1
|
Turnbull G, Lego S, Kennedy BL, Alexi J, Li YR, Engel MM, Mann G, Bayliss DM, Farrell S, Bell J. Sizing up the crowd: Assessing spatial integration difficulties in body size judgements across eating disorder symptomatology. Front Psychol 2023; 13:1003250. [PMID: 36687820 PMCID: PMC9853910 DOI: 10.3389/fpsyg.2022.1003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Body size judgements are frequently biased, or inaccurate, and these errors are further exaggerated for individuals with eating disorders. Within the eating disorder literature, it has been suggested that exaggerated errors in body size judgements are due to difficulties with integration. Across two experiments, we developed a novel integration task, named the Ebbinghaus Illusion for Bodies in Virtual Reality (VR), to assess whether nearby bodies influence the perceived size of a single body. VR was used to simulate the appearance of a small crowd around a central target body. Method and Results In Experiment 1 (N = 412), participants were required to judge the size of a central female target within a crowd. Experiment 1 revealed an Ebbinghaus Illusion, in which a central female appeared larger when surrounded by small distractors, but comparatively smaller when surrounded by large distractors. In other words, the findings of Experiment 1 demonstrate that surrounding crowd information is integrated when judging an individual's body size; a novel measure of spatial integration (i.e., an Ebbinghaus Illusion for Bodies in VR). In Experiment 2 (N = 96), female participants were selected based on high (n = 43) and low (n = 53) eating disorder symptomatology. We examined whether the magnitude of this illusion would differ amongst those with elevated versus low eating disorder symptomatology, in accordance with weak central coherence theory, with the high symptomatology group displaying less spatial integration relative to the low group. The results of Experiment 2 similarly found an Ebbinghaus Illusion for Bodies in VR. However, illusion magnitude did not vary across high and low symptomatology groups. Discussion Overall, these findings demonstrate that surrounding crowd information is integrated when judging individual body size; however, those with elevated eating disorder symptomatology did not show any integration deficit on this broader measure of spatial integration.
Collapse
Affiliation(s)
- Georgia Turnbull
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia,*Correspondence: Georgia Turnbull,
| | - Sophia Lego
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Briana L. Kennedy
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Joanna Alexi
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Yanqi R. Li
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Manja M. Engel
- Faculty of Social and Behavioural Sciences, Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
| | - Georgina Mann
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Donna M. Bayliss
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Simon Farrell
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| |
Collapse
|
2
|
Abstract
BACKGROUND Orthorexia nervosa (ON) is an emerging condition featuring restrictive eating behaviors on the basis of subjective beliefs about food healthiness. Many authors have stressed the similarities between ON and anorexia nervosa (AN) in both cognitive and behavioral patterns. Despite that, while the link between AN and female autism presentations is well known in the literature, no study has yet investigated the relationship between ON and autism spectrum. This work aims to investigate the relationship between ON and autistic traits in a university population. METHODS An e-mail invitation was sent to all the students and University workers of University of Pisa. Subjects were asked to fulfill the ORTO-15 and the Adult Autism Subthreshold spectrum (AdAS spectrum) questionnaires. RESULTS A total of 2426 subjects joined the survey: 623 subjects (26.3%) reported a score associated with significant orthorexic symptoms according to ORTO-15 (ON group), while 1789 subjects (73.7%) did not report ON symptomatology and were considered as healthy controls (HC). The ON group scored significantly higher on almost all AdAS spectrum domains. Moreover, being female and scoring higher on AdAS spectrum were statistically predictive factors for the presence of ON symptomatology. Among AdAS spectrum domains, higher scores on AdAS spectrum inflexibility and adherence to routine and restricted interests and rumination domains, as well as lower scores on verbal communication domain, were statistically predictive of orthorexic symptoms. CONCLUSIONS Our findings highlight an overlap between ON and autism spectrum psychopathology. Further studies are needed to clarify the relationship between restrictive eating disorders and female autism phenotypes.
Collapse
|
3
|
Tauro JL, Wearne TA, Belevski B, Filipčíková M, Francis HM. Social cognition in female adults with Anorexia Nervosa: A systematic review. Neurosci Biobehav Rev 2021; 132:197-210. [PMID: 34822877 DOI: 10.1016/j.neubiorev.2021.11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/26/2022]
Abstract
Deficits in interpersonal and social functioning are well established in females with Anorexia Nervosa (AN), and are thought to be key features involved in the onset and maintenance of the disease. Growing literature suggests these may be attributed to poor social cognitive processes. This systematic review evaluates whether differences in social cognition exist in adult females with AN. A total of 32 studies that compared females with AN against a healthy control group using social cognitive measures and/or questionnaires were analysed. The majority of studies were deemed to have a low or moderate risk of bias. Overall, empathy appears to be intact in AN, however greater emotion regulation difficulties, elevated alexithymia and reduced emotional awareness are evident in AN. Findings relating to emotion recognition and emotional Theory of Mind were inconsistent. The nature of the task appeared to influence the domains of cognitive ToM and social perception, warranting further research. These findings are discussed within the broader context of social cognitive models and AN rehabilitation.
Collapse
Affiliation(s)
- Joanna L Tauro
- Department of Psychology, Macquarie University, NSW, 2109, Australia.
| | - Travis A Wearne
- School of Psychology, Faculty of Science, University of New South Wales, NSW, 2052, Australia
| | - Bianca Belevski
- Department of Psychology, Macquarie University, NSW, 2109, Australia
| | - Michaela Filipčíková
- School of Psychology, Faculty of Science, University of New South Wales, NSW, 2052, Australia
| | - Heather M Francis
- Department of Psychology, Macquarie University, NSW, 2109, Australia
| |
Collapse
|
4
|
de Jorge Martínez C, Rukh G, Williams MJ, Gaudio S, Brooks S, Schiöth HB. Genetics of anorexia nervosa: an overview of genome-wide association studies and emerging biological links. J Genet Genomics 2021; 49:1-12. [PMID: 34634498 DOI: 10.1016/j.jgg.2021.09.005] [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: 03/01/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022]
Abstract
Anorexia nervosa (AN) is a complex disorder with a strong genetic component. Comorbidities are frequent and there is substantial overlap with other disorders. The lack of understanding of the molecular and neuroanatomical causes has made it difficult to develop effective treatments and it is often difficult to treat in clinical practice. Recent advances in genetics have changed our understanding of polygenic diseases, increasing the possibility of understanding better how molecular pathways are intertwined. This review synthetizes the current state of genetic research providing an overview of genome-wide association studies (GWAS) findings in AN as well as overlap with other disorders, traits, pathways, and imaging results. This paper also discusses the different putative global pathways that are contributing to the disease including the evidence for metabolic and psychiatric origin of the disease.
