Autism and anorexia
I have always been struck by similarities between the autism and eating disorder communities. Both conditions are rather misunderstood, and research into causes and cures is in its infancy at best. Both communities are home to parent-activists advocating for better research and care, for insurance coverage and a chance for their children to lead healthy, fulfilling lives. Causes into both disorders are filled with controversy, although scientists are getting closer to understanding the neurochemistry unique to each disorder.
But an interesting theory has been floating around, led largely by the efforts of Janet Treasure in the UK, that suggests some intriguing similarities between autism and anorexia. An article in New Scientist titled "Anorexia linked to 'autistic' thinking*," looks at the striking similarities in cognition patterns between people with autism and those with anorexia.
Now, evidence suggests that people with anorexia have cognitive traits associated with ASD [autism spectrum disorders]. "Eating disorders and autism spectrum disorders are obviously not the same thing, but they do have some things in common," says Janet Treasure of the Institute of Psychiatry in London. Treasure had already discovered that anorexia was associated with extreme attention to detail and a rigid, inflexible style of thinking - traits also associated with ASD...
...Simon Baron-Cohen of the Autism Research Centre in Cambridge, UK, is also measuring whether adolescents with anorexia score higher on autistic traits than healthy people, as he suspects that some of them may actually have undiagnosed Asperger's syndrome. "We have always known that Asperger's syndrome was diagnosed more often in males," he says. "The new question is whether it takes a different form in females, and can account for at least a subgroup of those who are diagnosed with anorexia."
If it does, this could have important implications for the way that anorexia is treated. "As well as treating the 'eating disorder' the clinician and the patient might [also] focus on social skills," says Baron-Cohen, although he adds that weight gain would remain a key target.
No one, of course, is suggesting that everyone who has anorexia is autistic--far from it. But there are other similarities between ASD and anorexia. A recent study found that adolescent males with Asperger's Syndrome had abnormal levels of cortisol [the paper's abstract is here]. The authors of the study "believe these findings may help to explain why individuals with this condition have difficulties with minor changes to their routine or changes in their environment." Similarly, people with AN have similar abnormalities in cortisol and these some cognitive traits.Males outnumber females in ASD, while the reverse is true for anorexia. Perhaps, assert Treasure et al., some females with AN have simply not been diagnosed with ASD because they are female.
Studies of women with AN showed that they have higher levels of autistic traits than healthy controls. Autistic-type thinking (which is usually roughly defined as poorer social skills, attention to detail, and resistance to change) is also associated with poorer outcomes in anorexia. A different study found a subgroup of AN patients that showed persistent stereotypical "autistic" thinking, a decade after diagnosis:
Ten years after AN onset, the former AN cases showed no major neuropsychological deficits. A subgroup with autistic features had test profiles similar to those observed in autism spectrum disorders. The AN group as a whole showed poor results on the object assembly subtest indicating weak central coherence with a tendency to focus on details at the expense of configural information. This cognitive style may account for their obsession with details, with implications for psychoeducational approaches in treatment programmes/interventions.
In my opinion, both autism and anorexia are caused by subtle differences in neurochemistry from a variety of systems. In anorexia alone, changes have been found in serotonin, dopamine/endorphins, leptin, ghrelin, cortisol, and neuropeptide Y, to name a few. Exactly which systems are altered, and by how much, probably explains to some degree why some people become addicted to exercise and others don't; why some begin bingeing and purging and others don't. Perhaps there is some overlap in this altered neurochemistry that could explain the overlap between the two sets of symptoms. No one has any answers for sure--the evidence is still out. But it's an interesting theory that deserves some attention.
*Picture could be triggering. I'm always baffled at some of these magazines' choices of images.
7 comments:
Interesting, thought-provoking post. I wasn't a textbook anorexic, if there is one, in that I wasn't a wholly Atype personality, wasn't "addicted" to exercise although I did use it to lose weight. My thinking was excessively black/white. I've learned how to start seeing the grey areas of life through cognitive therapy and proper nutrition. For me the glaring difference between anorexia and autism is the fact that there is no cure for autism whereas, I believe, that anorexia is a wholly curable condition (although the susceptibilities DO remain in our neurochemistry). Anyway, that's my 2 cents :)
Gwen,
Very good points you raise. I don't think there is such a thing as a "stereotypical" anorexic (well, one that exists outside lore and psychology texts). I do think some of the overlap in cognitive styles is quite interesting, but no one has any idea how significant this might be.
thanks for warning about the triggering in the article. I don't understand that! Who else is going to read that article??
It's in a general science magazine (well, the online edition), so I would imagine there are quite a few. I get their RSS feed, which is how I found the article. And autism is such a hot topic in neuroscience (that and PTSD are tops, especially in terms of controversy) that I would bet the ratio of ED people to others is pretty low.
Mostly, magazine editors don't think about things being "triggering." Good art is hard to find, and online stuff tends to be done on very short deadlines (ie, several hours). But I still have to wonder what that image is supposed to be illustrating...
Personally, I think one of the most interesting things about this possible link is the implications it may have in the future, treatment-wise.
The treatment goals of anorexia and autism are a stark contrast to one another (very few professionals would promote the idea of "acceptance" with regard to anorexia). I, personally, am okay with (and would prefer to) have autism the rest of my life. I can't say the same about my ED.
But, the line between the two is so blurred sometimes. If I really, really have no interest in socializing with others, is it okay to skip out? Or should, I go anyway (knowing I will get nothing out of it), simply to avoid "isolating?" If I don't want crunchy food, or I don't want to feel full, or I want to keep twitching constantly, is this okay? Do I accept these quirks as part of who I am or "challenge" them because they're part of the ED?
And then, to add another layer of complexity, there is the issue of conventional (inpatient) treatment for people with anorexia. It starts out with an abrupt change to the individual's routine and goes on to include forced exposure to all different textures/tastes of foods, pressure to socialize, group therapy, talk of abstract concepts like feelings, etc. Obviously, not the ideal situation for somebody with autism.
I guess we can hope that as more research is done investigating this link (and it will be done, hopefully -- $10 million of stimulus money will be devoted towards expression of autism in females), we will learn more. And treatment providers will learn more and adjust their methods appropriately. Hopefully.
Anon,
Very good, interesting points. Thank you for sharing your perspective. IP was overwhelming for me, and I don't have an ASD, so I can only imagine how difficult it must have been.
This topic has been on my mind so much for the past couple weeks! I've started outpatient treatment for AN again recently and have been wondering why, even with so many of the ED thoughts gone at this point in my recovery, it's still so hard to eat. I'm still trying to organise my thoughts around it.
But I do think there are some cognitive similarities between autism and AN, like the rigidity, weak central coherence, set-shifting difficulties, and attention to detail. I work with autistic kids and have definitely felt that I'm more sensitive to the kids than my coworkers, or that I "get" them better, and maybe that's due to some kind of AN endophenotype, I don't know. The more I hear from autistic people, the more I feel like most of them would probably also understand AN better than neurotypical individuals.
I'd really like to learn more about this though. It's an overlapping point for my areas of interest. We're covering anorexia in my Brain & Behaviour lectures soon, and I'm very excited to be seriously looking at AN as a brain-based disorder for once.
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