Relationship between Eating Disorder (Anorexia Nervosa) and Autism Spectrum Disorder (ASD)

Relationship between Eating Disorder (Anorexia Nervosa) and Autism Spectrum Disorder (ASD) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Relationship between Eating Disorder (Anorexia Nervosa) and Autism Spectrum Disorder (ASD) T Suratwala This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4014453/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract OBJECTIVE: Research has shown there is a potential link between Eating Disorders (Anorexia Nervosa) and Autism Spectrum Disorder (ASD). This quantitative study aimed to evaluate if there was a significant difference between those with AN and those without when assessing for ASD. METHOD: 100 participants aged 18 years and above, including n = 50 who did not have Anorexia and n = 50 who declared themselves to have Anorexia, used a pre-screening and online questionnaire, with a between-subject design and Independent Samples T-Tests in SPSS. RESULTS: The study found a link between AN and ASD, with a higher incidence of ASD among those with AN. However, the study excluded those under 18 and excluded participants over 51, potentially underrepresenting the overall age population. Additionally, no gender distinction was made in the results, focusing on the overall association between AN and ASD. CONCLUSION: Further research is needed to determine if gender differences affect the results and if a greater prevalence of ASD among AN still exists, particularly in younger and older generations, to ensure consistency and validity in the findings. Psychology Eating Disorders (EDs) Anorexia Nervosa (AN) Autism Spectrum Disorder (ASD) Statistical Package for The Social Sciences (SPSS) Introduction Anorexia Nervosa (AN) is a serious psychological Eating Disorder (ED). (Papadopoulos et al., 2009), which can be fatal according to Dietrich, (2019) and severely detrimental to health. AN has the highest mortality rate of any psychological disorder (Edakubo & Fushimi, 2020) and is characterised by exhibiting symptomatic behaviours of dramatic weight loss, excessive calorie restriction, and obsessive thoughts about food and body image, (American Psychiatric Association, 2013; National Institute of Mental Health, 2021). Whereas in contrast to Autism Spectrum Disorder (ASD) this is a developmental disorder with significant difficulties in social and communication interaction, combined with repetitive behaviours, (American Psychiatric Association, 2013). However, increasing research suggests that there is a connection between AN and ASD, (Westwood & Tchanturia 2017). Studies described by Hambrook et al. (2008) in the research paper ‘Empathy, systemising, and autistic traits in Anorexia Nervosa: A pilot study’ produced inconclusive results of the connections between the two conditions but recommend further research to investigate it fully. However, Westwood & Tchanturia (2017) reported more ASD symptoms in the AN population. The authors suggest individuals with ASD and AN would need to have adaptations to any treatment compared to those without ASD. Dattaro (2020) states that autistic individuals have worse results from AN treatment than those without ASD which could be due to the treatment model. For those with sensory sensitivities, visiting doctors and group therapy work can be counterproductive for some autistic individuals. Indeed Elisabet Wentz is a Professor of Psychiatry at the University of Gothenburg (European Society for Child and Adolescent Psychiatry (ESCAP), 2013) has adapted two of eight AN inpatient-beds, for ASD patients, Dattaro (2020). This reinforces the premise that there is a link between the two conditions and that ASD is common in AN clinics that professionals should be taking this into account and accommodating treatments accordingly, (Karjalainen et al., 2019). This is also reinforced by Tchanturia’s book, which also said treatment should be adapted as there was an overrepresentation of ASD within their Eating Disorder clinic at South London and Maudsley NHS Foundation Trust (SLaM), (Tchanturia, 2021). Westwood et al. (2018) state that once females are treated for AN it can help reduce symptoms of ASD. This again highlights the close association between the two conditions, (Westwood & Tchanturia 2017). Author Westwood et al. (2018) also recommended addressing symptoms of ASD in AN treatment. Hiller and Pellicano, (2013) commented that the physical symptoms of AN may well inflate the severity of ASD. However, Westwood et al. (2017) disagreed as they thought that some symptoms of AN only superficially are similar to those with ASD. This study thereby has subsequently brought evidence of higher rates of ASD according to Westwood & Tchanturia (2017) with adults declaring if have AN. Analysis using SPSS (Statistical Package for The Social Sciences), demonstrated higher rates of ASD amongst those with AN. Anticipated statical figures found in Huke et al. (2013) study with a projected prevalence of around a quarter. This report aimed to strengthen the predicted association between symptoms of these two conditions ASD and AN. Research question assessed ‘is there is a significant difference between those with AN and those without when assessing for ASD?’ The hypothesis was that there is a significantly higher mean score between those with AN and those without when assessing for ASD. Research showed evidence of a link between the two conditions, according to Westwood & Tchanturia (2017). Method Participants Participants were over the age of 18 years and were asked to self-identify if they had AN or not. In total N =100 participants were recruited, n =50 control group (who did not have AN) n =50 AN (declared themselves to have AN. The exclusion criterion included individuals who had excluded themselves if they felt it would be too difficult to take part in this particular study due to the sensitivity of the topic. Design A between-subject design with one independent variable was employed. The independent variable was AN or not AN with nominal two levels. The categorical dependent variable was the ASD score from The Autism-Spectrum Quotient Test (AQ50 questionnaire). Data was analysed using Independent Samples T-Tests in SPSS software. Materials Participants had confirmed that they were over the age of 18 years and whether or not they had AN. No other identifying information was recorded . Participants completed AQ50 Test (see Appendix A), this was first used in Baron Cohen (2001) and is widely used as a tool to measure the expression of Autism spectrum traits.For each of the 50 questions participants indicated: - Definitely Agree; Slightly Agree: Slightly Disagree or Definitely Disagree. (Baron-Cohen et al. 2001).Other materials included a Participant Information Sheet, Consent Form, and Debrief Sheet. Procedure Participants received an online invite via the National Eating Disorder Charity, asking to be part of the study. Individuals then followed the link to the Qualtrics hosted information sheet, which they read so that they became familiar with the nature of the research conducted. Once consent was given participants then received an online link to complete a short pre-screen two-part question. Subsequently, a second link was sent and had completed by individuals - the AQ50 questionnaire online test. Finally, then participants created their own unique code to allow them the right to withdraw consent up to a specified date. Individuals were then thanked and sent the debrief form. Ethical Considerations Participants were given the information sheet and outlined any risks, etc. Data collection of individuals completely remained anonymous, and no other details were taken. To respect participants individuals’ rights to consent withdrawal, a unique identifier code was created so individuals could withdraw their data if wished by the specified date. Any additional risks i.e., AN might be a sensitive topic etc participants were informed and warned before consenting to take part in the study. However, the benefits for the research are greater than the risk. There were no direct benefits to individuals in taking part themselves however the findings of the research would greatly contribute towards the literature study overall. Ethics approval was sought and approved by the Department of Psychology University’s Research Ethics Team. Results 50 participants were recruited for the AN group and 50 participants were recruited for the Non- AN Group. There was a low outlier in the AN group where a 33-year-old male scored 9 on the AQ50 questionnaire and the next lowest was a score of 14, this may be erroneous. The ratio for both groups of gender was split equally across the data output. It is interesting to note that all the recruited participants for the study were aged between 18-51 years old. The skewness and kurtosis are 'within acceptable limits' and so it can be continued under the assumption that the data is normally distributed. Levene's Test for Equality was of p < .001, which this means we cannot assume ‘equal variance’. The independent-samples t-test indicated that individuals with AN ( M = 21.40, SD = 5.0) scored significantly higher on the ASD scale that those without AN ( M = 18.30, SD =3.5), t (98) = 3.588, p < .001, d = 0.73, one-tailed. The effect of the sample size Cohen's d showed that there is a medium to large effect in terms of the results. Discussion The findings of this study support the hypothesis of a positive relationship between Eating Disorders, AN and ASD. People are more likely to have AN if they are autistic. (Westwood & Tchanturia 2017). This investigation provides important information about the consistency of the AQ questionnaire