Collapse
Affiliation(s)
| | - Gull Rukh
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden.
| | - Michael J Williams
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Samantha Brooks
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden; School of Psychology, Faculty of Health, Liverpool John Moores University, UK; Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden; Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
5
|
The Association Between Autistic Traits and Disordered Eating is Moderated by Sex/Gender and Independent of Anxiety and Depression. J Autism Dev Disord 2021; 51:1866-1879. [PMID: 32852639 PMCID: PMC8124044 DOI: 10.1007/s10803-020-04669-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Previous studies have reported positive correlations between autistic traits and disordered eating, though it is unclear whether the association is moderated by sex/gender or whether it is independent of anxiety or depression. We present the findings of an online survey of 691 participants who completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), and Eating Attitudes Test-26 (EAT-26). Following a pre-registered analysis plan, we observed positive correlations between AQ and EAT-26 in males and females, with the association being significantly stronger in females. AQ also remained a significant predictor of EAT-26 when anxiety and depression were controlled for statistically. These findings may be relevant when considering therapeutic interventions in disordered eating populations that exhibit autistic traits.
Collapse
|
6
|
Inoue T, Otani R, Iguchi T, Ishii R, Uchida S, Okada A, Kitayama S, Koyanagi K, Suzuki Y, Suzuki Y, Sumi Y, Takamiya S, Tsurumaru Y, Nagamitsu S, Fukai Y, Fujii C, Matsuoka M, Iwanami J, Wakabayashi A, Sakuta R. Prevalence of autism spectrum disorder and autistic traits in children with anorexia nervosa and avoidant/restrictive food intake disorder. Biopsychosoc Med 2021; 15:9. [PMID: 34001197 PMCID: PMC8130445 DOI: 10.1186/s13030-021-00212-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) and feeding and eating disorders (FEDs) such as anorexia nervosa (AN) are strongly linked as evidenced by frequent comorbidity and overlapping traits. However, eating and social behaviors are shaped by culture, so it is critical to examine these associations in different populations. Moreover, FEDs are heterogeneous, and there has been no examination of autistic traits in avoidant/restrictive food intake disorder (ARFID). METHODS Therefore, we investigated the prevalence of ASD and autistic traits among Japanese children with AN (n = 92) or ARFID (n = 32) from a prospective multicenter cohort study using the Autism Spectrum Quotient Children's version (AQC) and Children's Eating Attitudes Test (ChEAT26). RESULTS ASD prevalence was high in both AN and ARFID (16.3 and 12.5%, respectively). The AN group exhibited significantly higher scores on all AQC subscales than an age-matched healthy control (HC) group, but there were no significant correlations between AQC scores and ChEAT26 scores. In the AFRID group, AQC scores did not differ from HCs, but significant correlations were found between total AQC and ChEAT26 scores and between several AQC and ChEAT26 subscales. CONCLUSIONS Both the AN and ARFID groups had high prevalence rates of ASD. The AN group showed a significantly higher degree of autistic traits than the HC group; however, no difference was found between the ARFID and HC groups. Clinicians need to be aware of these rates when working with children with ED.
Collapse
Affiliation(s)
- Takeshi Inoue
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan.
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Ryoko Otani
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan
| | - Toshiyuki Iguchi
- Department of Pediatrics, Hoshigaoka Maternity Hospital, Aichi, Japan
| | - Ryuta Ishii
- Department of Pediatrics and Child health, Kurume University School of Medicine, Fukuoka, Japan
| | - Soh Uchida
- Department of Pediatrics, Tachikawa Hospital, Tokyo, Japan
| | - Ayumi Okada
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Kenshi Koyanagi
- Nagasaki Prefectural Center of Medicine and Welfare for Children, Nagasaki, Japan
| | - Yuki Suzuki
- Department of Pediatrics, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Yuichi Suzuki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshino Sumi
- Mental and developmental clinic for children "Elm Tree", Hokaido, Japan
| | - Shizuo Takamiya
- Psychiatry Department, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
- Takamiya Psychiatry Clinic, Hyogo, Japan
| | - Yasuko Tsurumaru
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics and Child health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yoshimitsu Fukai
- Tokyo Metropolitan Children's Medical Center, Psychosomatic Medicine, Tokyo, Japan
| | - Chikako Fujii
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Michiko Matsuoka
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Junpei Iwanami
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan
| | | | - Ryoichi Sakuta
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan
| |
Collapse
|
7
|
D’Agata F, Caroppo P, Spalatro A, Lavagnino L, Abbate Daga G, Boghi A, Bergui M, Cicerale A, Vitiello B, Fassino S, Derntl B, Amianto F. Emotional imagination of negative situations: Functional neuroimaging in anorexia and bulimia. PLoS One 2021; 16:e0231684. [PMID: 33836002 PMCID: PMC8034744 DOI: 10.1371/journal.pone.0231684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
Aim The present study aims to extend the knowledge of the neural correlates of emotion processing in first episode subjects affected by anorexia nervosa (AN) or bulimia nervosa (BN). We applied an emotional distress paradigm targeting negative emotions thought to be relevant for interpersonal difficulties and therapeutic resistance mechanisms. Methods The current study applied to 44 female participants with newly diagnosed AN or BN and 20 matched controls a neuroimaging paradigm eliciting affective responses. The measurements also included an extensive assessment comprising clinical scales, neuropsychological tests, measures of emotion processing and empathy. Results AN and BN did not differ from controls in terms of emotional response, emotion matching, self-reported empathy and cognitive performance. However, eating disorder and psychopathological clinical scores, as well as alexithymia levels, were increased in AN and BN. On a neural level, no significant group differences emerged, even when focusing on a region of interest selected a priori: the amygdala. Some interesting findings put in relation the hippocampal activity with the level of Body Dissatisfaction of the participants, the relative importance of the key nodes for the common network in the decoding of different emotions (BN = right amygdala, AN = anterior cingulate area), and the qualitative profile of the deactivations. Conclusions Our data do not support the hypothesis that participants with AN or BN display reduced emotional responsiveness. However, peculiar characteristics in emotion processing could be associated to the three different groups. Therefore, relational difficulties in eating disorders, as well as therapeutic resistance, could be not secondary to a simple difficulty in feeling and identifying basic negative emotions in AN and BN participants.
Collapse
Affiliation(s)
- Federico D’Agata
- Department of Neurosciences, University of Torino, Turin, Italy
- Computational Imaging Group for MR diagnostics & therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Paola Caroppo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angela Spalatro
- Department of Neurosciences, University of Torino, Turin, Italy
| | - Luca Lavagnino
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, Texas, United States of America
| | | | - Andrea Boghi
- ASL TO2 San Giovanni Bosco Hospital, Turin, Italy
| | - Mauro Bergui
- Department of Neurosciences, University of Torino, Turin, Italy
| | | | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, University of Torino, Turin, Italy
| | - Secondo Fassino
- Department of Neurosciences, University of Torino, Turin, Italy
| | - Birgit Derntl
- Department for Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | | |
Collapse
|
8
|
Marchiol F, Lionetti F, Luxardi GL, Cavallero C, Roberts M, Penolazzi B. Cognitive inflexibility and over‐attention to detail: The Italian validation of the
DFlex
Questionnaire in patients with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:671-686. [DOI: 10.1002/erv.2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
Affiliation(s)
| | - Francesca Lionetti
- Department of Neurosciences Imaging and Clinical Sciences University "G. D'Annunzio", Chieti‐Pescara, IT; Department of Biological and Experimental Psychology, Queen Mary University of London London UK
| | - Gian Luigi Luxardi
- Center for Eating Disorders, AAS n5 'Friuli Occidentale’ – Pordenone Pordenone Italy
| | | | - Marion Roberts
- Department of General Practice & Primary Health Care, Faculty of Medical & Health Sciences University of Auckland Auckland New Zealand
| | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Oldershaw A, Startup H, Lavender T. Anorexia Nervosa and a Lost Emotional Self: A Psychological Formulation of the Development, Maintenance, and Treatment of Anorexia Nervosa. Front Psychol 2019; 10:219. [PMID: 30886593 PMCID: PMC6410927 DOI: 10.3389/fpsyg.2019.00219] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022] Open
Abstract
In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a 'lost sense of emotional self.' We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of 'emotional self.' Further, we discuss how, once established, AN becomes 'self-perpetuating' and the 'lost sense of emotional self' relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an 'emotional self' which can be flexibly and adaptively used to direct an individual's needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.
