High Autistic Traits in Women with Eating Disorders

Background:

An increasing body of literature has demonstrated a degree of comorbidity between Autism Spectrum Disorders (ASD) and various eating disorders (EDs) in females, but little is known about the relationship EDs have with ASD, and what effect an ED has on the detection and diagnosis of ASD.

Objectives:

The current study aimed to evaluate whether females with high autistic traits were likely to receive a diagnosis of an ED, which may serve to obscure their potential diagnosis of an ASD. It was hypothesised that women with high autistic traits would be undiagnosed with ASD in many cases, and would instead present with a diagnosis of an ED.

Methods:

Using an online data collection method, 670 women over the age of 18 were recruited through social media and specialist ASD and ED support services. The women completed two screening measures: the Autism-Spectrum Quotient (AQ) and the Eating Attitudes Test (EAT-26). Participants were classified as either ‘high’ or ‘low’ on specific variables based on established cut off scores for these instruments, and designated the following labels: high autistic traits (HATs); low autistic traits (LATs); high eating disorder traits (HEDs); low eating disorder traits (LEDs).

Results:

Of all 670 participants, 21.5% were classified as HATs and 78.5% as LATs, while 24.0% were classified as having HEDs and 76.0% as having LEDs. Of the total, 16.7% reported having received a diagnosis of ASD, and 21.7% reported having received a diagnosis of an ED. Fewer women with HATs were diagnosed with ASD than with an ED (Z=3.33, p<0.001). When asked if they had symptoms typical of an eating disorder, 49.3% responded that they had. Women with HATs (diagnosed & undiagnosed) were significantly more likely to also display HEDs than LEDs (χ²₍₁₎=24.31, p<0.001). Women with a diagnosis of ASD, compared to those without, were significantly more likely to display HED traits (χ²₍₂₎=22.21, p<0.001). However, women with HATs but no diagnosis of ASD, were not more likely than those with LATs to receive a diagnosis of ED (χ²₍₂₎=0.43, OR=1.3 95%CI [0.623, 2.580], p=0.32). Participants, who were otherwise undiagnosed, but displayed high traits of ASD, were not more likely to have been diagnosed with an ED. Last, women with an ED were significantly more likely to be in the HATs group than women without an ED (χ²₍₂₎=16.16, p<0.001).

Conclusions:

The results support the conclusion that women with HATs are more likely to be diagnosed with an ED than ASD. While it may appear that this diagnosis may obscure a diagnosis of ASD, preventing early intervention, the finding that those lacking a diagnosis but having HATs were not more likely to receive a diagnosis of an ED, suggests that an ED diagnosis does not preclude or camouflage a diagnosis of ASD. Nonetheless, the high rate of ED traits in women with ASD reflects the obsessional nature and desire for environmental control that is frequently found in ASD.