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Carpita B, Nardi B, Pronestì C, Parri F, Giovannoni F, Cremone IM, Pini S, Dell’Osso L. May Female Autism Spectrum Be Masked by Eating Disorders, Borderline Personality Disorder, or Complex PTSD Symptoms? A Case Series. Brain Sci 2023; 14:37. [PMID: 38248252 PMCID: PMC10813290 DOI: 10.3390/brainsci14010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: The prevalence of Autism Spectrum Disorder (ASD) is four times higher in males than females; however, females are significantly more likely to go undiagnosed due to the existence of a "female autistic phenotype", a manifestation unique to females that conflicts with conventional, masculine conceptualizations of ASD. Furthermore, subthreshold autistic traits, which exert a significantly negative impact on quality of life and represent a vulnerability factor for the development of other psychopathological conditions, may remain even more under-recognized. Subsequently, many women with ASD may never receive a diagnosis or any resulting care, with serious consequences for their health. Aims: We aimed to describe two brief cases in order to confirm the diagnostic difficulties that ASD female undergo during their clinical evaluation and the possible alternative phenotype that they can manifest. Methods: We reported the cases of two young women on the autism spectrum that came to clinical attention only after the development of severe symptomatology attributed to other mental disorders, overlooking the presence of underlying autism spectrum features and a brief résumé of the literature on this topic. Results: These cases confirm the need for a timely and proper identification of females on the autism spectrum in order to prevent complications and improve the outcome. Conclusions: Research on gender differences could lead to a reexamination of the sex ratio in the prevalence of ASD and provide a better understanding of several psychiatric conditions that are frequently diagnosed in women, supporting the neurodevelopmental approach to psychopathology.
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Affiliation(s)
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.P.); (F.P.); (F.G.); (S.P.); (L.D.)
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Fithall K, Gray IE, Linardon J, Phillipou A, Donaldson PH, Albein-Urios N, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Exploring the role of autistic traits and eating disorder psychopathology on mentalising ability in the general population. BMC Psychol 2023; 11:269. [PMID: 37674242 PMCID: PMC10483798 DOI: 10.1186/s40359-023-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study evaluated the role of overlapping traits and characteristics related to autism spectrum disorder (autism) and anorexia nervosa (AN) in the general population, and the impact of these traits on mentalising ability. METHODS A sample of young adults (N = 306), aged 18-25 years, was recruited to complete an online study that consisted of 4 measures: the Autism-Spectrum Quotient, Eating Disorder Examination Questionnaire, the Mentalization Scale, and the Reading the Mind in the Eyes task. RESULTS Higher levels of autistic traits, particularly difficulty with attention switching, were associated with increased eating disorder psychopathology. Overall, autistic traits and eating disorder psychopathology were related among females, but not males. Difficulty with attention switching, however, was related to eating disorder psychopathology among both females and males. Autistic traits also appear to have a greater role in mentalising ability than does eating disorder psychopathology. CONCLUSION The role of attention switching in overlapping traits of autism and eating disorder psychopathology needs to be more comprehensively evaluated by future research, as does the role of biological sex. Expanded knowledge in this field will help to better understand and evaluate symptoms at presentation, leading to clearer diagnoses and potentially better treatment outcomes.
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Affiliation(s)
- Kate Fithall
- School of Psychology, Deakin University, Geelong, Australia
| | - Indigo E Gray
- School of Psychology, Deakin University, Geelong, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
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Parsons MA. Autism diagnosis in females by eating disorder professionals. J Eat Disord 2023; 11:73. [PMID: 37170136 PMCID: PMC10173598 DOI: 10.1186/s40337-023-00785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
IMPORTANCE Autism and eating disorders cooccur at high rates, with autism impacting the efficacy of eating disorder treatments and outcomes. Females are underdiagnosed with autism and diagnosed later in life than their male counterparts. OBJECTIVE The purpose of this study was to define the incidence of eating disorder professionals identifying autism in female adolescents and young adults engaged in treatment for an eating disorder. DESIGN The research design is a cross-sectional retrospective records review. The charts reviewed were from the medical records of forty assigned-at-birth females between the ages of 13-25 who received treatment for an eating disorder at the partial hospitalization program (PHP) level of care between 2020 and 2022. MAIN OUTCOMES Upon entering PHP for an eating disorder, 10% of the study participants had a pre-existing diagnosis of autism. A total of 27.5% of participants had clinical suspicion of autism. The number of autism traits that an individual possessed directly correlated with the number of calendar days in treatment. CONCLUSION Eating disorder professionals in this study identified autism in 17.5% of adolescent and young adult females who entered PHP treatment for an eating disorder who had not previously been diagnosed with autism. Eating disorder professionals can anticipate that individuals with autism may be in treatment for a longer duration. Further studies should explore effective treatment measures for those with autism in treatment for an eating disorder.
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Affiliation(s)
- Marissa A Parsons
- Recovery and Wellness Center of Eastern Washington, 1950 Keene Rd Bldg G, Richland, WA, 99336, USA.