Collapse
Affiliation(s)
- Anna Oldershaw
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
- Kent and Medway All Age Eating Disorder Service, North East London NHS Foundation Trust, London, United Kingdom
| | - Helen Startup
- Sussex Eating Disorders Service and Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Tony Lavender
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
| |
Collapse
|
16
|
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: 50] [Impact Index Per Article: 10.0] [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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Batista M, Žigić Antić L, Žaja O, Jakovina T, Begovac I. PREDICTORS OF EATING DISORDER RISK IN ANOREXIA NERVOSA ADOLESCENTS. Acta Clin Croat 2018; 57:399-410. [PMID: 31168171 PMCID: PMC6536277 DOI: 10.20471/acc.2018.57.03.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
SUMMARY – The purpose of the present study was to examine the association among the risk of eating disorder (ED), psychological adjustment, empathy, attachment style and thin-ideal internalization among adolescents with anorexia nervosa (AN), as compared to a healthy control (HC) group. The Questionnaire of General Data, the Eating Disorders Inventory-3 (EDI-3), the Questionnaire of Sociocultural Attitudes Towards Appearance-3 (SATAQ-3), the Experiences in Close Relationships-Revised (ECR-R) and the Basic Empathy Scale (BES) were administered to 35 female adolescents with AN and 35 HC adolescents. Eating disorder risk was found to be highest in AN females with higher levels of general psychological maladjustment (GPMC), followed by HC females with higher thin-ideal internalization. In the AN group, attachment style and thin-ideal internalization in combination with GPMC were not indicated as significant predictors of eating disorder risk. Study data provide support to conceptualizations of EDs that emphasize the role of general psychological maladjustment in the development of EDs.
Collapse
Affiliation(s)
| | - Lana Žigić Antić
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Orjena Žaja
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Trpimir Jakovina
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Begovac
- 1Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
20
|
Abstract
Empathy is the ability to recognize and respond to the emotional states of other individuals. It is an important psychological process that facilitates navigating social interactions and maintaining relationships, which are important for well-being. Several psychological studies have identified difficulties in both self-report and performance-based measures of empathy in a range of psychiatric conditions. To date, no study has systematically investigated the genetic architecture of empathy using genome-wide association studies (GWAS). Here we report the results of the largest GWAS of empathy to date using a well-validated self-report measure of empathy, the Empathy Quotient (EQ), in 46,861 research participants from 23andMe, Inc. We identify 11 suggestive loci (P < 1 × 10-6), though none were significant at P < 2.5 × 10-8 after correcting for multiple testing. The most significant SNP was identified in the non-stratified analysis (rs4882760; P = 4.29 × 10-8), and is an intronic SNP in TMEM132C. The EQ had a modest but significant narrow-sense heritability (0.11 ± 0.014; P = 1.7 × 10-14). As predicted, based on earlier work, we confirmed a significant female advantage on the EQ (P < 2 × 10-16, Cohen's d = 0.65). We identified similar SNP heritability and high genetic correlation between the sexes. Also, as predicted, we identified a significant negative genetic correlation between autism and the EQ (rg = -0.27 ± 0.07, P = 1.63 × 10-4). We also identified a significant positive genetic correlation between the EQ and risk for schizophrenia (rg = 0.19 ± 0.04; P = 1.36 × 10-5), risk for anorexia nervosa (rg = 0.32 ± 0.09; P = 6 × 10-4), and extraversion (rg = 0.45 ± 0.08; 5.7 × 10-8). This is the first GWAS of self-reported empathy. The results suggest that the genetic variations associated with empathy also play a role in psychiatric conditions and psychological traits.
Collapse
|
21
|
Dell'Osso L, Carpita B, Gesi C, Cremone IM, Corsi M, Massimetti E, Muti D, Calderani E, Castellini G, Luciano M, Ricca V, Carmassi C, Maj M. Subthreshold autism spectrum disorder in patients with eating disorders. Compr Psychiatry 2018; 81:66-72. [PMID: 29268154 DOI: 10.1016/j.comppsych.2017.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022] Open
Abstract
AIM Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours. METHODS 138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R). RESULTS participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs. CONCLUSIONS Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged.
Collapse
Affiliation(s)
- L Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - B Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - C Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - I M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - D Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Calderani
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - G Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - M Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Burns BD, Zhang Y, Wieth M, Touyz S. An exploratory study of creativity and eating disorders. J Eat Disord 2017; 5:45. [PMID: 29075495 PMCID: PMC5649089 DOI: 10.1186/s40337-017-0176-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/02/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We examined whether cognitive rigidity associated with having an eating disorder generalized to creativity. METHOD One hundred twelve participants from the participant pool of an Australian university were given a measure of disordered eating (EDE-Q), asked if they had ever had a diagnosis of an eating disorder (16 reported yes), and given 3 min to generate alternative uses for a paper-clip. The alternative uses task yielded measures of creative fluency, originality, elaboration and flexibility. RESULTS A logistic regression found that only lower flexibility predicted a self-reported ED diagnosis. Across the spectrum of disordered eating behaviour there was no association between creativity measures and EDE-Q global scores. CONCLUSION Our results were consistent with previous findings of an association between cognitive inflexibility and having an ED. However we found no evidence that cognitive inflexibility generalized to creativity more broadly. Our results may lend support to Cognitive Remediation Therapy, but further study is required.
Collapse
Affiliation(s)
- Bruce D Burns
- University of Sydney, Sydney, New South Wales Australia
| | | | | | - Stephen Touyz
- University of Sydney, Sydney, New South Wales Australia
| |
Collapse
|
24
|
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.
Collapse
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.
| |
Collapse
|
25
|
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.