score where there was a greater variation in the AN than the Non-Eating Disorder AN group. These results agree with Westwood & Tchanturia's (2017) findings that there is a definite link between the two conditions. However, this disagrees with Hambrook et al. (2008) where the authors assert their results were inconclusive. Tchanturia (King’s College London, 2022) has conducted extensive research in the field of AN and ASD in females, and to the extent, she helped develop a specialist National Health website called the PEACE, {Pathway for Eating Disorders and Autism developed from Clinical Experience} (2020). An additional written practice guidebook has been newly published for those with autistic individuals with Eating Disorders including Anorexia, (Tchanturia, 2021). As the Lead Investigator of the PEACE Pathway, Tchanturia has firmly established a link between the two conditions which is an extremely helpful resource for health professionals/members of the public, service users, and carer/family members, (PEACE Pathway, 2020). However, to note in this study there were limitations, and all study participants were under the age of 51 years. Having investigated the dramatic increase in ASD diagnoses people are four times more likely to be diagnosed with ASD now than they were historically according to academic clinical neurologist Steven Novella, (The Increase in Autism Diagnoses 2008). In addition, this is the same in late diagnoses with AN. DSM III stated that diagnosis of AN would not be possible over the age of 30 years, (Mulchandani et al. 2021). This was the historic view that was prevalent at that time and reaffirms Dr. Novella ‘s statement, (The Increase in Autism Diagnoses 2008). Tchanturia et al. (2019) also used a similar age group for their study which may have reinforced the lack of diagnoses for over the age 30 plus with AN and ASD. This could be the evident reason why both conditions may generally not be picked in late middle age plus due to the possibility of having no diagnose within these older age groups. The study also excludes those under 18 years of age possibly due to ethical considerations. This eliminates many young individuals with AN (Halmi et al., 1979). These authors also discovered the age of onset for AN has two peaks, one at 14 1/2 and another at 18 years old. This means the potential younger participants have been discounted from this research analysis. This also could be another limitation and may leave the study more underrepresented for under 18 years and over 51 years old. In addition, no distinction was made between the results for gender as the study aimed to focus on the overall association with AN and having ASD (Westwood & Tchanturia 2017). This could have contributed to some bias and it would have been interesting to see if Westwood et al., (2017) findings would have supported the argument of having more females with AN and ASD should gender have been included as part of this study analyses. Also due to the nature of the study participants completed the online tasks which would exclude those who do not have a reasonable level of Literacy and IT skills. The Autism-Spectrum Quotient Test (AQ50 questionnaire) has been used for the purposes of pre-screening. This has been widely used to measure the expression of Autism spectrum traits and assess if further ASD diagnoses are needed. Baron-Cohen et al., (2001) assert that any score above 32 points should be put forward for further investigation for a full Autism diagnosis. Although the AQ50 questionnaire has reasonable validity it is not a definitive diagnosis of Autism. To conclude the results should be understood in the context of methodological limitations. Evidence suggested that there were higher incidents of ASD amongst those who had AN, (Dattaro, 2020; European Society for Child and Adolescent Psychiatry (ESCAP), 2013; Huke et al., 2013; Karjalainen et al., 2019). Further research would be needed to assess whether gender would cause any significant difference to these results. It would also be interesting to see whether research could be extended to include younger and older generations to have identified if these results would be consistent particularly with a more varied and diverse age range group. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). American Psychiatric Association. Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of autism and developmental disorders, 31, 5-17. Dattaro, L. (2020). Anorexia’s link to autism, explained. Spectrum | Autism Research News. https://www.spectrumnews.org/news/anorexias-link-to-autism-explained/ Dietrich, J. R. (2019). Assessing Eating Disorder Signs and Associated Personalities in an Adolescent Sample. Tennessee Research and Creative Exchange (TRACE), 47. Edakubo, S., & Fushimi, K. (2020). Mortality and risk assessment for anorexia nervosa in acute-care hospitals: A nationwide administrative database analysis. BMC Psychiatry, 20(1), 19. European Society for Child and Adolescent Psychiatry (ESCAP). (2013). Eating disorders and social communication. ESCAP. eating disorders (ED) and social communication disorder (SCD). https://www.escap.eu/events/past-escap-congresses/dublin-2013/dublin-keynote-and-symposiums/eating-disorders-and-social-communication Halmi, K. A., Casper, R. C., Eckert, E. D., Goldberg, S. C., & Davis, J. M. (1979). Unique features associated with age of onset of anorexia nervosa. Psychiatry Research, 1(2), 209–215. Hambrook, D., Tchanturia, K., Schmidt, U., Russell, T., & Treasure, J. (2008). Empathy, systemizing, and autistic traits in anorexia nervosa: A pilot study. The British Journal of Clinical Psychology, 47(Pt 3), 335–339. Hiller, R., & Pellicano, L. (2013). Anorexia and autism: a cautionary note. Psychologist, 26(11), 780. Huke, V., Turk, J., Saeidi, S., Kent, A., & Morgan, J. F. (2013). Autism spectrum disorders in eating disorder populations: a systematic review. European Eating Disorders Review, 21(5), 345-351. Karjalainen, L., Råstam, M., Paulson-Karlsson, G., & Wentz, E. (2019). Do autism spectrum disorder and anorexia nervosa have some eating disturbances in common? European Child & Adolescent Psychiatry, 28(1), 69–78. King’s College London. (2022). Professor Kate Tchanturia—Biography—Research Portal, King’s College, London, https://www.kcl.ac.uk/people/professor-kate-tchanturia Mulchandani, M., Shetty, N., Conrad, A., Muir, P., & Mah, B. (2021). Treatment of eating disorders in older people: A systematic review. Systematic Reviews, 10(1), 275. National Institute of Mental Health. (2021). Eating Disorders: About More Than Food. National Institute of Mental Health. https://infocenter.nimh.nih.gov/pubstatic/21-MH-4901/21-MH-4901.pdf Papadopoulos, F. C., Ekbom, A., Brandt, L., & Ekselius, L. (2009). Excess mortality, causes of death and prognostic factors in anorexia nervosa. The British Journal of Psychiatry, 194(1), 10–17. PEACE Pathway. (2020). PEACE- Pathway for Eating disorders and Autism developed from Clinical Experience. https://www.peacepathway.org/ Tchanturia, K. (Ed.). (2021). Supporting autistic people with eating disorders: A guide to adapting treatment and supporting recovery. Jessica Kingsley Publishers. Tchanturia, K., Adamson, J., Leppanen, J., & Westwood, H. (2019). Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme. Autism, 23(1), 123-130. The Increase in Autism Diagnoses: Two Hypotheses | Science-Based Medicine. (2008, April 16). https://sciencebasedmedicine.org/the-increase-in-autism-diagnoses-two-hypotheses/ Westwood, H., & Tchanturia, K. (2017). Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review. Current Psychiatry Reports, 19, 1-10. Westwood, H., Mandy, W., & Tchanturia, K. (2017). Clinical evaluation of autistic symptoms in women with anorexia nervosa. Molecular Autism, 8, 12. Westwood, H., Mandy, W., Simic, M., & Tchanturia, K. (2018). Assessing ASD in Adolescent Females with Anorexia Nervosa using Clinical and Developmental Measures: A Preliminary Investigation. Journal of Abnormal Child Psychology, 46(1), 183–192. Additional Declarations The authors declare no competing interests. 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AN has the highest mortality rate of any psychological disorder\u0026nbsp;(Edakubo \u0026amp; Fushimi, 2020)\u0026nbsp;and is characterised by exhibiting symptomatic behaviours of dramatic weight loss, excessive calorie restriction, and obsessive thoughts about food and body image,\u0026nbsp;(American Psychiatric Association, 2013; National Institute of Mental Health, 2021). Whereas in contrast to Autism Spectrum Disorder (ASD) this is a developmental disorder with significant difficulties in social and communication interaction, combined with repetitive behaviours, (American Psychiatric Association, 2013). However, increasing research suggests that there is a connection between AN and ASD, (Westwood \u0026amp; Tchanturia 2017).\u003c/p\u003e\n\u003cp\u003eStudies described by Hambrook et al. (2008) in the research paper \u0026lsquo;Empathy, systemising, and autistic traits in Anorexia Nervosa: A pilot study\u0026rsquo; produced inconclusive results of the connections between the two conditions but recommend further research to investigate it fully. However, Westwood \u0026amp; Tchanturia (2017) reported more ASD symptoms in the AN population. The authors suggest individuals with ASD and AN would need to have adaptations to any treatment compared to those without ASD. Dattaro (2020) states that autistic individuals have worse results from AN treatment than those without ASD which could be due to the treatment model. For those with sensory sensitivities, visiting doctors and group therapy work can be counterproductive for some autistic