, scornful and commanding). Perceptual prosody discrimination was addressed with a behavioral sound-discrimination test. RESULTS Overall, children with ASD (no LI) were slower in behaviorally discriminating prosodic features of speech stimuli than typically developed control children. Further, smaller standard-stimulus event related potentials (ERPs) and MMN/LDNs were found in children with ASD (no LI) than in controls. In addition, the amplitude of the P3a was diminished and differentially distributed on the scalp in children with ASD (no LI) than in control children. CONCLUSIONS Processing of words and changes in emotional speech prosody is impaired at various levels of information processing in school-aged children with ASD (no LI). SIGNIFICANCE The results suggest that low-level speech sound discrimination and orienting deficits might contribute to emotional speech prosody processing impairments observed in ASD.
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Affiliation(s)
- R Lindström
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | - T Lepistö-Paisley
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Department of Pediatric Neurology, Helsinki University Hospital, Helsinki, Finland
| | - T Makkonen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - O Reinvall
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Department of Pediatric Neurology, Helsinki University Hospital, Helsinki, Finland
| | - T Nieminen-von Wendt
- Neuropsychiatric Rehabilitation and Medical Centre NeuroMental, Helsinki, Finland
| | - R Alén
- Department of Child Neurology, Central Finland Central Hospital, Jyväskylä, Finland
| | - T Kujala
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
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Lindström R, Lepistö-Paisley T, Vanhala R, Alén R, Kujala T. Impaired neural discrimination of emotional speech prosody in children with autism spectrum disorder and language impairment. Neurosci Lett 2016; 628:47-51. [PMID: 27291458 DOI: 10.1016/j.neulet.2016.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/13/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
Autism spectrum disorders (ASD) are characterized by deficient social and communication skills, including difficulties in perceiving speech prosody. The present study addressed processing of emotional prosodic changes (sad, scornful and commanding) in natural word stimuli in typically developed school-aged children and in children with ASD and language impairment. We found that the responses to a repetitive word were diminished in amplitude in the children with ASD, reflecting impaired speech encoding. Furthermore, the amplitude of the MMN/LDN component, reflecting cortical discrimination of sound changes, was diminished in the children with ASD for the scornful deviant. In addition, the amplitude of the P3a, reflecting involuntary orienting to attention-catching changes, was diminished in the children with ASD for the scornful deviant and tended to be smaller for the sad deviant. These results suggest that prosody processing in ASD is impaired at various levels of neural processing, including deficient pre-attentive discrimination and involuntary orientation to speech prosody.
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Affiliation(s)
- R Lindström
- Cognitive Brain Research Unit, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
| | - T Lepistö-Paisley
- Cognitive Brain Research Unit, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland; Department of Child Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - R Vanhala
- Department of Child Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - R Alén
- Department of Child Neurology, Central Finland Central Hospital, Jyväskylä, Finland
| | - T Kujala
- Cognitive Brain Research Unit, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
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