Collapse
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.
| |
Collapse
|
26
|
Kucharska K, Jeschke J, Mafi R. Intact social cognitive processes in outpatients with anorexia nervosa: a pilot study. Ann Gen Psychiatry 2016; 15:24. [PMID: 27594894 PMCID: PMC5009686 DOI: 10.1186/s12991-016-0108-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 08/04/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess social cognition in community patients suffering from anorexia nervosa (AN) compared to healthy controls. METHODS 25 women diagnosed with AN and 25 women matched for education level and age were involved in the study. Both subject groups were assessed using a set of validated experimental tasks, such as the facial expression recognition test, short recognition memory test for faces, 'Reading the mind in the eyes' test. Patients were assessed for symptoms of: eating disorder (the eating attitudes test-EAT-26), OCD (the Yale-Brown obsessive compulsive scale-Y-BOCS) and depression (Beck depression inventory-BDI). The research hypothesis indicated that patients suffering from anorexia represent no significant difference in social cognitive functioning in comparison to the healthy controls. These assessment scales were used to identify whether there are any problems according to social cognitive functioning especially emotion recognition and theory of mind (ToM). The primary outcome assessment was to identify social cognitive deficits in anorexic outpatients and secondary outcome was to verify whether these problems in emotional functioning found in women in acute phase of AN are state or trait effects. RESULTS Anorexic patients showed significantly higher scores on EAT-26, BDI and Y-BOCS. No significant differences were found in performance of social cognitive tests and facial perception test. DISCUSSION No marked alterations were found in social cognitive functioning in community patients with average body mass index (BMI) of 17.6. This may indicate that social cognition is a very complex construct to be reliably measured in anorexia nervosa considering relatively limited psychometric data for many social cognitive tasks. Further longitudinal studies are needed to untangle ongoing controversy whether social cognitive deficits in AN could be state or trait related.
Collapse
Affiliation(s)
- Katarzyna Kucharska
- Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland
| | - Julia Jeschke
- Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland
| | | |
Collapse
|
27
|
Cardi V, Corfield F, Leppanen J, Rhind C, Deriziotis S, Hadjimichalis A, Hibbs R, Micali N, Treasure J. Emotional Processing, Recognition, Empathy and Evoked Facial Expression in Eating Disorders: An Experimental Study to Map Deficits in Social Cognition. PLoS One 2015; 10:e0133827. [PMID: 26252220 PMCID: PMC4529105 DOI: 10.1371/journal.pone.0133827] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/02/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Difficulties in social cognition have been identified in eating disorders (EDs), but the exact profile of these abnormalities is unclear. The aim of this study is to examine distinct processes of social-cognition in this patient group, including attentional processing and recognition, empathic reaction and evoked facial expression in response to discrete vignettes of others displaying positive (i.e. happiness) or negative (i.e. sadness and anger) emotions. METHOD One hundred and thirty-eight female participants were included in the study: 73 healthy controls (HCs) and 65 individuals with an ED (49 with Anorexia Nervosa and 16 with Bulimia Nervosa). Self-report and behavioural measures were used. RESULTS Participants with EDs did not display specific abnormalities in emotional processing, recognition and empathic response to others' basic discrete emotions. However, they had poorer facial expressivity and a tendency to turn away from emotional displays. CONCLUSION Treatments focusing on the development of non-verbal emotional communication skills might be of benefit for patients with EDs.
Collapse
Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
- * E-mail:
| | - Freya Corfield
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Jenni Leppanen
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Charlotte Rhind
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Stephanie Deriziotis
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Alexandra Hadjimichalis
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Rebecca Hibbs
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| |
Collapse
|
28
|
Baldwin S, Costley D. The experiences and needs of female adults with high-functioning autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 20:483-95. [PMID: 26111537 DOI: 10.1177/1362361315590805] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is limited large-scale research into the lived experiences of female adults who have an autism spectrum disorder with no co-occurring intellectual disability. Drawing on the findings of an Australia-wide survey, this report presents self-report data from n = 82 women with high-functioning autism spectrum disorder in the areas of health, education, employment, social and community activities. Where relevant, comparisons are provided with the male subset of the same study population; however, in the majority of analyses, no discernible gender differences emerged. The findings highlight the diverse and complex challenges faced by women with high-functioning autism spectrum disorder, including high levels of mental health disorder, unmet support needs in education settings and the workplace, and social exclusion and isolation.
Collapse
|
29
|
Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Mol Autism 2015; 6:6. [PMID: 26056560 PMCID: PMC4459459 DOI: 10.1186/2040-2392-6-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/08/2015] [Indexed: 12/25/2022] Open
Abstract
Background Many women with eating disorders (EDs) have social impairments and difficulties with flexibility. It is unclear to what extent these are manifestations of an underlying autism spectrum disorder (ASD); or whether they are instead the consequence of starvation, anxiety, low mood or obsessive compulsive disorder, all of which are highly prevalent in EDs. The resolution of this clinically and theoretically important uncertainty will require the use of gold-standard ASD assessment measures. To date these have not been employed in ED research. This case series is the first report of a well-validated, direct-observational measure of ASD, the Autism Diagnostic Observation Schedule (ADOS), being administered to women with EDs. We aimed to learn about the feasibility of the ADOS in this population, and to contribute to debates about whether a sub-group with EDs really have ASD. Methods Ten women (mean age = 26.4 years, range = 19 to 38 years) who had a suspected ASD due to social and flexibility difficulties and were receiving treatment for ED (seven anorexia, two ED not otherwise specified, one bulimia) at a specialist service (four inpatient, six outpatient) received an ADOS Module 4 assessment. Results All 10 participants completed all activities of the ADOS Module 4. Five scored in the ASD range on the ADOS diagnostic algorithm. An additional two were judged likely to have ASD, even though they scored below the ADOS’s diagnostic threshold. This was on the basis of clinical observation, participant self-report and parent report. The seven women who we estimated to have ASD all reported autistic difficulties prior to the onset of their ED. They commonly described longstanding non-autistic neurodevelopmental problems, including dyslexia, dyspraxia and epilepsy. Only one had a childhood diagnosis of ASD. Conclusions A substantial proportion of women with EDs who present with social and flexibility difficulties may have an unrecognised ASD, indicated by a constellation of autistic difficulties that appears to predate the onset of their eating problems. The ADOS is a useful component of an ASD assessment for adult women with ED.
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Rhind C, Bonfioli E, Hibbs R, Goddard E, Macdonald P, Gowers S, Schmidt U, Tchanturia K, Micali N, Treasure J. An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents. Mol Autism 2014; 5:56. [PMID: 25553237 PMCID: PMC4280745 DOI: 10.1186/2040-2392-5-56] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/20/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There may be a link between anorexia nervosa and autism spectrum disorders. The aims of this study were to examine whether adolescents with anorexia nervosa have autism spectrum and/or obsessive-compulsive traits, how many would meet diagnostic criteria for autism spectrum disorder, and whether these traits are shared by parents. METHODS A total of 150 adolescents receiving outpatient treatment for anorexia nervosa or subthreshold anorexia nervosa and their parents completed the autism spectrum disorder and eating disorder sections of the Development and Well-being Assessment. Patients also completed the Children Yale-Brown Obsessive-Compulsive Scale and other measures of psychiatric morbidity, and parents completed the short Autism Quotient and Obsessive-Compulsive Inventory Revised. RESULTS Adolescents with anorexia nervosa had a below average social aptitude (19% below cut-off) and high levels of peer relationship problems (39% above cut-off) and obsessive-compulsive symptoms (56% above cut-off). Six cases (4%, all females) were assigned a possible (n = 5) or definite (n = 1) diagnosis of autism spectrum disorder. Parental levels of autism spectrum and obsessive-compulsive traits were within the normal range. CONCLUSIONS This study suggests that adolescents with anorexia nervosa have elevated levels of autism spectrum traits, obsessive-compulsive symptoms, and a small proportion fulfil diagnostic criteria for a probable autism spectrum disorder. These traits did not appear to be familial. This comorbidity has been associated with a poorer prognosis. Therefore, adaptation of treatment for this subgroup may be warranted. TRIAL REGISTRATION Controlled-trials.com: ISRCTN83003225. Registered on 29 September 2011.
