Levels of autistic traits in anorexia nervosa: a comparative psychometric study

BMC Psychiatry

Sylvie Berthoz⁴  Caroline Barry⁴  Jean-Louis Adrien⁸  Anne Philippe²  François Pinabel¹  Lydia Pouga⁶  Coralie Chevallier⁵  Christine Vindreau⁷  Damien Ringuenet⁷  Christophe Lalanne³  Anne Solène Maria⁴  Annaig Courty⁸ 

[1] Private Practice, 6 avenue de Tourville, Paris 75007, France;Inserm U781 & Department of Genetic, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France;Inserm Unit UMR-SO 669, University Paris Sud, Paris Descartes, Paris, France;Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France;Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA;Inserm U960 – LNC, Paris, France;Department of Psychiatry and Addictology, Eating disorders unit, AP-HP, Hôpital Paul Brousse, Paris Sud University, Villejuif, France;LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, Paris, France

关键词: Alexithymia;    Empathy;    Interpersonal functioning;    Flexibility;    Neuropsychology;    Autism;    Anorexia nervosa;   

Others  :  1123971
DOI  :  10.1186/1471-244X-13-222

 received in 2013-05-28, accepted in 2013-08-20,  发布年份 2013

【 摘 要 】

Background

A number of characteristics associated with Autism Spectrum Disorders (ASD) are over-represented among patients with Anorexia Nervosa (AN) as well as among relatives of these patients. Yet the co-occurrence of autistic traits in AN has not been fully explored and no previous study has directly compared self-reported evaluations of cognitive and socio-affective skills in AN and ASD.

Methods

We aimed to determine the degree of overlap between AN and ASD from scores on questionnaires classically used to measure ASD impairments. Fifteen AN participants, 15 ASD participants and two groups of matched controls completed a battery of self-reports measuring: autistic traits (Autism-Spectrum Quotient), empathy (Empathy Quotient-short and Interpersonal Reactivity Index), systemizing (Systemizing Quotient-short) and alexithymia (Bermond-Vorst Alexithymia Questionnaire-B). Univariate comparisons of mean totalled scores were performed on each measure (patients vs. controls, and AN vs. ASD), and a Principal Component Analysis was used to study subject proximities in a reduced-factor space constructed from AQ, BVAQ-B and IRI subscales.

Results

These analyses revealed similarities in a few cognitive domains (Attention Switching, Perspective Taking and Fantasy, lack of emotional introspection) and in some nonspecific affective dimensions (depression and feelings of distress), but also marked dissimilarities in social skills (the ability to communicate emotions to others, empathizing).

Conclusion

The AN and ASD participants reported similar needs for sameness, and similar difficulties understanding their emotions and taking the perspective of another, but contrasting abilities to feel concerned in interpersonal situations. Our mixed findings encourage further exploration of transdiagnostic similarities and associations between these disorders.

