Cognitive Behavioral and Cognitive Remediation Strategies for Managing Co-Occurring Anorexia Nervosa and Elevated Autism Spectrum Traits

Abstract

Anorexia nervosa (AN) is a potentially severe eating disorder whose core characteristics include energy intake restriction leading to low body weight. Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social interaction and communication as well as repetitive, stereotyped behavior and interests. Both high ASD traits and diagnosed ASD are overrepresented among individuals with AN, and AN and ASD appear to share certain neurocognitive features. These features are associated with the severity of eating disorder symptoms and prolongation of AN. Thus, individuals with AN and high ASD traits or ASD may benefit less from traditional treatment when compared to those with low ASD traits. No previous reviews have summarized what is known about treatment adaptations for individuals with AN and high ASD traits or ASD. The purpose of this narrative review was to investigate the feasibility of cognitive remediation therapy (CRT), cognitive remediation and emotional skill training (CREST), and cognitive behavioral therapy (CBT), and give an overview of treatment modifications for individuals with AN and co-occurring ASD or high ASD traits. We found nine studies that fulfilled our inclusion criteria. The combined results suggest that individuals with AN and high ASD traits or ASD benefit less from CRT, CREST, and CBT than those with AN and low ASD traits. However, CRT and CREST administered in individual format may be associated with improved cognitive flexibility, motivation for change, and decreased alexithymia among adults with AN and high ASD traits or ASD. Individuals with comorbid AN and ASD themselves highlight the importance of treatment adaptations that take the characteristics of ASD into account. In the future, controlled studies of the treatment strategies for individuals with AN and ASD/high ASD traits are needed in order to improve the outcome of individuals with this challenging comorbidity.

Autism and anorexia nervosa: Longitudinal prediction of eating disorder outcomes

“…Thus far, few treatment adaptations have been introduced to better serve autistic ED patients ( 55 – 57 ). A recent review synthesized findings from nine studies exploring various ways to adapt interventions based on cognitive remediation therapy (CRT), emotion skills training and cognitive behavioral therapy (CBT) to better suit the needs of autistic ED patients ( 58 ). The authors also reported that autistic ED patients, or those with high levels of autistic features, may be less likely to benefit from standard interventions, which frequently focus on altering the autistic social and cognitive processing styles.…”

Autism and anorexia nervosa: longitudinal prediction of eating disorder outcomes

“…Thus far, few treatment adaptations have been introduced to better serve autistic ED patients Tchanturia et al, 2021;Treasure et al, 2019). A recent review synthesised findings from nine studies exploring various ways to adapt interventions based on cognitive remediation therapy (CRT), emotion skills training and cognitive behavioural therapy (CBT) to better suit the needs of autistic ED patients (Saure et al, 2022). The authors also reported that autistic ED patients, or those with high levels of autistic traits, may be less likely to standard interventions, which frequently focus on altering the autistic social and cognitive processing styles.…”

Exploring the intersection of autism spectrum disorder and eating disorders: understanding the unique challenges and treatment considerations for autistic women with eating disorders

“…Even though research into the effectiveness of recommended eating disorder treatments of autistic women with an eating disorder are still lacking, some qualitative studies have reported that in some autistic women, ‘traditional’ eating disorder motivations, such as a desire to lose weight or a low self-esteem because of body image issues were less relevant in the development of the eating disorder than other motivations, such as a need for control, sensory sensitivities, or organisational problems around cooking and food shopping or the eating disorder as a special interest [98]. Another recent narrative review has reported that autistic individuals or individuals with high autistic traits and anorexia nervosa seem to benefit less from cognitive remediation therapy (CRT) and cognitive remediation therapy and emotional skills training (CREST) [100 ▪ ]. The authors argue that this could possibly be linked to autistic traits such as difficulties in social cognition and emotion processing, cognitive inflexibility and sensory processing.…”