individuals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndeed Elisabet Wentz is a Professor of Psychiatry at the University of Gothenburg (European Society for Child and Adolescent Psychiatry (ESCAP), 2013) has adapted two of eight AN inpatient-beds, for ASD patients, Dattaro (2020). This reinforces the premise that there is a link between the two conditions and that ASD is common in AN clinics that professionals should be taking this into account and accommodating treatments accordingly, (Karjalainen et al., 2019). This is also reinforced by Tchanturia\u0026rsquo;s book, which also said treatment should be adapted as there was an overrepresentation of ASD within their Eating Disorder clinic at South London and Maudsley NHS Foundation Trust (SLaM), (Tchanturia, 2021). Westwood et al. (2018) state that once females are treated for AN it can help reduce symptoms of ASD. This again highlights the close association between the two conditions, (Westwood \u0026amp; Tchanturia 2017). Author Westwood et al. (2018) also recommended addressing symptoms of ASD in AN treatment. Hiller and Pellicano, (2013) commented that the physical symptoms of AN may well inflate the severity of ASD. However, Westwood et al. (2017) disagreed as they thought that some symptoms of AN only superficially are similar to those with ASD.\u003c/p\u003e\n\u003cp\u003eThis study thereby has subsequently brought evidence of higher rates of ASD according to Westwood \u0026amp; Tchanturia (2017) with adults declaring if have AN. Analysis using SPSS (Statistical Package for The Social Sciences), demonstrated higher rates of ASD amongst those with AN. Anticipated statical figures found in Huke et al. (2013) study with a projected prevalence of around a quarter. This report aimed to strengthen the predicted association between symptoms of these two conditions ASD and AN. Research question assessed \u0026lsquo;is there is a significant difference between those with AN and those without when assessing for ASD?\u0026rsquo; The hypothesis was that there is a significantly higher mean score between those with AN and those without when assessing for ASD. Research showed evidence of a link between the two conditions, according to Westwood \u0026amp; Tchanturia (2017).\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were over the age of 18 years and were asked to self-identify if they had AN or not. In total \u003cem\u003eN\u003c/em\u003e=100 participants were recruited, \u003cem\u003en\u003c/em\u003e=50 control group (who did not have AN) \u003cem\u003en\u003c/em\u003e=50 AN (declared themselves to have AN. The exclusion criterion included individuals who had excluded themselves if they felt it would be too difficult to take part in this particular study due to the sensitivity of the topic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA between-subject design with one independent variable was employed. The independent variable was AN or not AN with nominal two levels. The categorical dependent variable was the ASD score from The Autism-Spectrum Quotient Test (AQ50 questionnaire). Data was analysed using Independent Samples T-Tests in SPSS software.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants had confirmed that they were over the age of 18 years and whether or not they had AN. No other identifying information was recorded\u003cem\u003e.\u0026nbsp;\u003c/em\u003eParticipants completed AQ50 Test \u003cem\u003e(see Appendix A),\u003c/em\u003e this was first used in\u0026nbsp;Baron Cohen (2001)\u0026nbsp;and is widely used as a tool to measure the expression of Autism spectrum traits.For each of the 50 questions participants indicated: - Definitely Agree; Slightly Agree: Slightly Disagree or Definitely Disagree.\u0026nbsp;(Baron-Cohen et al. 2001).Other materials included a Participant Information Sheet, Consent Form, and Debrief Sheet.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants received an online invite via the National Eating Disorder Charity, asking to be part of the study. Individuals then followed the link to the Qualtrics hosted information sheet, which they read so that they became familiar with the nature of the research conducted.\u0026nbsp;Once consent was given\u0026nbsp;participants then received an online link to complete a short pre-screen two-part question. Subsequently, a second link was sent and had completed by individuals - the AQ50 questionnaire online test. Finally, then participants created their own unique code to allow them the right to withdraw consent up to a specified date. Individuals were then thanked and sent the debrief form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were given the information sheet and outlined any risks, etc. Data collection of individuals completely remained anonymous, and no other details were taken. To respect participants individuals’ rights to consent withdrawal, a unique identifier code was created so individuals could withdraw their data if wished by the specified date. Any additional risks i.e., AN might be a sensitive topic etc participants were informed and warned before consenting to take part in the study. However, the benefits for the research are greater than the risk. There were no direct benefits to individuals in taking part themselves however the findings of the research would greatly contribute towards the literature study overall. Ethics approval was sought and approved by the Department of Psychology University’s Research Ethics Team.