【 授权许可】

   
2013 Courty et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Treasure JL: Getting beneath the phenotype of anorexia nervosa: the search for viable endophenotypes and genotypes. Can J Psychiatry 2007, 52:212-219.
• [2]Zucker NL, Losh M, Bulik CM, LaBar KS, Piven J, Pelphrey KA: Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychol Bull 2007, 133:976-1006.
• [3]Gillberg IC, Billstedt E, Wentz E, Anckarsater H, Rastam M, Gillberg C: Attention, executive functions, and mentalizing in anorexia nervosa eighteen years after onset of eating disorder. J Clin Exp Neuropsychol 2010, 32:358-365.
• [4]Anckarsater H, Hofvander B, Billstedt E, Gillberg IC, Gillberg C, Wentz E, Rastam M: The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study. Psychol Med 2012, 42:1-11.
• [5]Pooni J, Ninteman A, Bryant-Waugh R, Nicholls D, Mandy W: Investigating autism spectrum disorder and autistic traits in early onset eating disorder. Int J Eat Disord 2012, 45:583-591.
• [6]Holliday J, Tchanturia K, Landau S, Collier D, Treasure J: Is impaired set-shifting an endophenotype of anorexia nervosa? Am J Psychiatry 2005, 162:2269-2275.
• [7]Lopez C, Tchanturia K, Stahl D, Treasure J: Central coherence in eating disorders: a systematic review. Psychol Med 2008, 38:1393-1404.
• [8]Tchanturia K, Davies H, Lopez C, Schmidt U, Treasure J, Wykes T: Neuropsychological task performance before and after cognitive remediation in anorexia nervosa: a pilot case-series. Psychol Med 2008, 38:1371-1373.
• [9]Tchanturia K, Harrison A, Davies H, Roberts M, Oldershaw A, Nakazato M, Stahl D, Morris R, Schmidt U, Treasure J: Cognitive flexibility and clinical severity in eating disorders. PLoS One 2011, 6:e20462.
• [10]Tchanturia K, Davies H, Roberts M, Harrison A, Nakazato M, Schmidt U, Treasure J, Morris R: Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. PLoS One 2012, 7:e28331.
• [11]Hambrook D, Tchanturia K, Schmidt U, Russell T, Treasure J: Empathy, systemizing, and autistic traits in anorexia nervosa: a pilot study. Br J Clin Psychol 2008, 47:335-339.
• [12]Harrison A, Sullivan S, Tchanturia K, Treasure J: Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation. Psychol Med 2010, 40:1887-1897.
• [13]Oldershaw A, Hambrook D, Stahl D, Tchanturia K, Treasure J, Schmidt U: The socio-emotional processing stream in anorexia nervosa. Neurosci Biobehav Rev 2011, 35:970-988.
• [14]Pollatos O, Herbert BM, Schandry R, Gramann K: Impaired central processing of emotional faces in anorexia nervosa. Psychosom Med 2008, 70:701-708.
• [15]Rozenstein MH, Latzer Y, Stein D, Eviatar Z: Perception of emotion and bilateral advantage in women with eating disorders, their healthy sisters, and nonrelated healthy controls. J Affect Disord 2011, 134:386-395.
• [16]Hambrook D, Brown G, Tchanturia K: Emotional intelligence in anorexia nervosa: is anxiety a missing piece of the puzzle? Psychiatry Res 2012, 200:12-19.
• [17]Deborde AS, Berthoz S, Wallier JM, Fermanian J, Falissard B, Jeammet P, Corcos M: The bermond-vorst alexithymia questionnaire cutoff scores: a study in eating-disordered and control subjects. Psychopathology 2008, 41:43-49.
• [18]Morris R, Bramham J, Smith E, Tchanturia K: Empathy and social functioning in anorexia nervosa before and after recovery. Cogn Neuropsychiatry 2013. Epub ahead of print
• [19]Lecrubier Y, Sheehan D, Weiller E, Amorin P, Bonora I, Janavs J, Hergueta T, Baker R, Dunbar GC: The MINI international neuropsychiatric interview (MINI) a short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 1999, 12:224-231.
• [20]Lord C, Risi S, Lambrecht L, Cook EH Jr, Leventhal BL, DiLavore PC, Pickles A, Rutter M: The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord 2000, 30:205-223.
• [21]Grégoire J, Wierzbicki C: Comparaison de quatre formes abrégées de l’échelle d’intelligence de Wechsler pour adultes – troisième edition (WAIS-III). Rev Eur Psychol App 2009, 59:17-24.
• [22]Garner D, Olmsted M, Polivy J: Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eating Disorders 1983, 2:15-34.
• [23]Beck AT, Beamesderfer A: Assessment of depression: the depression inventory. Mod Probl Pharmacopsychiatry 1974, 7:151-169.
• [24]Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E: The autism-spectrum quotient (AQ): evidence from asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. JADD 2001, 31:5-17.
• [25]Wheelwright S, Auyeung B, Allison C, Baron-Cohen S: Defining the broader, medium and narrow autism phenotype among parents using the autism spectrum quotient (AQ). Mol Autism 2010, 1:10. BioMed Central Full Text
