Eating Problems in Autistic Females and Males: A Co-twin Control Study

Remnélius, Karl Lundin; Neufeld, Janina; Isaksson, Johan; Bölte, Sven

doi:10.1007/s10803-021-05198-z

Cited by 13 publications

(11 citation statements)

References 67 publications

(119 reference statements)

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“…Our data corroborated the few existing studies purporting an association between autistic traits (or diagnosed autism) and ED psychopathology in men [30,53,54], but again showed that this relationship was only an indirect one, carried by intermediary variables. In contrast to the smaller, non-clinical male group of Vuillier et al [16], in this male sample autistic traits were associated with ED psychopathology (at least ostensibly, in the total effect, though not in fact when the direct effect was examined).…”

Section: Discussionsupporting

confidence: 91%

“…Studying sex differences in eating behaviours and psychopathology in autistic children is complicated by the fact that autistic girls are likely to be diagnosed markedly later than autistic boys, especially if they have higher verbal and cognitive abilities [24][25][26][27][28][29]. In adolescence and adulthood, however, there is suggestion that autistic girls and women have more difficulty eating in social contexts than do boys and men [30]. As pertains to males, though, one recent study (albeit unpublished and not peer-reviewed) suggested a particular role for anxiety in relation to eating psychopathology in autistic men [31].…”

Section: Introductionmentioning

confidence: 99%

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Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

et al. 2023

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Background A poorly understood relationship exists between eating disorders (ED) and autism spectrum conditions (ASC: henceforth ‘autism’). ED are more prevalent in autistic people and people with high autistic traits, and autistic features are prognostic of longer illness. Aiming to understand what increases the risk of ED in relation to autism and autistic traits, previous research has implicated alexithymia as a causal mechanism in this relationship. These studies could not, however, disentangle whether alexithymia explains the relationship between ED pathology and autistic traits directly or through its impact on anxious/depressive symptoms, which in turn result in higher ED symptomatology. Moreover, despite evidence for sex differences in the aetiology of ED, little research has examined the impact of sex on these relationships. Methods Focusing on the association between autistic traits and ED psychopathology, we examined independent mediating effects of alexithymia and anxious/depressive symptoms, as well as sequential mediation effects where alexithymia affects ED psychopathology via its impact on anxious/depressive symptoms. Participants were 198 men and 265 women with formally diagnosed and suspected ED, who completed an online survey of standardised scales. Results In men, higher autistic traits were associated with ED psychopathology sequentially via greater alexithymia and through that, greater depressive/anxious symptoms. In women, alexithymia mediated the relationship between autistic traits and ED psychopathology both directly and sequentially through its impact on anxious/depressive symptoms. Interestingly, depressive/anxious symptoms also mediated that relationship independently from alexithymia. Conclusions While cross-sectional, these findings suggest that the relationship between autistic traits and ED symptomatology is mediated by other variables. In support of its proposed role in the aetiology of ED, alexithymia was directly associated with ED symptoms in women. It also affected ED symptoms indirectly, in all participants, via its effect on depressive/anxious symptoms. Interventions focusing on alexithymia may facilitate recovery not only via their effect on ED, but via their effect on other forms of state psychopathology which contribute to the maintenance and development of ED. Sex differences, however, reflect that alternative therapeutic targets for men and women may be beneficial.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

et al. 2023

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“…Finally, it should be noted that although autistic traits predicted the change in fussy eating behaviours over time, it could be that overlapping genetic influences explain the association between these two constructs (e.g., pleiotropy). Twin research has been suggestive of genetic correlations between eating problems and autism in childhood (Lundin Remnelius et al., 2021), however, genome‐wide analyses have not found a genetic correlation between autism and anorexia nervosa (Brainstorm et al., 2018). Binge eating has been genetically linked to anxiety and ADHD, however, although the genetic correlation with autism was positive, this did not reach statistical significance (Hubel et al., 2021), leaving scope for future investigation.…”