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e50 participants were recruited for the AN group and 50 participants were recruited for the Non- AN Group. There was a low outlier in the AN group where a 33-year-old male scored 9 on the AQ50 questionnaire and the next lowest was a score of 14, this may be erroneous. The ratio for both groups of gender was split equally across the data output. It is interesting to note that all the recruited participants for the study were aged between 18-51 years old. The skewness and kurtosis are \u0026apos;within acceptable limits\u0026apos; and so it can be continued under the assumption that the data is normally distributed. Levene\u0026apos;s Test for Equality was of \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, which this means we cannot assume \u0026lsquo;equal variance\u0026rsquo;. The independent-samples t-test indicated that individuals with AN (\u003cem\u003eM\u003c/em\u003e = 21.40, \u003cem\u003eSD\u003c/em\u003e= 5.0) scored significantly higher on the ASD scale that those without AN (\u003cem\u003eM\u0026nbsp;\u003c/em\u003e= 18.30, \u003cem\u003eSD\u003c/em\u003e=3.5), t (98) = 3.588, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003cem\u003ed\u003c/em\u003e= 0.73, one-tailed. The effect of the sample size Cohen\u0026apos;s d showed that there is a medium to large effect in terms of the results.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study support the hypothesis of a positive relationship between Eating Disorders, AN and ASD. People are more likely to have AN if they are autistic. (Westwood \u0026amp; Tchanturia 2017). This investigation provides important information about the consistency of the AQ questionnaire score where there was a greater variation in the AN than the Non-Eating Disorder AN group. These results agree with Westwood \u0026amp; Tchanturia's (2017) findings that there is a definite link between the two conditions. However, this disagrees with Hambrook et al. (2008) where the authors assert their results were inconclusive. Tchanturia (King’s College London, 2022) has conducted extensive research in the field of AN and ASD in females, and to the extent, she helped develop a specialist National Health website called the PEACE, {Pathway for Eating Disorders and Autism developed from Clinical Experience} (2020).\u003c/p\u003e\n\u003cp\u003eAn additional written practice guidebook has been newly published for those with autistic individuals with Eating Disorders including Anorexia, (Tchanturia, 2021). As the Lead Investigator of the PEACE Pathway, Tchanturia has firmly established a link between the two conditions which is an extremely helpful resource for health professionals/members of the public, service users, and carer/family members, (PEACE Pathway, 2020).\u003c/p\u003e\n\u003cp\u003eHowever, to note in this study there were limitations, and all study participants were under the age of 51 years. Having investigated the dramatic increase in ASD diagnoses people are four times more likely to be diagnosed with ASD now than they were historically according to academic clinical neurologist Steven Novella, (The Increase in Autism Diagnoses 2008). In addition, this is the same in late diagnoses with AN. DSM III stated that diagnosis of AN would not be possible over the age of 30 years, (Mulchandani et al. 2021). This was the historic view that was prevalent at that time and reaffirms Dr. Novella ‘s statement, (The Increase in Autism Diagnoses 2008). Tchanturia et al. (2019) also used a similar age group for their study which may have reinforced the lack of diagnoses for over the age 30 plus with AN and ASD. This could be the evident reason why both conditions may generally not be picked in late middle age plus due to the possibility of having no diagnose within these older age groups.