Collapse
Affiliation(s)
- Charlotte Rhind
- />Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, PO59 103 Denmark Hill, London, SE5 8AF UK
| | - Elena Bonfioli
- />Department of Public Health and Community Medicine, University of Verona, P.le L.A. Scuro 10, Verona, 37134 Italy
| | - Rebecca Hibbs
- />Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, PO59 103 Denmark Hill, London, SE5 8AF UK
| | - Elizabeth Goddard
- />Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, PO59 103 Denmark Hill, London, SE5 8AF UK
| | - Pamela Macdonald
- />Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, PO59 103 Denmark Hill, London, SE5 8AF UK
| | - Simon Gowers
- />University of Liverpool, Psychological Sciences, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL UK
| | - Ulrike Schmidt
- />Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, PO59 103 Denmark Hill, London, SE5 8AF UK
| | - Kate Tchanturia
- />Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, PO59 103 Denmark Hill, London, SE5 8AF UK
- />Ilia State University, Kakutsa Cholokashvili Ave 3/5, Tbilisi, 0162 Georgia
| | - Nadia Micali
- />Institute of Child Health, Behavioral and Brain Sciences Unit, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Janet Treasure
- />Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, PO59 103 Denmark Hill, London, SE5 8AF UK
| |
Collapse
|
32
|
Morris R, Bramham J, Smith E, Tchanturia K. Empathy and social functioning in anorexia nervosa before and after recovery. Cogn Neuropsychiatry 2014; 19:47-57. [PMID: 23697879 DOI: 10.1080/13546805.2013.794723] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION People with anorexia nervosa (AN) are known to have difficulties with social and emotional functioning, as indicated by their symptom presentation and also performance on tests of emotion perception. This study explores the level of empathy in AN, in terms of resonant experience of emotion in other people using a self-report measure. METHODS Twenty-eight women with acute AN were compared to 25 women who have recovered from AN, and a further 54 healthy control (HC) participants. They were assessed using a questionnaire to measure reported levels of empathy, emotional recognition, social conformity, and antisocial behaviour. RESULTS The acute AN group reported lower levels of empathy than the recovered AN group and HC, but they also reported less antisocial behaviour. No differences were found in emotional recognition or social conformity. CONCLUSIONS These results suggest that emotional empathy is reduced during acute AN. Lower levels of antisocial behaviour may reflect a contrasting desire of people with AN to minimise presentation of antisocial behaviour in the acute state.
Collapse
Affiliation(s)
- Robin Morris
- a Department of Psychology , Institute of Psychiatry, King's College London , London , UK
| | | | | | | |
Collapse
|
33
|
Kim YR, Kim CH, Cardi V, Eom JS, Seong Y, Treasure J. Intranasal oxytocin attenuates attentional bias for eating and fat shape stimuli in patients with anorexia nervosa. Psychoneuroendocrinology 2014; 44:133-42. [PMID: 24703429 DOI: 10.1016/j.psyneuen.2014.02.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 01/17/2023]
Abstract
We examined the impact of oxytocin on attentional processes for eating, shape, and weight stimuli in patients with anorexia nervosa (AN). A double-blind, placebo-controlled within-subject crossover design was used. Intranasal oxytocin or placebo followed by a visual probe detection task with food, weight, and shape images was administered to 64 female subjects: 31 patients with AN and 33 control students. The AN group showed significant reductions in the attentional biases toward eating-related stimuli (p=0.030, d=0.516) and toward negative shape stimuli (p=0.015, d=0.498) under the influence of intranasal oxytocin. The effect of oxytocin was correlated with autistic spectrum traits in the AN group. Oxytocin had no effect on the amount of juice consumed in either group. The results of this study suggest that oxytocin attenuates the attentional vigilance to eating and fat shape stimuli in patients with AN. Further studies using oxytocin as a form of intervention for patients with AN are needed.
Collapse
Affiliation(s)
- Youl-Ri Kim
- Eating Disorders Clinic, Department of Neuropsychiatry, Seoul Paik Hospital, Inje University, Seoul, Republic of Korea.
| | - Chan-Hyung Kim
- Department of Psychiatry, Severance Mental Health Hospital, Yonsei University College of Medicine, Gyeonggi Do, South Korea
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom
| | - Jin-Sup Eom
- Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea
| | - Yoori Seong
- Eating Disorders Clinic, Department of Neuropsychiatry, Seoul Paik Hospital, 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
| |
Collapse
|
34
|
Anorexia nervosa and its relation to depression, anxiety, alexithymia and emotional processing deficits. Eat Weight Disord 2014; 19:209-16. [PMID: 24474662 DOI: 10.1007/s40519-014-0101-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/11/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Psychopathological changes and dysfunction in emotion processing have been described for anorexia nervosa (AN). Yet, findings are applicable to adult patients only. Furthermore, potential for discriminative power in clinical practice in relation to clinical parameters has to be discussed. The aim of this study was to investigate psychopathology and emotional face processing in adolescent female patients with AN. METHODS In a sample of 15 adolescent female patients with AN (16.2 years, SD ± 1.26) and 15 age and sex matched controls we assessed alexithymia, depression, anxiety and empathy in addition to emotion labelling and social information processing. RESULTS AN patients had significantly higher alexithymia, higher levels of depression, and state and trait anxiety compared to controls. There was a trend for a lower ability to recognize disgust. Happiness as a positive emotion was recognized better. All facial expressions were recognized significantly faster by AN patients. Associations of pathological eating behaviour and trait anxiety were seen. CONCLUSION In accordance with the stress reduction hypothesis, typical psychopathology of alexithymia, anxiety and depression is prevalent in female adolescent AN patients. It is present detached from physical stability. Pathogenesis of AN is multifactorial and already fully present in adolescence. An additional reinforcement process can be discussed. For clinical practice, those parameters might have a better potential for early prognostic factors related to AN than physical parameters and possible implication for intervention is given.