• [26]Davis M: Measuring individual differences in empathy: evidence from a mutli-dimensional approach. J Pers Soc Psychol 1983, 44:113-126.
• [27]Wakabayashi A, Baron-Cohen S, Wheelwright S, Goldenfeld N, Delaney J, Fine D, Smith R, Weil L: Development of short forms of the empathy quotient (EQ-short) and the systemizing quotient (SQ-short). PAID 2006, 41:929-940.
• [28]Vorst HCM, Bermond B: Validity and reliability of the Bermond &Vorst alexithymia questionnaire. Personal Individ Differ 2001, 30:413-434.
• [29]Bagby RM, Parker JD, Taylor GJ: The twenty-item Toronto alexithymia scale–I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994, 38:23-32.
• [30]Berthoz S, Pouga L, Wessa M: Alexithymia from the social neuroscience perspective. In Handbook of Social Neuroscience. Edited by Decety J, Cacioppo J. Cambridge: CUP; 2011:906-934.
• [31]R Development Core Team: R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2010.
• [32]Oldershaw A, Treasure J, Hambrook D, Tchanturia K, Schmidt U: Is anorexia nervosa a version of autism spectrum disorders? Eur Eat Disord Rev 2011, 19:462-474.
• [33]Constantino JN, Todd RD: Autistic traits in the general population: a twin study. Arch Gen Psychiatry 2003, 60:524-530.
• [34]Tchanturia K, Lloyd S, Lang K: Cognitive remediation therapy for anorexia nervosa: current evidence and future research directions. Int J Eat Disord 2013, 46:492-495.
• [35]Baron-Cohen S, Richler J, Bisarya D, Gurunathan N, Wheelwright S: The systemizing quotient: an investigation of adults with asperger syndrome or highfunctioning autism, and normal sex differences. Phil Trans R Soc Lond B 2003, 358:361-374.
• [36]Baron-Cohen S, Ashwin E, Ashwin C, Tavassoli T, Chakrabati B: Talent in autism: hyper-systemizing, hyper-attention to detail and sensory hypersensitivity. Philos Trans R SocLond B Biol Sci 2009, 364:1377-1383.
• [37]Baron-Cohen S, Wheelwright S: The empathy quotient (EQ). An investigation of adults with asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord 2004, 34:163-175.
• [38]Arcelus J, Haslam M, Farrow C, Meyer C: The role of interpersonal functioning in the maintenance of eating psychopathology: a systematic review and testable model. Clin Psychol Rev 2013, 33:156-167.
• [39]Tchanturia K, Davies H, Harrison A, Fox JR, Treasure J, Schmidt U: Altered social hedonic processing in eating disorders. Int J Eat Disord 2012, 45:962-969.
• [40]Herbert BM, Pollatos O: The body in the mind: on the relationship between interoception and embodiment. Top Cogn Sci 2012, 4:692-704.
• [41]Bruch H: Eating disorders: obesity, anorexia nervosa, and the person within. New York: Basic Books; 1973.
• [42]Skarderud F: Bruch revisited and revised. Eur Eat Disord Rev 2009, 17:83-88.
• [43]Taylor GJ, Bagby RM, Parker JDA: Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: New York, NY, USA: Cambridge University Press; 1997.
• [44]Szatmari P, Georgiades S, Duku E, Zwaigenbaum L, Goldberg J, Bennett T: Alexithymia in parents of children with autism spectrum disorder. J Autism Dev Disord 2008, 38:1859-1865.
• [45]Berthoz S, Lalanne C, Crane L, Hill EL: Investigating emotional impairments in adults with autism spectrum disorders and the broader autism phenotype. Psychiatry Res 2013. Epub ahead of print
• [46]Bird G, Press C, Richardson D: The role of alexithymia in reduced eye-fixation in autism spectrum conditions. JADD 2011, 41:1556-1564.
• [47]Katsyri J, Saalasti S, Tiippana K, von Wendt L, Sams M: Impaired recognition of facial emotions from low-spatial frequencies in asperger syndrome. Neuropsychologia 2008, 46:1888-1897.
• [48]Silani G, Bird G, Brindley R, Singer T, Frith C, Frith U: Levels of emotional awareness and autism: an fMRI study. Soc Neurosci 2008, 3:97-112.
• [49]Lopez C, Stahl D, Tchanturia K: Estimated intelligence quotient in anorexia nervosa: a systematic review and meta-analysis of the literature. Ann Gen Psychiatry 2010, 9:40. BioMed Central Full Text
• [50]Fonville L, Lao-Kaim NP, Giampietro V, Van den Eynde F, Davies H, Lounes N, Andrew C, Dalton J, Simmons A, Williams SC, Baron-Cohen S, Tchanturia K: Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test; an FMRI study. PLoS One 2013, 8:e63964.
• [51]Goel N, Bale TL: Examining the intersection of sex and stress in modelling neuropsychiatric disorders. J Neuroendocrinol 2009, 21:415-420.
• [52]Odent M: Autism and anorexia nervosa: two facets of the same disease? Med Hypotheses 2010, 75:79-81.
• [53]van Honk J, Schutter DJ, Bos PA, Kruijt AW, Lentjes EG, Baron-Cohen S: Testosterone administration impairs cognitive empathy in women depending on second-to-fourth digit ratio. Proc Natl Acad Sci USA 2011, 108:3448-3452.