Section: Discussionmentioning

confidence: 99%

Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating

Leno

Micali

Bryant‐Waugh

et al. 2022

Euro Eating Disorders Rev

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Objective: Previous literature shows an increased risk for eating disorders in autistic individuals. This study tested whether fussy eating contributes to the association between childhood autistic traits and adolescent eating disorder behaviours. Method: Using data from the Avon Longitudinal Study of Parents and Children, we estimated the intercept and slope of parent-rated autistic traits and fussy eating between 7 and 14 years (N = 8982) and their association with selfreported eating disorder behaviours at age 14 years, including the indirect path from autistic traits to eating disorder behaviours via fussy eating. Analyses were adjusted for child sex, maternal age at delivery, maternal body mass index and maternal education. Results: Analyses found a small indirect pathway from autistic traits intercept to eating disorder behaviours via fussy eating slope (b = 0.017, 95% CI = 0.002-0.032, p = 0.026), with higher levels of autistic traits at age 7 years being associated with a shallower decline in fussy eating, which in turn was associated with greater eating disorder behaviours. Conclusion: Findings point towards fussy eating as a potential link between childhood autistic traits and later disordered eating. Addressing fussy eating patterns before they become entrenched may decrease risk for eating disorders later in development.

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“…Moreover, autistic women have reported more hyperreactivity to sensory information compared to autistic men (Lai et al., 2015; Spek et al., 2019), which might pose an additional vulnerability to developing problematic eating behaviours (i.e., eating behaviours frequently seen in ASD and/or disordered eating behaviours) because of the various sensory properties of food. However, most studies on problematic eating behaviours of autistic adults either do not provide separate information for men and women (Blomqvist et al., 2015; Demartini et al., 2021; Karjalainen et al., 2016; Karlsson et al., 2013; Nieminen‐von Wendt et al., 2005), have included very few female participants (Courty et al., 2013) or have included autistic women with intellectual disability (Lundin Remnélius et al., 2021). To generalise the findings of autistic women with intellectual disabilities to those of autistic women without intellectual disabilities is difficult, since deficits in cognitive functioning might play a bigger role in the development and maintenance of these behaviours in autistic individuals with intellectual disabilities than in autistic individuals without intellectual disabilities (Funayama et al., 2017; Gravestock, 2000; Råstam, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…The consequences of these eating behaviours are manyfold and have been linked to gastrointestinal problems (Leader et al., 2020), being over‐ or under‐weight (Matheson & Douglas, 2017; Ptomey et al., 2020; Sobanski et al., 1999) and nutrient deficiencies (Zimmer et al., 2012). These eating behaviours have been shown to persist into adolescence and adulthood (Fodstad & Matson, 2008; Lundin Remnélius et al., 2021; Nieminen‐von Wendt et al., 2005; Spek et al., 2019), but very little is still known about the eating behaviours and corresponding problems of autistic adults, especially those of women.…”

Section: Introductionmentioning

confidence: 99%

Problematic eating behaviours of autistic women—A scoping review

Schröder

Danner

Spek

et al. 2022

Euro Eating Disorders Rev

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Aim: Eating and feeding behaviours of autistic individuals and related consequences have been mainly investigated in autistic children or in autistic adults with intellectual disabilities. Behaviours such as food selectivity or food neophobia have been shown to persist into adolescence and adulthood and are associated with aversive consequences. However, much less is known about the eating behaviours of autistic adults without intellectual disabilities, especially those of women. By means of a scoping review, we aim to assess the extent of the scientific literature on what is known about the eating behaviours of these women and the possible consequences of such eating behaviour.Method: Medline, Cochrane, PubMed and PsycInfo databases were searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results:Five studies met the eligibility criteria and were included in this review. Autistic women not only reported high levels of eating behaviour frequently seen in autism spectrum disorders (ASD), but also high levels of disordered eating behaviour, similar to that of women with eating disorders. Conclusions: Autistic women seem to exhibit high levels of eating behaviour frequently seen in ASD as well as disordered eating behaviour. Future research needs to shed light on what underlies these problematic eating behaviours, in order to help to adapt current treatment modalities to meet the unique needs of these women.

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Eating Problems in Autistic Females and Males: A Co-twin Control Study

Cited by 13 publications

References 67 publications

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia

Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating

Problematic eating behaviours of autistic women—A scoping review

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