\u003c/p\u003e\n\u003cp\u003eThe study also excludes those under 18 years of age possibly due to ethical considerations. This eliminates many young individuals with AN (Halmi et al., 1979). These authors also discovered the age of onset for AN has two peaks, one at 14 1/2 and another at 18 years old. This means the potential younger participants have been discounted from this research analysis. This also could be another limitation and may leave the study more underrepresented for under 18 years and over 51 years old. \u003c/p\u003e\n\u003cp\u003eIn addition, no distinction was made between the results for gender as the study aimed to focus on the overall association with AN and having ASD (Westwood \u0026amp; Tchanturia 2017). This could have contributed to some bias and it would have been interesting to see if Westwood et al., (2017) findings would have supported the argument of having more females with AN and ASD should gender have been included as part of this study analyses.\u003c/p\u003e\n\u003cp\u003eAlso due to the nature of the study participants completed the online tasks which would exclude those who do not have a reasonable level of Literacy and IT skills. The Autism-Spectrum Quotient Test (AQ50 questionnaire) has been used for the purposes of pre-screening. This has been widely used to measure the expression of Autism spectrum traits and assess if further ASD diagnoses are needed. Baron-Cohen et al., (2001) assert that any score above 32 points should be put forward for further investigation for a full Autism diagnosis. Although the AQ50 questionnaire has reasonable validity it is not a definitive diagnosis of Autism. \u003c/p\u003e\n\u003cp\u003eTo conclude the results should be understood in the context of methodological limitations. Evidence suggested that there were higher incidents of ASD amongst those who had AN, (Dattaro, 2020; European Society for Child and Adolescent Psychiatry (ESCAP), 2013; Huke et al., 2013; Karjalainen et al., 2019). Further research would be needed to assess whether gender would cause any significant difference to these results. It would also be interesting to see whether research could be extended to include younger and older generations to have identified if these results would be consistent particularly with a more varied and diverse age range group. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: \u003cem\u003eDSM-5. (5th ed.). American Psychiatric Association.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eBaron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., \u0026amp; Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from asperger syndrome/high-functioning autism, males and females, scientists and mathematicians.\u003cem\u003e Journal of autism and developmental disorders, 31, 5-17.\u003c/em\u003e \u003c/li\u003e\n\u003cli\u003eDattaro, L. (2020). Anorexia\u0026rsquo;s link to autism, explained. Spectrum | Autism Research News. https://www.spectrumnews.org/news/anorexias-link-to-autism-explained/\u003c/li\u003e\n\u003cli\u003eDietrich, J. R. (2019). Assessing Eating Disorder Signs and Associated Personalities in an Adolescent Sample. \u003cem\u003eTennessee Research and Creative Exchange (TRACE), 47.\u003c/em\u003e \u003c/li\u003e\n\u003cli\u003eEdakubo, S., \u0026amp; Fushimi, K. (2020). Mortality and risk assessment for anorexia nervosa in acute-care hospitals: A nationwide administrative database analysis. \u003cem\u003eBMC Psychiatry, 20(1), 19. \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eEuropean Society for Child and Adolescent Psychiatry (ESCAP). (2013). Eating disorders and social communication. ESCAP. eating disorders (ED) and social communication disorder (SCD). https://www.escap.eu/events/past-escap-congresses/dublin-2013/dublin-keynote-and-symposiums/eating-disorders-and-social-communication \u003c/li\u003e\n\u003cli\u003eHalmi, K. A., Casper, R. C., Eckert, E. D., Goldberg, S. C., \u0026amp; Davis, J. M. (1979). Unique features associated with age of onset of anorexia nervosa. \u003cem\u003ePsychiatry Research, 1(2), 209\u0026ndash;215.\u003c/em\u003e \u003c/li\u003e\n\u003cli\u003eHambrook, D., Tchanturia, K., Schmidt, U., Russell, T., \u0026amp; Treasure, J. (2008). Empathy, systemizing, and autistic traits in anorexia nervosa: A pilot study. \u003cem\u003eThe British Journal of Clinical Psychology, 47(Pt 3), 335\u0026ndash;339. \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eHiller, R., \u0026amp; Pellicano, L. (2013). Anorexia and autism: a cautionary note. \u003cem\u003ePsychologist, 26(11), 780.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eHuke, V., Turk, J., Saeidi, S., Kent, A., \u0026amp; Morgan, J. F. (2013). Autism spectrum disorders in eating disorder populations: a systematic review. \u003cem\u003eEuropean Eating Disorders Review, 21(5), 345-351.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eKarjalainen, L., R\u0026aring;stam, M., Paulson-Karlsson, G., \u0026amp; Wentz, E. (2019). Do autism spectrum disorder and anorexia nervosa have some eating disturbances in common? \u003cem\u003eEuropean Child \u0026amp; Adolescent Psychiatry, 28(1), 69\u0026ndash;78. \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eKing\u0026rsquo;s College London. (2022). Professor Kate Tchanturia\u0026mdash;Biography\u0026mdash;Research Portal, King\u0026rsquo;s College, London, https://www.kcl.ac.uk/people/professor-kate-tchanturia \u003c/li\u003e\n\u003cli\u003eMulchandani, M., Shetty, N., Conrad, A., Muir, P., \u0026amp; Mah, B. (2021). Treatment of eating disorders in older people: \u003cem\u003eA systematic review. Systematic Reviews, 10(1), 275.