ABSTRACT
Rationale: Symptoms of autism spectrum disorder (ASD) are overrepresented among individuals with anorexia nervosa (AN)*. We aimed to study the prevalence of ASD symptoms in extremely malnourished inpatients with AN and focus on potential cognitive and nutritional correlates.
Methods: We recruited prospectively all extremely malnourished patients with AN** admitted to the Nutritional Care Unit of Paul Brousse Hospital over four months. ASD traits and AN psychopathology were assessed by administering the Autism Quotient (AQ) and the Eating Disorder Inventory-2 (EDI-2). Neuropsychological and bio-nutritional data were also collected.
Results: Among 33 participants aged 25.5 ± 9.3 (91% females, BMI: 12.1 ± 1.4), 18% (N= 6) scored above screening cut-off for ASD on the AQ and 12% (N= 4) scored above clinical cut-off. Independently of age and BMI, EDI-2 scores were significantly correlated with AQ-total scores (r= 0.62; p< 0.01) and the AQ-communication subscale (r= 0.58; p< 0.05). Significant correlations were found between the eating psychopathology, higher levels of cognitive rigidity (r= 0.61; p< 0.001) and sensory sensitivity alterations (p < 0.01). Metacognitive beliefs about uncontrollability of danger, punishment and responsibility and cognitive confidence were associated with lower levels of Transthyretin (p <0.02).
Conclusion: ASD traits presented high prevalence in extremely malnourished patients with AN. Despite the impact that malnutrition can have on cognitive functioning, most of these traits appear to be independent of BMI but associated with the severity of eating psychopathology. Only Transthyretin was associated with dysfunctional metacognitions. These preliminary results suggest that ASD symptoms might co-occur in severe AN and require specific therapeutic interventions.