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Patients with co-occurring anorexia nervosa and autism respond differently to eating disorder treatments. Previous interviews with patients with both conditions and clinicians working in eating disorder services has highlighted service and treatment adaptations might be beneficial and could improve outcomes for these individuals.
The aim of this study was to explore carers’ experiences of current treatment approaches for people with autism who have anorexia nervosa, and their views on how these can be improved.
Ten carers of a loved one diagnosed with autism and anorexia nervosa were interviewed using a semi-structured interview schedule and the transcripts were analysed with thematic analysis.
Four key themes emerged from the interviews: the role of autism in anorexia nervosa, carers’ problems with clinical services, the impact on carers and suggestions for future improvements.
Carers agreed that autism played a significant role in the development and maintenance of their daughters’ anorexia nervosa. However, this comorbidity does not appear to be appropriately addressed in current treatment provisions. They described several difficulties, including problems getting an autism diagnosis and the perception that eating disorder services did not accept or adapt around the condition. This resulted in feelings of frustration and isolation for families, a scenario exacerbated by a perceived lack of support or specific resources for carers of individuals on the autism spectrum. Clinical recommendations on the basis of the current and previous studies are outlined.
New research suggests that, rather than representing a core feature of autism spectrum disorder (ASD), emotional processing difficulties reflect co-occurring alexithymia. Autistic individuals with alexithymia could therefore represent a specific subgroup of autism who may benefit from tailored interventions. The aim of this systematic review and meta-analysis was to explore the nature and prevalence of alexithymia in autism using the Toronto Alexithymia Scale (TAS).
Online scientific databases were searched systematically for studies on ASD popu lations using the TAS. Meta-analyses were performed to evaluate differences in scores between the ASD and neurotypical groups, and to determine the prevalence of alexithymia in these populations.
15 articles comparing autistic and neurotypical (NT) groups were identified. Autistic people scored significantly higher on all scores compared to the NT group. There was also a higher prevalence of alexithymia in the ASD group (49.93% compared to 4.89%), with a significantly increased risk of alexithymia in autistic participants.
This review highlights that alexithymia is common, rather than universal, in ASD, supporting a growing body of evidence that co-occurring autism and alexithymia represents a specific subgroup in the ASD population that may have specific clinical needs. More research is needed to understand the nature and implications of co-occurring ASD and alexithymia.
Social anxiety disorder is one of the most common comorbid conditions in eating disorders (EDs). The aim of the current review and meta-analysis is to provide a qualitative summary of what is known about social anxiety (SA) in EDs, as well as to compare levels of SA in those with EDs and healthy controls. Electronic databases were systematically searched for studies using self-report measures of SA in ED populations. In total, 38 studies were identified, 12 of which were included in the meta-analyses. For both anorexia nervosa (AN) and bulimia nervosa, there were significant differences between ED groups and HCs, with medium to large effect sizes. Findings from the qualitative review indicate that levels of SA are similar across the ED diagnoses, and SA improves with treatment in AN. In addition, high levels of SA are associated with more severe ED psychopathology, but not body mass index. These findings add to the wider literature on socio-emotional functioning in EDs, and may have implications for treatment strategies.
Background: Perfectionism is implicated in a range of psychiatric disorders, impedes treatment and is associated with poorer treatment outcomes. Aims: The aim of this systematic review and meta-analysis was to summarize the existing evidence for psychological interventions targeting perfectionism in individuals with psychiatric disorders associated with perfectionism and/or elevated perfectionism. Method: Eight studies were identified and were analysed in meta-analyses. Meta-analyses were carried out for the Personal Standards and Concern over Mistakes subscales of the Frost Multi-Dimensional Perfectionism Scale (FMPS) and the Self Orientated Perfectionism and Socially Prescribed Perfectionism subscales of the Hewitt and Flett MPS (HMPS) in order to investigate change between pre and postintervention. Results: Large pooled effect sizes were found for the Personal Standards and Concern over Mistakes subscales of the FMPS and the Self Orientated Perfectionism subscale of the HMPS, whilst a medium sized effect was found for change in Socially Prescribed Perfectionism. Medium pooled effect sizes were also found for symptoms of anxiety and depression. Conclusions: There is some support that it is possible to significantly reduce perfectionism in individuals with clinical disorders associated with perfectionism and/or clinical levels of perfectionism. There is also some evidence that such interventions are associated with decreases in anxiety, depression, eating disorder and obsessive compulsive symptoms. Further research is needed in order to investigate the optimal dosage and format of such interventions as well as into specific disorders where there is a lack of evidence for their effectiveness.
