Autistic Traits and Social Responsiveness: The Relationship Between Autistic Traits and Comorbid Psychiatric Symptoms in Adolescents With Anorexia Nervosa

Abstract

Introduction: It is known that patients with anorexia nervosa (AN) display social difficulties like social responsiveness and high levels of autistic behaviors such as rigidity, narrow interests of food and weight; however it is not clear whether they have comorbid Autism Spectrum Disorders (ASD) or it is about acute phase of illness. In this study it is aimed to investigate autistic traits and social responsiveness in adolescents with AN. Methods: Study group was consisted of 39 female AN patients aged between 12-18 years. Control group was consisted of 34 female adolescents who did not have any psychiatric disorder. K-SADS-PL was applied to all participants in order to detect the psychiatric disorders. Autism traits and social responsiveness were evaluated using Social Responsiveness Scale. All adolescents of the study were administered The Eating Attitude Test, Beck Depression Inventory, Screen for Child Anxiety and Related Disorders, Maudsley Obsesive Compulsive Inventory. Results: Results of the study indicated that adolescents with AN had higher symptoms of depression, anxiety and autism-like symptom clusters; and lower social responsiveness. Psychiatric comorbidities were not associated with these difficulties. Conclusion: The results show that AN patients have an impairment of social responsiveness, the impairment seems to be associated with AN regardless of psychiatric comorbidities. Despite these two disorders are considered unrelated, they have several traits in common. These results suggest that there may be a common pathogenesis between ASD and AN.

Changes in the psychosocial and clinical profiles of anorexia nervosa patients during the pandemic

“…It is well-established that anorexia nervosa can be associated with autistic features, such as difficulties in social cognition, emotion regulation, and abnormal attention processing ( 4 ). Previous studies have reported that female adolescents diagnosed with anorexia nervosa exhibit lower social communication skills and higher autistic characteristics ( 33 ). Approximately one-fifth of individuals with anorexia nervosa are reported to display autism-related features, which can manifest as challenges in communication, social analysis, and theory of mind ( 34 ).…”

Cognitive and emotional empathy in acute and remitted anorexia nervosa: a systematic review

“…Individuals with AN have been shown to have smaller social support groups (22), demonstrate diminished responsiveness and sensitivity to social cues (23,24), and can be more negative in their interpretation of social situations (25), particularly when feeling ostracized (26). Research investigating the presence of social deficits in AN and illness outcomes found lower effectiveness of treatment and longer AN duration when social impairments were present (27)(28)(29)(30).…”

“…The consensus among researchers is that the presence of interpersonal difficulties in AN negatively impacts treatment outcomes (24,35,36). Given a large component of success in AN treatment is dependent on therapeutic relationship quality (37,38), deficits in socialisation and possible poor relationship quality may hinder the therapeutic relationship and, by extension, the effectiveness of treatment.…”

“…This explanation is supported by research comparing acute versus recovered patients, which has identified that autistic symptomology is more profound in acute AN when starvation is present (also referred to as the 'state-like' hypothesis) (4,45,46). Conversely, it has also been suggested that autistic symptomology in AN is more stable or trait-based, where, irrespective of starvation and malnutrition effects, individuals in acute and recovered phases of AN both demonstrate cognitive and emotional empathy challenges (also referred to as the 'trait-like' hypothesis) (22, 24,47,48). Moreover, literature observing autistic symptomology prior to AN onset (49) also supports this "trait-like" hypothesis.…”