Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa

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, 22.267 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 o 16, not severe (AN -) if BMI X 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 ANcases. 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. A, Fusco A, Senatore I, et al. Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa. Braz J Psychiatry. 2020;42:153-161. http://dx.

The Association Between Autistic Traits and Disordered Eating is Moderated by Sex/Gender and Independent of Anxiety and Depression

“…The assessment of autistic traits within eating disordered populations may also be of further importance, as scores on the AQ-10 (a shorted version of the AQ that is used in clinical settings; Allison et al 2012) in a population of AN patients were correlated with higher anxiety and depression, and with lower ability to maintain close relationships (Tchanturia et al 2013). Although AQ-10 scores did not correlate significantly with the level of disordered eating symptoms in this sample, Fornaro et al (2019) reported a significant (negative) correlation between AQ scores and BMI in a sample of n = 60 AN patients who were experiencing current depressive episodes. However, Solmi et al (2020) demonstrated significant correlations between autistic traits and disordered eating even after BMI had been controlled for statistically.…”

Análisis filosófico sobre la concepción neurocientífica de los rasgos autistas: aportes desde el normativismo vital de Georges Canguilhem

“…De un modo u otro, los rasgos autistas se han constituido como un objeto de estudio en sí mismo, a tal punto que durante los últimos quince años se produjo un marcado incremento de publicaciones que buscan vincular la presencia de rasgos autistas con diversas condiciones o características particulares de individuos agrupados bajo diferentes criterios relacionados a la edad, género, demografía, presencia de patologías físicas o mentales previas, entre otros. Así, hay investigaciones que afirman la presencia elevada de rasgos autistas entre personas que han intentado cometer suicidio (9) , entre mujeres con anorexia nerviosa (10) , entre criminales de una prisión de máxima seguridad en Portugal (11) , entre personas en situación de indigencia (28) , entre nietas de abuelas maternas fumadoras (29) , entre hombres con desorden de abuso de sustancias (30) , entre personas transgénero y de género diverso (31) , entre adultos jóvenes que nacieron en un parto extremadamente prematuro (32) , y un largo etcétera.…”

“…En este contexto, cada vez es más frecuente la publicación de artículos del ámbito de las neurociencias que reportan la manifestación de rasgos autistas en diversas poblaciones, diferenciadas por criterios vinculados a la edad, género, demografía, presencia de patologías físicas o mentales previas, entre otros. Para ejemplificar brevemente, hay investigaciones que resaltan la presencia de niveles elevados de rasgos autistas entre personas que han intentado cometer suicidio (9) , entre mujeres con anorexia nerviosa (10) , entre criminales de una prisión de máxima seguridad (11) , etc. La base común de estos trabajos radica en considerar que los rasgos autistas se distribuyen entre la población general (12) , lo cual habilita evaluarlos y hallarlos en grupos de personas no autistas, con las más variadas características.…”

Autism and anorexia nervosa: longitudinal prediction of eating disorder outcomes

“…Autistic social and cognitive styles clashing with the neurotypical world has been proposed to underlie high levels of mental health problems in autism, which are further compounded by other factors including stigma, trauma, and prejudice (Botha & Frost, 2020;Mitchell et al, 2021;Stark et al, 2021). In the same vein, in the field of eating disorders (ED), cross-sectional studies have documented that those who report more autistic traits present more severe ED psychopathology and complex illness profiles, with more comorbid anxiety, depression, and OCD symptoms (Fornaro et al, 2019;Kerr-Gaffney et al, 2020). Furthermore, previous longitudinal, naturalistic studies of AN patients admitted to inpatient ED services found that those who self-reported higher levels of autistic traits also reported more ED symptoms, depression and anxiety, and poorer social functioning at both admission and discharge Stewart et al, 2017;Tchanturia et al, 2019).…”