Collapse
|
35
|
Rhind C, Hibbs R, Goddard E, Schmidt U, Micali N, Gowers S, Beecham J, Macdonald P, Todd G, Tchanturia K, Treasure J. Experienced Carers Helping Others (ECHO): protocol for a pilot randomised controlled trial to examine a psycho-educational intervention for adolescents with anorexia nervosa and their carers. EUROPEAN EATING DISORDERS REVIEW 2014; 22:267-77. [PMID: 24888426 DOI: 10.1002/erv.2298] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/24/2014] [Accepted: 05/06/2014] [Indexed: 11/07/2022]
Abstract
Experienced Carers Helping Others (ECHO) is an intervention for carers of people with eating disorders. This paper describes the theoretical background and protocol of a pilot multicentre randomised controlled trial that will explore the use of two variants of ECHO for improving outcomes for adolescents with anorexia nervosa (AN) referred for outpatient care. Adolescent patients and their carers (typically parents and close others in a supportive role) will be recruited from 38 eating disorder outpatient services across the UK. Carers will be randomly allocated to receive 'ECHOc' guided self-help (in addition to treatment as usual), 'ECHO' self-help only (in addition to treatment as usual) or treatment as usual only. Primary outcomes are a summary measure of the Short Evaluation of Eating Disorders at 6- and 12-month follow-ups. Secondary outcomes are general psychiatric morbidity of AN patients and carer, carers' coping and behaviour, and change in healthcare use and costs at 6- and 12-month follow-ups. Therapist effects will be examined, and process evaluation of ECHOc will be completed. The findings from this pilot trial will be used in preparation for executing a definitive trial to determine the impact of the preferred variant of ECHO to improve treatment outcomes for AN.
Collapse
Affiliation(s)
- Charlotte Rhind
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Caglar-Nazali HP, Corfield F, Cardi V, Ambwani S, Leppanen J, Olabintan O, Deriziotis S, Hadjimichalis A, Scognamiglio P, Eshkevari E, Micali N, Treasure J. A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders. Neurosci Biobehav Rev 2014; 42:55-92. [PMID: 24333650 DOI: 10.1016/j.neubiorev.2013.12.002] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/08/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
|
37
|
Pohl A, Cassidy S, Auyeung B, Baron-Cohen S. Uncovering steroidopathy in women with autism: a latent class analysis. Mol Autism 2014; 5:27. [PMID: 24717046 PMCID: PMC4022124 DOI: 10.1186/2040-2392-5-27] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/10/2014] [Indexed: 11/30/2022] Open
Abstract
Background Prenatal exposure to increased androgens has been implicated in both polycystic ovary syndrome (PCOS) and autism spectrum conditions (ASC), suggesting that PCOS may be increased among women with ASC. One study suggested elevated steroidopathic symptoms (‘steroidopathy’) in women with ASC. As the symptoms are not independent, we conducted a latent class analysis (LCA). The objectives of the current study are: (1) to test if these findings replicate in a larger sample; and (2) to use LCA to uncover affected clusters of women with ASC. Methods We tested two groups of women, screened using the Autism Spectrum Quotient - Group 1: n = 415 women with ASC (mean age 36.39 ± 11.98 years); and Group 2: n = 415 controls (mean age 39.96 ± 11.92 years). All participants completed the Testosterone-related Medical Questionnaire online. A multiple-group LCA was used to identify differences in latent class structure between women with ASC and controls. Results There were significant differences in frequency of steroid-related conditions and symptoms between women with ASC and controls. A two-class semi-constrained model best fit the data. Based on response patterns, we identified the classes as ‘Typical’ and ‘Steroidopathic’. The prevalence of the ‘Steroidopathic’ class was significantly increased within the ASC group (ΔG2 = 15, df =1, P = 0.0001). In particular, we confirmed higher frequencies of epilepsy, amenorrhea, dysmenorrhea, severe acne, gender dysphoria, and transsexualism, and differences in sexual preference in women with ASC. Conclusions Women with ASC are at increased risk for symptoms and conditions linked to steroids. LCA revealed this steroidopathy despite the apparent underdiagnosis of PCOS.
Collapse
Affiliation(s)
- Alexa Pohl
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK
| | - Sarah Cassidy
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK ; Department of Psychology and Behavioural Sciences, Coventry University, James Starley Building, Cox Street, Coventry CV1 5LW, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK ; Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9 AD, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge CB2 8AH, UK ; CLASS Clinic, Cambridgeshire and Peterborough Mental Health Foundation NHS Trust, The Chitra Sethia Autism Centre, The Gatehouse, Fulborn Hospital, Fulborn, Cambridge CB21 5EF, UK
| |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Doris E, Westwood H, Mandy W, Tchanturia K. A Qualitative Study of Friendship in Patients with Anorexia Nervosa and Possible Autism Spectrum Disorder. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/psych.2014.511144] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
40
|
Fonville L, Giampietro V, Surguladze S, Williams S, Tchanturia K. Increased BOLD signal in the fusiform gyrus during implicit emotion processing in anorexia nervosa. NEUROIMAGE-CLINICAL 2013; 4:266-73. [PMID: 24501698 PMCID: PMC3913832 DOI: 10.1016/j.nicl.2013.12.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/30/2013] [Accepted: 12/02/2013] [Indexed: 12/02/2022]
Abstract
Background The behavioural literature in anorexia nervosa (AN) has suggested impairments in psychosocial functioning and studies using facial expression processing tasks (FEPT) have reported poorer recognition and slower identification of emotions. Methods Functional magnetic resonance imaging (fMRI) was used alongside a FEPT, depicting neutral, mildly happy and happy faces, to examine the neural correlates of implicit emotion processing in AN. Participants were instructed to specify the gender of the faces. Levels of depression, anxiety, obsessive–compulsive symptoms and eating disorder behaviour were obtained and principal component analysis (PCA) was performed to acquire uncorrelated variables. Results fMRI analysis revealed a greater blood-oxygenation level dependent (BOLD) response in AN in the right fusiform gyrus to all facial expressions. This response showed a linear increase with the happiness of the facial expression and was found to be stronger in those not taking medication. PCA analysis revealed a single component indicating a greater level of general clinical symptoms. Conclusion Neuroimaging findings would suggest that alterations in implicit emotion processing in AN occur during early perceptual processing of social signals and illustrate greater engagement on the FEPT. The lack of separate components using PCA suggests that the questionnaires used might not be suited as predictive measures. Greater BOLD response in AN in the right fusiform gyrus to all facial expressions. The BOLD response showed a linear increase with the happiness of the expression The BOLD response was stronger in those not taking psychotropic medication These alterations occur during early perceptual processing of social signals
Collapse
Affiliation(s)
- Leon Fonville
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Vincent Giampietro
- King's College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Simon Surguladze
- King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, United Kingdom ; Cognitive & Affective Neuroscience Lab, Ilia University, Tblisi, Georgia
| | - Steven Williams
- King's College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom ; NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, United Kingdom
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| |
Collapse
|
41
|
Huke V, Turk J, Saeidi S, Kent A, Morgan JF. The Clinical Implications of High Levels of Autism Spectrum Disorder Features in Anorexia Nervosa: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2013; 22:116-21. [DOI: 10.1002/erv.2269] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Vanessa Huke
- St George's, University of London; London UK
- Yorkshire Centre for Eating Disorders; Leeds UK
| | - Jeremy Turk
