Same behaviours, different reasons: what do patients with co-occurring anorexia and autism want from treatment?

Abstract

Key words: Qualitative, Autism, anorexia, treatment, comorbidityResearch suggests that up to 1 in 4 individuals with anorexia nervosa (AN) may be on the autistic spectrum, and that these autistic traits may not have been recognised or diagnosed prior to eating disorder (ED) treatment. Significantly, these heightened autistic traits are associated with poorer treatment outcomes, suggesting that treatment may need to be adapted for this population. The purpose of this study was to explore with people with AN on the autistic spectrum their experiences of ED treatment, and their views on what needs to be changed. Women with AN (n= 13) either with an autism diagnosis, or presenting with clinically significant levels of autistic traits, were interviewed on their experiences of treatment and potential improvements. Interviews were analysed using thematic analysis. The findings suggest that this population experience unique needs associated with their autism that are not being met by standard ED treatments, and recommendations are made for potential future adaptations. Future research into a more systematic approach for treatment adaptations for this population, including education programmes for clinicians, could potentially lead to better treatment experiences.

Interoception in Anorexia Nervosa: Exploring Associations With Alexithymia and Autistic Traits

“…Autism is a neurodevelopmental disorder associated with differences in social communication, and restricted behaviours and interests (1). People with AN exhibit heightened levels of autistic traits compared to HC (28), and qualitative research suggest that altered interoception could contribute to disordered eating in autistic adults (29,30). Research suggests that interoceptive accuracy may be lowered in autism (31,32), although other studies have found no differences in autism compared to HC (33)(34)(35).…”

The relationship of autistic traits to taste and olfactory processing in anorexia nervosa

“…Sensory differences driven by alterations in bottomup processing are common in autism, to the extent that atypical responses to sensory stimuli have been included as a diagnostic criteria in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1,11]. Qualitative research on co-occurring autism and AN has highlighted sensory sensitivities as potentially contributing to eating difficulties in AN; however, this area remains under-explored using experimental methods [12,13]. This is significant as sensory sensitivity may play a role in neurobiological models of AN maintenance.…”

“For Me, the Anorexia is Just a Symptom, and the Cause is the Autism”: Investigating Restrictive Eating Disorders in Autistic Women

“…Whilst most ED clinicians recognised the importance of considering autism in AN treatment, many did not feel they had enough knowledge to provide adequate treatment for this client group (Kinnaird et al 2017). In line with this finding, autistic women in treatment for AN in the UK reported that they experience unique needs associated with their autism, which they feel are not met by currently offered treatments (Kinnaird et al 2019b). Although there will be some differences in how ED services are organised across different countries, given the lack of knowledge on the overlap between the two conditions and lack of official guidance on how to recognise and support autistic women in ED services, these findings are likely to also apply to the service experience of women in other countries.…”

“…Despite a significant proportion of autistic women in ED services, current service provision does not acknowledge or address their needs (Kinnaird et al 2017(Kinnaird et al ,2019b. Evidence from both the UK and Sweden suggests that women with high autistic traits benefit less from current interventions and care pathways and have worse outcomes than other women with AN, experiencing especially low recovery rates and levels of functioning (Nielsen et al 2015;Tchanturia et al 2017Tchanturia et al ,2016Nazar et al 2018).…”

“…Participants described how rigidity and inflexibility associated with their autism had contributed towards the development of fixed routines and rituals around food. Participants also felt that commonly assumed motivations, such as a desire to lose weight, low self-esteem, and body image issues, were less relevant in the development of their illness compared to other less typical motivations, such as need for control, sensory difficulties, social confusion, organisational problems surrounding cooking and food shopping, exercise as a method of stimulation, and the ED acting as a special interest (Kinnaird et al 2019b). Kinnaird et al's findings (2019b) therefore suggest that there may be autism-specific mechanisms underlying AN in autistic women and that restrictive eating difficulties in autistic women, although being labelled AN, may deviate from traditional AN presentations.…”