Autistic characteristics in eating disorders: Treatment adaptations and impact on clinical outcomes

Abstract

Objective: Autistic people with eating disorders (EDs) may have special needs that are not met in standard ED treatment, raising the need for treatment adaptations to accommodate co-existing autism spectrum condition (ASC).Little is currently known about the nature of existing treatment options or adaptations for this population. We conducted a pre-registered systematic review to: (1) identify research articles describing existing interventions for patients with ED and comorbid ASC, and to critically review evidence of their clinical effectiveness and cost-effectiveness (Review 1); (2) review the impact of ASC comorbidity on ED clinical outcomes (Review 2). Method: Peer-reviewed studies published until the end of December 2020 were identified through a systematic search of the electronic databases: Medline, Embase, PsycINFO, Web of Science, CINAHL, Scopus and Cochrane Library. Results: Only one clinical pathway of treatment adaptations (the 'PEACE' pathway) was identified in Review 1 with early evidence of cost-savings and favourable treatment outcomes. ASC characteristics were shown in Review 2 to have no direct impact on physical outcomes or ED symptoms, but could be associated with higher rates of comorbidities and greater use of intensive ED treatment. Additionally, patients with ASC characteristics may benefit more from individual sessions, rather than group sessions.Conclusions: Any new treatments or treatment adaptations may not directly impact on ED symptoms, but may be better able to support the complex needs of the ASC population, thus reducing subsequent need for intensive treatment. Future research is warranted to explore evidence of clinical and costeffectiveness of interventions for this population.

Autism and anorexia nervosa: Longitudinal prediction of eating disorder outcomes

“…In the same vein, in the field of eating disorders (ED), cross-sectional studies have documented that those who report more autistic features present more severe ED psychopathology and complex illness profiles, with more comorbid anxiety, depression, and OCD symptoms ( 22 , 23 ). Furthermore, previous longitudinal, naturalistic studies of AN patients admitted to inpatient ED services found that those who self-reported higher levels of autistic features also reported more ED symptoms, depression and anxiety, and poorer social functioning at both admission and discharge ( 24 – 26 ). However, notably the average duration inpatient treatment was 16 weeks making it difficult to draw long-term conclusions from these findings.…”

Association of autism diagnosis and polygenic scores with eating disorder severity

“…The association appears to be strongest with anorexia nervosa (AN), but also other EDs (OED) such as bulimia nervosa and binge‐eating disorder are overrepresented in individuals with autism, as are weight extremes (underweight and obesity) (Nickel et al., 2019; Sedgewick et al., 2020; Westwood & Tchanturia, 2017). Among individuals with ED, those with co‐occurring autism are often considered to have more severe and enduring ED presentations (i.e., poorer prognosis), and efforts have been made to adapt ED treatment specifically to the needs of individuals with co‐occurring autism (Li et al., 2021; Tchanturia et al., 2020). However, the evidence supporting the association of autism with increased ED severity is marked by weak findings and contradictory results, which we will summarise below.…”

What we can do about Autism and Eating Disorder comorbidity

“…In this special issue, several manuscripts which are reviewed address the subjects of: screening for autism (Adamson et al., 2022; Carter Leno et al., 2022), understanding of recovery from EDs (Sedgewick et al., 2021), and how autism and ED comorbidity affects treatment outcomes (Li et al., 2021). Also covered are: patients’ experiences of treatment and clinical services (Babb et al., 2022) and how sensory processing and eating behaviours are related in autism (Nimbly et al., 2022).…”