Autism and anorexia nervosa: longitudinal prediction of eating disorder outcomes

Abstract

Background: Recently, elevated levels of autistic traits and autism diagnoses have been reported among people with anorexia nervosa (AN). In clinical settings high levels of autistic traits have been linked to more complex, highly comorbid illness presentation and poorer outcome. This study aimed to examine whether autistic traits predict AN symptom profile in long term. Methods: Altogether 118 women with lived experience of AN completed two autism assessments at time 1, the Autism Diagnostic Observation Schedule (ADOS) and the short version of the Autism Quotient (AQ10). Measures assessing AN symptom profile, including eating disorders symptoms, anxiety, depression, OCD symptoms, and BMI, were also recorded. The symptom profile measures were administered again 6 months and 2 years later. We conducted two analyses to examine the extent to which the ADOS and AQ10 scores predicted broad AN symptom profile at each three time points.Results: Overall, high levels of autistic traits were consistently associated with worse psychological symptoms, but not BMI, across all time points. Both the analysis using baseline ADOS scores and self-reported AQ10 scores showed similar pattern. Limitations: The sample consisted of young women only and it is therefore, difficult to ascertain whether these findings extend to other genders. Additionally, 70% of the participants who completed the self-report questionnaires at Time 1 also agreed to undergo ADOS assessment. This may have limited the power of the analysis involving ADOS scores compared to the analysis using AQ10 scores. Conclusions: The present findings solidify previously reported associations between autistic traits and worse psychological outcome among people with AN. The findings also suggest that self-report measures may be sufficient for assessing autistic traits among people with AN. Importantly, the study highlights the need for development and further investigation of neurodiversity accommodations in the treatment of AN.