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Schröder SS, Danner UN, Spek AA, van Elburg AA. Problematic eating behaviours of autistic women-A scoping review. EUROPEAN EATING DISORDERS REVIEW 2022; 30:510-537. [PMID: 35701074 PMCID: PMC9544491 DOI: 10.1002/erv.2932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/21/2022]
Abstract
Aim Eating and feeding behaviours of autistic individuals and related consequences have been mainly investigated in autistic children or in autistic adults with intellectual disabilities. Behaviours such as food selectivity or food neophobia have been shown to persist into adolescence and adulthood and are associated with aversive consequences. However, much less is known about the eating behaviours of autistic adults without intellectual disabilities, especially those of women. By means of a scoping review, we aim to assess the extent of the scientific literature on what is known about the eating behaviours of these women and the possible consequences of such eating behaviour. Method Medline, Cochrane, PubMed and PsycInfo databases were searched according to Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. Results Five studies met the eligibility criteria and were included in this review. Autistic women not only reported high levels of eating behaviour frequently seen in autism spectrum disorders (ASD), but also high levels of disordered eating behaviour, similar to that of women with eating disorders. Conclusions Autistic women seem to exhibit high levels of eating behaviour frequently seen in ASD as well as disordered eating behaviour. Future research needs to shed light on what underlies these problematic eating behaviours, in order to help to adapt current treatment modalities to meet the unique needs of these women. This scoping review indicates that autistic women exhibit both eating behaviours frequently seen in autism spectrum disorders (ASD) and disordered eating behaviours, similar to those of women with eating disorders. The review also indicates that studies investigating these eating behaviours of autistic women are still very scarce, and those that are available often lack a comprehensive assessment of the ASD diagnosis. Future studies are needed to confirm the findings and to further explore how and why autistic women eat the way they eat, 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 RintveldZeistThe Netherlands
- Department of Clinical PsychologyUtrecht UniversityUtrechtThe Netherlands
| | - Unna N. Danner
- Altrecht Eating Disorders RintveldZeistThe Netherlands
- Department of Clinical PsychologyUtrecht UniversityUtrechtThe Netherlands
| | | | - Annemarie A. van Elburg
- Altrecht Eating Disorders RintveldZeistThe Netherlands
- Department of Clinical PsychologyUtrecht UniversityUtrechtThe Netherlands
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Leppanen J, Sedgewick F, Halls D, Tchanturia K. Autism and anorexia nervosa: Longitudinal prediction of eating disorder outcomes. Front Psychiatry 2022; 13:985867. [PMID: 36213911 PMCID: PMC9533087 DOI: 10.3389/fpsyt.2022.985867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recently, elevated levels of autistic features and autism diagnoses have been reported among people with anorexia nervosa (AN). In clinical settings high levels of autistic features have been linked to more complex, highly comorbid illness presentation and poorer treatment outcome. This study aimed to examine whether autistic features predict AN symptom profile in long term. METHODS Altogether 118 women with lived experience of AN completed two autism assessments at time 1, the Autism Diagnostic Observation Schedule (ADOS) and the short version of the Autism Quotient (AQ10). Measures assessing AN symptom profile, including eating disorders symptoms, anxiety, depression, OCD symptoms, and Body Mass Index (BMI), were also recorded. The symptom profile measures were administered again 6 months and 2 years later. We conducted two analyses to examine the extent to which the ADOS and AQ10 scores predicted broad AN symptom profile at each three time points. RESULTS Overall, high levels of autistic features were consistently associated with worse psychological symptoms, but not BMI, across all time points. Both the analysis using baseline ADOS scores and self-reported AQ10 scores showed similar pattern. CONCLUSION The present findings consolidate previously reported associations between autistic features and worse psychological outcome among people with AN. The findings also suggest that self-report measures may be sufficient for assessing the impact of autistic features on illness outcome among people with AN. Importantly, the study highlights the need for development and further investigation of neurodiversity accommodations in the treatment of AN.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | | | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, United Kingdom.,Department of Psychology, Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
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Steegers C, Dieleman G, Moskalenko V, Santos S, Hillegers M, White T, Jansen PW. The longitudinal relationship between set-shifting at 4 years of age and eating disorder related features at 9 years of age in the general pediatric population. Int J Eat Disord 2021; 54:2180-2191. [PMID: 34716719 PMCID: PMC9298047 DOI: 10.1002/eat.23633] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Individuals with anorexia nervosa (AN) tend to have rigid thoughts and behaviors regarding their body weight, body image, and eating habits. While a diagnosis of AN implies severe levels of impairment, AN traits can vary on a continuum within the population. However, little is known about how early markers of AN relate to rigid thought patterns and to what extent cognitive rigidity is already present in early childhood. We examined the association of set-shifting abilities as a measure of cognitive flexibility in preadolescents with AN-related features. METHODS Participants included 3,987 children participating in the Generation R Study, a Dutch population-based birth cohort. Set-shifting abilities (mother report) were assessed at 4 years of age, body mass index (BMI) was determined at 4 and 9 years and restrictive eating patterns (mother report) and body image (child report) were assessed at 9 years. RESULTS Lower set-shifting abilities at 4 years were associated with a lower BMI (β = -.44, p = 2.2 × 10-4 ) in girls, and more restrictive eating (β = 0.15, p = 2.7 × 10-6 ) in both boys and girls at 9 years of age. Moreover, set-shifting at age 4 was not associated with body image at age 9. CONCLUSION These findings contribute to the idea that the association between set-shifting problems and AN-related features are present early in childhood, prior to the typical range of the onset of eating disorders (EDs). Longitudinal studies that capture the peak age for the development of EDs will be important to assess whether early cognitive inflexibility is an early marker of AN.
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Affiliation(s)
- Cathelijne Steegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Valeria Moskalenko
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
| | - Susana Santos
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands,Department of Pediatrics, Erasmus MC – Sophia Children's HospitalUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands,The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands,Department of Radiology and Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - Pauline W. Jansen
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands,The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands,Department of Psychology, Education, and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
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