\u003c/em\u003e \u003c/li\u003e\n\u003cli\u003eNational Institute of Mental Health. (2021). Eating Disorders: About More Than Food. National Institute of Mental Health. https://infocenter.nimh.nih.gov/pubstatic/21-MH-4901/21-MH-4901.pdf \u003c/li\u003e\n\u003cli\u003ePapadopoulos, F. C., Ekbom, A., Brandt, L., \u0026amp; Ekselius, L. (2009). Excess mortality, causes of death and prognostic factors in anorexia nervosa. \u003cem\u003eThe British Journal of Psychiatry, 194(1), 10\u0026ndash;17.\u003c/em\u003e \u003c/li\u003e\n\u003cli\u003ePEACE Pathway. (2020). PEACE- Pathway for Eating disorders and Autism developed from Clinical Experience. https://www.peacepathway.org/ \u003c/li\u003e\n\u003cli\u003eTchanturia, K. (Ed.). (2021). Supporting autistic people with eating disorders: A guide to adapting treatment and supporting recovery. \u003cem\u003eJessica Kingsley Publishers.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eTchanturia, K., Adamson, J., Leppanen, J., \u0026amp; Westwood, H. (2019). Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme. \u003cem\u003eAutism, 23(1), 123-130.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eThe Increase in Autism Diagnoses: Two Hypotheses | Science-Based Medicine. (2008, April 16). https://sciencebasedmedicine.org/the-increase-in-autism-diagnoses-two-hypotheses/ \u003c/li\u003e\n\u003cli\u003eWestwood, H., \u0026amp; Tchanturia, K. (2017). Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review. \u003cem\u003eCurrent Psychiatry Reports, 19, 1-10.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eWestwood, H., Mandy, W., \u0026amp; Tchanturia, K. (2017). Clinical evaluation of autistic symptoms in women with anorexia nervosa. \u003cem\u003eMolecular Autism, 8, 12. \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eWestwood, H., Mandy, W., Simic, M., \u0026amp; Tchanturia, K. (2018). Assessing ASD in Adolescent Females with Anorexia Nervosa using Clinical and Developmental Measures: A Preliminary Investigation. \u003cem\u003eJournal of Abnormal Child Psychology, 46(1), 183\u0026ndash;192.\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Eating Disorders (EDs), Anorexia Nervosa (AN), Autism Spectrum Disorder (ASD), Statistical Package for The Social Sciences (SPSS)","lastPublishedDoi":"10.21203/rs.3.rs-4014453/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4014453/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eOBJECTIVE:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch has shown there is a potential link between Eating Disorders (Anorexia Nervosa) and Autism Spectrum Disorder (ASD). This quantitative study aimed to evaluate if there was a significant difference between those with AN and those without when assessing for ASD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHOD:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e100 participants aged 18 years and above, including n = 50 who did not have Anorexia and n = 50 who declared themselves to have Anorexia, used a pre-screening and online questionnaire, with a between-subject design and Independent Samples T-Tests in SPSS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found a link between AN and ASD, with a higher incidence of ASD among those with AN. However, the study excluded those under 18 and excluded participants over 51, potentially underrepresenting the overall age population. Additionally, no gender distinction was made in the results, focusing on the overall association between AN and ASD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurther research is needed to determine if gender differences affect the results and if a greater prevalence of ASD among AN still exists, particularly in younger and older generations, to ensure consistency and validity in the findings.\u003c/p\u003e","manuscriptTitle":"Relationship between Eating Disorder (Anorexia Nervosa) and Autism Spectrum Disorder (ASD)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-06 04:24:28","doi":"10.21203/rs.3.rs-4014453/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9a163ef3-2917-4a82-8de3-8712cf797722","owner":[],"postedDate":"March 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29129610,"name":"Psychology"}],"tags":[],"updatedAt":"2024-03-06T04:24:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-06 04:24:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4014453","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4014453","identity":"rs-4014453","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}