- St George's, University of London; London UK
- Southwark Child & Adolescent Mental Health Neurodevelopmental Service; South London and Maudsley NHS Foundation Trust; UK
- Institute of Psychiatry; King's College; London UK
| | | | - Andrew Kent
- St George's, University of London; London UK
| | - John. F. Morgan
- St George's, University of London; London UK
- Yorkshire Centre for Eating Disorders; Leeds UK
| |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Courty A, Maria AS, Lalanne C, Ringuenet D, Vindreau C, Chevallier C, Pouga L, Pinabel F, Philippe A, Adrien JL, Barry C, Berthoz S. Levels of autistic traits in anorexia nervosa: a comparative psychometric study. BMC Psychiatry 2013; 13:222. [PMID: 24015680 PMCID: PMC3848448 DOI: 10.1186/1471-244x-13-222] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of characteristics associated with Autism Spectrum Disorders (ASD) are over-represented among patients with Anorexia Nervosa (AN) as well as among relatives of these patients. Yet the co-occurrence of autistic traits in AN has not been fully explored and no previous study has directly compared self-reported evaluations of cognitive and socio-affective skills in AN and ASD. METHODS We aimed to determine the degree of overlap between AN and ASD from scores on questionnaires classically used to measure ASD impairments. Fifteen AN participants, 15 ASD participants and two groups of matched controls completed a battery of self-reports measuring: autistic traits (Autism-Spectrum Quotient), empathy (Empathy Quotient-short and Interpersonal Reactivity Index), systemizing (Systemizing Quotient-short) and alexithymia (Bermond-Vorst Alexithymia Questionnaire-B). Univariate comparisons of mean totalled scores were performed on each measure (patients vs. controls, and AN vs. ASD), and a Principal Component Analysis was used to study subject proximities in a reduced-factor space constructed from AQ, BVAQ-B and IRI subscales. RESULTS These analyses revealed similarities in a few cognitive domains (Attention Switching, Perspective Taking and Fantasy, lack of emotional introspection) and in some nonspecific affective dimensions (depression and feelings of distress), but also marked dissimilarities in social skills (the ability to communicate emotions to others, empathizing). CONCLUSION The AN and ASD participants reported similar needs for sameness, and similar difficulties understanding their emotions and taking the perspective of another, but contrasting abilities to feel concerned in interpersonal situations. Our mixed findings encourage further exploration of transdiagnostic similarities and associations between these disorders.
Collapse
Affiliation(s)
- Annaig Courty
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, Paris, France
| | - Anne Solène Maria
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
| | - Christophe Lalanne
- AP-HP, Department of Clinical Research, Saint-Louis Hospital, Paris, France
- Inserm Unit UMR-SO 669, University Paris Sud, Paris Descartes, Paris, France
| | - Damien Ringuenet
- Department of Psychiatry and Addictology, Eating disorders unit, AP-HP, Hôpital Paul Brousse, Paris Sud University, Villejuif, France
| | - Christine Vindreau
- Department of Psychiatry and Addictology, Eating disorders unit, AP-HP, Hôpital Paul Brousse, Paris Sud University, Villejuif, France
| | - Coralie Chevallier
- Inserm U960 – LNC, Paris, France
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - François Pinabel
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpétrière, Paris Descartes University, Paris, France
- Private Practice, 6 avenue de Tourville, Paris 75007, France
| | - Anne Philippe
- Inserm U781 & Department of Genetic, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Jean-Louis Adrien
- LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, Paris, France
| | - Caroline Barry
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
| | - Sylvie Berthoz
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
| |
Collapse
|
44
|
Huke V, Turk J, Saeidi S, Kent A, Morgan JF. Autism Spectrum Disorders in Eating Disorder Populations: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2013; 21:345-51. [DOI: 10.1002/erv.2244] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Andy Kent
- St George's, University of London; London; UK
| | | |
Collapse
|
45
|
Baron-Cohen S, Jaffa T, Davies S, Auyeung B, Allison C, Wheelwright S. Do girls with anorexia nervosa have elevated autistic traits? Mol Autism 2013; 4:24. [PMID: 23915495 PMCID: PMC3735388 DOI: 10.1186/2040-2392-4-24] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 06/20/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients with anorexia may have elevated autistic traits. In this study, we tested test whether patients with anorexia nervosa (anorexia) have an elevated score on a dimensional measure of autistic traits, the Autism Spectrum Quotient (AQ), as well as on trait measures relevant to the autism spectrum: the Empathy Quotient (EQ), and the Systemizing Quotient (SQ). METHODS Two groups were tested: (1) female adolescents with anorexia: n = 66, aged 12 to 18 years; and (2) female adolescents without anorexia: n =1,609, aged 12 to 18 years. Both groups were tested using the AQ, EQ, and SQ, via the parent-report adolescent versions for patients aged 12 to 15 years old, and the self-report adult versions for patients aged over 16 years. RESULTS As predicted, the patients with anorexia had a higher AQ and SQ. Their EQ score was reduced, but only for the parent-report version in the younger age group. Using EQ-SQ scores to calculate 'cognitive types', patients with anorexia were more likely to show the Type S profile (systemizing (S) better than empathy (E)), compared with typical females. CONCLUSIONS Females with anorexia have elevated autistic traits. Clinicians should consider if a focus on autistic traits might be helpful in the assessment and treatment of anorexia. Future research needs to establish if these results reflect traits or states associated with anorexia.
Collapse
Affiliation(s)
- Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
- CLASS Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Tony Jaffa
- Phoenix Centre, Ida Darwin, Fulbourn, Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sarah Davies
- Phoenix Centre, Ida Darwin, Fulbourn, Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
| | - Sally Wheelwright
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
| |
Collapse
|
46
|
Fonville L, Lao-Kaim NP, Giampietro V, Van den Eynde F, Davies H, Lounes N, Andrew C, Dalton J, Simmons A, Williams SC, Baron-Cohen S, Tchanturia K. Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test; an FMRI study. PLoS One 2013; 8:e63964. [PMID: 23691129 PMCID: PMC3653828 DOI: 10.1371/journal.pone.0063964] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 04/08/2013] [Indexed: 01/12/2023] Open
Abstract
The behavioural literature in anorexia nervosa and autism spectrum disorders has indicated an overlap in cognitive profiles. One such domain is the enhancement of local processing over global processing. While functional imaging studies of autism spectrum disorder have revealed differential neural patterns compared to controls in response to tests of local versus global processing, no studies have explored such effects in anorexia nervosa. This study uses functional magnetic resonance imaging in conjunction with the embedded figures test, to explore the neural correlates of this enhanced attention to detail in the largest anorexia nervosa cohort to date. On the embedded figures tests participants are required to indicate which of two complex figures contains a simple geometrical shape. The findings indicate that whilst healthy controls showed greater accuracy on the task than people with anorexia nervosa, different brain regions were recruited. Healthy controls showed greater activation in the precuneus whilst people with anorexia nervosa showed greater activation in the fusiform gyrus. This suggests that different cognitive strategies were used to perform the task, i.e. healthy controls demonstrated greater emphasis on visuospatial searching and people with anorexia nervosa employed a more object recognition-based approach. This is in accordance with previous findings in autism spectrum disorder using a similar methodology and has implications for therapies addressing the appropriate adjustment of cognitive strategies in anorexia nervosa.
