Study Review; Autism and Anorexia


Today I was reading a Cambridge University Study done just last year into the similarities between Autism and Anorexia.

Here is the abstract that Simon Baron Cohen and his team looked into:

“The objectives of this study were to explore associations between autistic traits and self- reported clinical symptoms in a population with anorexia nervosa (AN). Experimental and self-report evidence reveals similarities between AN and autism spectrum condition (ASC) populations in socio-emotional and cognitive domains; this includes difficulties with empathy, set-shifting and global processing. Focusing on these similarities may lead to better tailored interventions for both conditions”

“Similarities” is a strange way to describe the results of a scientific study. Earth is “similar” to Mars in that it is a planet, its roundish and whatnot…….All humans are more similar to one another than they are to horses. So, similar is not telling me anything specific, but its sparked my interest nonetheless.

And…. I get it, the current research on anorexia is far from nearing anything conclusive so ‘similar’ is about as good as anything is going to get.

Similarities between anorexia nervosa and autism spectrum conditions were first observed in the 1980s by Christopher Gillberg. He subsequently proposed that AN should be ASDconceptualized as an empathy disorder on the same spectrum as autism. There is some suggestion that anorexia may be the female version of autism, as autism is underrepresented in females and mostly those that are diagnosed are male.

Autism is a spectrum of neuro-developmental conditions, characterized by difficulties in the development of social relationships and communication skills, in the presence of unusually strong narrow interests, repetitive behavior, and difficulties in coping with unexpected change.

The characteristics of autism vary from one person to another but are generally divided into three main groups. These are:

Difficulty with social communication
Difficulty with social interaction
Difficulty with social imagination.

Looking at this list, I do not think that any of these applied to me. I became socially awkward due to most social situations requiring that I eat food. I was not, nor have I ever been, unable to read social situations, body language or non- verbal communication.

I think that if I had been given a test or observed when I was anorexic that I would have displayed behaviors that would have led the observer to conclude that I had difficulty with social communication, interaction and situations. However, I believe that my behavioral traits here are a product of anorexia and were not apparent before I developed the illness, nor are they apparent since I have recovered. I would seem uncommunicative and shut down due to my fear that I would be asked to go somewhere or do something and that those things would involve food. As my illness progressed and the exercise component of it developed I would avoid talking to people because I did not want to stand still for any length of time.

The characteristics of autism vary from one person to another but as well as the three main areas of difficulty, people with autism may have:

Love of routines
Sensory sensitivity
Special interests
Learning disabilities.

This seems closer, I certainly had routines. Or, less that I loved routines, I personally felt more like my routines were trapping me and I was unable to do without them. I have become more sensitive to sensory stimulation and more introverted since my onset of anorexia. I developed special interests in food, cooking and exercise, but I think that this was due to the increased stimulation reward that I would get from working and looking at food and not actually eating it. I do not have a learning disability, but  I would not spend time studying when I could be spending time in the gym so I am sure my grades suffered as a result. Due to extreme fatigue I  often felt like my thinking was fuddled.

The study that I have read today focused more on the cognitive similarities between autism and anorexia, such as difficulty and dislike for set- shifting (set shifting is moving from one thing to another) and a superior eye for detail. These things I do think are closer to the mark. Set shifting can be better explained as task orientation. It seems that anorexics are very task focused types that do not like to shift from one thing to another without. We do not tend to get bored of doing the same thing, we like routines and doing the same thing every day. I think this is interesting to look at if it is one the autism spectrum. I would like to make it clear that since recovery I have no problem shifting from one task to another and I do not like doing the same thing day in and day out. In fact, I fell blessed to work to my own schedule so that I can do something different every day.

For the study, an experimental group consisted of 66 clinically diagnosed anorexics and 66 healthy controls, all female.  Participants completed self-report questionnaires including the Short (10- Item) Version Autism Spectrum Quotient (AQ-10) questionnaire (the first time this has been implemented in this population), the Eating Disorder Examination Questionnaire, the Hospital Anxiety and Depression Scale and the Work and Social Adjustment Scale. Group differences and the relationship between autistic traits and other questionnaire measures were investigated.

This study set out to investigate autistic traits in individuals with anorexia. Individuals with anorexia scored significantly higher on the AQ-10 than typical control participants. Furthermore,analysis of responses to individual items on the test scale revealed significant differences for the majority of questions. This supports the hypothesis that women with anorexia possess a greater number of autistic traits than typical women. It gets really interesting when the cognitive types are looked into:

“In terms of ‘cognitive types’, patients with anorexia were significantly more likely to be Type S (systemizing significantly better than empathy). Because Type S is usually more common in males, the finding that females with anorexia show this more ‘masculinized’ cognitive profile is anomalous, and warrants further exploration. The link between Type S and anorexia merits some consideration. A person who is ‘obsessed’ with calories, body size, and body weight may be directing their strong systemizing towards the domain of food or food intake, and indeed may have systemized the relationship between food and weight to a high degree of detail. One view is that their anorexia is then the result of their systemizing having latched onto this particular domain, the implication being that if their systemizing had latched onto a different domain, their behavior would not necessarily have resulted in anorexia, but instead would have had a different obsessive focus”.

Now that is something to ponder on! This is pretty much throwing it out there that anorexia is the female form of autism. I just love it that people are thinking of anorexia as more than an eating disorder, whether this is right or wrong, its refreshing!

I think that these similarities are interesting, but I do not think that currently these similarities are any more telling about anorexia. The correlation’s were mostly on issues that involved mood and sociability, and malnutrition certainly effects these elements and many more within a person. I think it is a bit of a chicken or egg situation. I do however applaud the way that researchers are thinking about anorexia and looking at it as a mental and physiological disorder rather than simply young women wanting to be thin. I have always known that anorexia was so much more than a desire to be thin. The more we compare anorexia to other disorders, see similarities and question the causal relationships the closer we will get to understanding.

Want something spicy to add to this little cauldron of thought? In her master’s thesis (read it here) Grimes posits that introversion is not the opposite of extroversion, but that they are two different traits altogether. And she proposes something that has come up here from time to time: That introversion actually is on the autism scale. I consider myself in many aspects an introvert and this is something that I am always fascinated in with other anorexics and clients. I DO see trends in introversion and extroversion in different forms of eating disorders, but that I will discuss in another post!

 

There is no piece of research that does not contribute something and there is no area that should not been looked into.

And finally a note on how this study relates to treatment:

“Clinicians may find it useful to shift the focus of intervention away from the battle over weight and towards helping the patient to recognize that they have a mind that is more attracted to systems and less to people’s emotional lives”

Hallelujah!

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