Eating Disorders Linked to Subthreshold Autism Spectrum Disorder

This finding “could have significant implications for both clinical and research perspectives, helping to identify individuals at risk for eating disorders and shedding more light on psychopathology and different clinical presentations of autism spectrum disorder,” wrote first author Liliana Dell’Osso, MD, of the University of Pisa, Italy, and colleagues.[1]

Past studies have looked just at anorexia nervosa, and found overlap with some symptoms of ASD though not always enough to meet a full diagnosis. Shared symptoms include rigidity, inflexibility, perfectionism, and impaired social skills. Yet lack of awareness means that symptoms of ASD may often be overlooked or misdiagnosed in individuals with anorexia nervosa. Part of the problem may be that most individuals with anorexia nervosa are female, but questionnaires developed to diagnose autism often reflect a male bias. For example, female-specific tools could include questions about the tendency for women with ASD to camouflage their symptoms by imitating others.

Researchers assessed symptoms of ASD using a validated questionnaire with female-specific questions. The questionnaire was also designed to assess subthreshold autistic symptoms in people who do not necessarily meet criteria for a full diagnosis. They also used a validated questionnaire to assess core and psychological symptoms of eating disorders.

The study was cross-sectional: whether symptoms of eating disorders develop before or after those of ASD cannot be determined. Some studies have suggested that symptoms of ASD may result from malnutrition and starvation. Larger, longitudinal studies are needed to clarify the relationship between eating disorders and ASD, and whether they may share an underlying mechanism.

REFERENCE
1. Dell'Osso L, Carpita B, Gesi C, et al. Subthreshold autism spectrum disorder in patients with eating disorders. Compr Psychiatry. 2018; 81:66-72.