Collapse
Affiliation(s)
- Leon Fonville
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Nick P. Lao-Kaim
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Vincent Giampietro
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Frederique Van den Eynde
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
- Eating Disorders Program, Douglas University Institute, Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | - Helen Davies
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Naima Lounes
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Christopher Andrew
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Jeffrey Dalton
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Andrew Simmons
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College, London, United Kingdom
| | - Steven C.R. Williams
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College, London, United Kingdom
| | - Simon Baron-Cohen
- Autism Research Centre, University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom
| | - Kate Tchanturia
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| |
Collapse
|
47
|
Martinez G, Cook-Darzens S, Chaste P, Mouren MC, Doyen C. [Anorexia nervosa in the light of neurocognitive functioning: New theoretical and therapeutic perspectives]. Encephale 2013; 40:160-7. [PMID: 23541918 DOI: 10.1016/j.encep.2012.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/26/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Anorexia nervosa is a serious psychiatric disorder, for which very few validated therapeutic strategies exist. The specific sociocognitive style of anorexic patients has already been described in the 1960s: it involves a concrete style with abstraction difficulties. Current neuropsychological tests have contributed to a more precise definition of these difficulties. NEUROPSYCHOLOGICAL DATA IS THERE A SPECIFIC COGNITIVE PROFILE?: Contrary to common beliefs, these patients' intellectual performances are not superior to those of the general population. However, detailed comparisons of profiles on the Weschler Scales suggest difficulties in synthesizing information and better abilities in concrete problem solving. EXCESSIVE ATTENTION TO DETAILS The dominant hypothesis concerning the attentional dimension is the existence of a weakness in central coherence, resulting in superior detail processing and a weakness in global integration. This trend appears to be stable even after the normalization of nutritional status. IMPAIRED COGNITIVE FLEXIBILITY The impairment of set-shifting abilities leads to rigidity, expressed by inflexibility and perseveration, both in reasoning and behaviour. This reduced cognitive flexibility appears to persist after recovery, and may constitute a familial trait. In addition, this likely endophenotype seems to be independent from obsessional traits. CONTROVERSIAL SOCIAL SKILL Alexithymia is frequently described in anorexic individuals. It is the verbal description of feelings which seems to be particularly impaired. It may explain underlying difficulties in empathy. Indeed, these subjects have lower scores on emotional tests drawn from the theory of mind. These cognitive abnormalities are well documented in pervasive developmental disorders. NEUROANATOMICAL DATA: NEUROIMAGING IN SUPPORT OF LIMBIC AND FRONTO-STRIATAL ABNORMALITIES: Evidence from neuroimaging suggests abnormalities in cortical and subcortical structures, involving the temporal and orbito-frontal lobes. Various functional hypotheses are formulated, involving fronto-striatothalamic circuits, amygdala or insula. IS ANOREXIA NERVOSA A DEVELOPMENTAL DISORDER?: Pervasive developmental disorders are over-represented among anorexic subjects in comparison to the general population. Conversely, restrictive and selective eating disorders are more frequent among individuals presenting an autistic spectrum disorder. THERAPEUTIC IMPLICATIONS AND FUTURE DIRECTIONS In view of the common cognitive and neuroanatomical data that are found in anorexia nervosa and neurodevelopmental disorders, we adhere to the hypothesis that anorexia nervosa may be similar to a neurodevelopmental disorder. Clinical observations suggest that this hypothesis may be especially relevant in the early forms of anorexia nervosa. These cognitive data confirm the potential relevance of new therapeutic modalities such as cognitive remediation. Initial results from its application to anorexia nervosa seem promising. CONCLUSION A review of the recent literature highlights the possible existence of a developmental impairment of cortical and subcortical structures, associated with specific abnormalities in cognitive development such as a weakness in central coherence, reduced set-shifting ability and poor social skills. On this basis, cognitive remediation may be a promising therapeutic innovation.
Collapse
Affiliation(s)
- G Martinez
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - S Cook-Darzens
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - P Chaste
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - M-C Mouren
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - C Doyen
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| |
Collapse
|
48
|
Treasure J. Coherence and other autistic spectrum traits and eating disorders: building from mechanism to treatment. The Birgit Olsson lecture. Nord J Psychiatry 2013; 67:38-42. [PMID: 22468644 DOI: 10.3109/08039488.2012.674554] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To revisit Gillberg's hypothesis proposed in 1992, which was that anorexia nervosa should be considered within the spectrum of autistic disorders. METHOD A search was made of the literature relating to the behavioural traits, and cognitive, emotional and neuroanatomical intermediate phenotypes that are shared between autistic spectrum disorders (ASD) and anorexia nervosa. RESULTS People with eating disorders in the acute phase (less so after recovery) share some behavioural traits (social impairment and restricted and repetitive behaviours) and intermediate phenotypes (weak central coherence, and impaired set shifting and theory of mind) with people in the autistic spectrum. CONCLUSION Behavioural and intermediate neuropsychological traits are shared between eating disorders and ASD. In part, these are familial but also they are accentuated by the illness state and may be secondary to starvation. These traits have implications for prognosis and treatment.
Collapse
Affiliation(s)
- Janet Treasure
- Kings College London Institute of Psychiatry, Department Academic Psychiatry, Denmark Hill, London, UK.
| |
Collapse
|
49
|
Calderoni S, Muratori F, Leggero C, Narzisi A, Apicella F, Balottin U, Carigi T, Maestro S, Fabbro F, Urgesi C. Neuropsychological functioning in children and adolescents with restrictive-type anorexia nervosa: An in-depth investigation with NEPSY–II. J Clin Exp Neuropsychol 2013; 35:167-79. [DOI: 10.1080/13803395.2012.760536] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
50
|
Work and social adjustment in patients with anorexia nervosa. Compr Psychiatry 2013; 54:41-5. [PMID: 22534033 DOI: 10.1016/j.comppsych.2012.03.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 02/26/2012] [Accepted: 03/11/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE AND METHODS The Work and Social Adjustment Scale (WSAS) assesses patients' perceptions of impairment in everyday functioning and has been reported as a simple and reliable self-report measure in different psychiatric disorders. This study compared WSAS data from an anorexia nervosa (AN) patient group with that from healthy controls (HCs) and published data from other patient groups. A total of 160 female participants (AN, 77; HC, 83) completed the WSAS as well as measures of eating disorder symptom severity and brief assessments of anxiety and depression. RESULTS Work and Social Adjustment Scale scores for the AN group were found to be in the severely impaired range, whereas the scores for those within the HC group indicated very little, or no impairment. Total WSAS scores in the AN group were significantly correlated with severity of clinical symptoms, and eating disorder-specific symptoms were the best predictor of social and occupational functional impairment. The greatest impairment in the AN group was reported in the realm of social leisure. CONCLUSIONS Consistent with reports in other clinical populations, it is suggested that the WSAS could be an extremely useful and meaningful measure to assess social and occupational functioning in people with eating disorders, in addition to eating disorder-specific assessments.
Collapse
|