Very limited evidence is available on how to treat adults with anorexia
nervosa and treatment outcomes are poor. Novel treatment approaches are
To evaluate the efficacy and acceptability of a novel psychological
therapy for anorexia nervosa (Maudsley Model of Anorexia Nervosa
Treatment for Adults, MANTRA) compared with specialist supportive
clinical management (SSCM) in a randomised controlled trial.
Seventy-two adult out-patients with anorexia nervosa or eating disorder
not otherwise specified were recruited from a specialist eating disorder
service in the UK. Participants were randomly allocated to 20 once weekly
sessions of MANTRA or SSCM and optional additional sessions depending on
severity and clinical need (trial registration: ISRCTN62920529). The
primary outcomes were body mass index, weight and global score on the
Eating Disorders Examination at end of treatment (6 months) and follow-up
(12 months). Secondary outcomes included: depression, anxiety and
clinical impairment; neuropsychological outcomes; recovery rates; and
additional service utilisation.
At baseline, patients randomised to MANTRA were significantly less likely
to be in a partner relationship than those receiving SSCM (3/34
v. 10/36; P < 0.05). Patients in
both treatments improved significantly in terms of eating disorder and
other outcomes, with no differences between groups. Strictly defined
recovery rates were low. However, MANTRA patients were significantly more
likely to require additional in-patient or day-care treatment than those
receiving SSCM (7/34 v. 0/37;
Adults with anorexia nervosa are a difficult to treat group. The
imbalance between groups in partner relationships may explain differences
in service utilisation favouring SSCM. This study confirms SSCM as a
useful treatment for out-patients with anorexia nervosa. The novel
treatment, MANTRA, designed for this patient group may need adaptations
to fully exploit its potential.
Background: Difficulties with comprehending and managing emotions are core features of the pathology of anorexia nervosa (AN). Advancements in understanding aetiology and treatment have been made within other clinical domains by targeting worry and rumination. However, worry and rumination have been given minimal consideration in AN. Aims: This study is the largest to date of worry and rumination in AN. Method: Sixty-two outpatients with a diagnosis of AN took part. Measures of worry, rumination, core AN pathology and neuropsychological correlates were administered. Results: Findings suggest that worry and rumination are elevated in AN patients compared with both healthy controls and anxiety disorder comparison groups. Regression analyses indicated that worry and rumination were significant predictors of eating disorder symptomatology, over and above the effects of anxiety and depression. Worry and rumination were not associated with neuropsychological measures of set-shifting and focus on detail. Conclusions: The data suggest that worry and rumination are major concerns for this group and warrant further study.
This study investigated the correspondence between self-report and experimental measures of cognitive flexibility in individuals with anorexia nervosa (AN) and healthy controls (HCs). Ninety-four participants (45 individuals with AN and 49 HCs) completed the self-report Cognitive Flexibility Scale (CFS) and an experimental task, the Brixton Spatial Anticipation Test. The AN group performed poorly on both measures of cognitive flexibility compared with HCs. There was no significant correlation between the CFS scores and the errors on the Brixton Test for both groups. The findings suggest there is poor correspondence between the self-report measure of cognitive flexibility and performance on the flexibility test. These two assessment tools therefore cannot be used interchangeably to assess cognitive flexibility. Flexibility is an important clinical characteristic in AN. The results suggest that self-report and behavioral measures can be complementary, but cannot be used as an alternative to one another. (JINS, 2011, 17, 925–928)
The objective of this study was to examine whether there is an association between individual and family eating patterns during childhood and early adolescence and the likelihood of developing a subsequent eating disorder (ED). A total of 1664 participants took part in the study. The ED cases (n 879) were referred for assessment and treatment to specialized ED units in five different European countries and were compared to a control group of healthy individuals (n 785). Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire, a retrospective measure, which has been developed as part of a European multicentre trial in order to detect dimensions associated with ED in different countries. In the control group, also the General Health Questionnaire-28 (GHQ-28), the semi-structured clinical interview (SCID-I) and the Eating Attitudes Test (EAT-26) were used. Five individually Categorical Principal Components Analysis (CatPCA) procedures were adjusted, one for each theoretically expected factor. Logistic regression analyses indicated that the domains with the strongest effects from the CatPCA scores in the total sample were: food used as individualization, and control and rules about food. On the other hand, healthy eating was negatively related to a subsequent ED. When differences between countries were assessed, results indicated that the pattern of associated ED factors did vary between countries. There was very little difference in early eating behaviour on the subtypes of ED. These findings suggest that the fragmentation of meals within the family and an excessive importance given to food by the individual and the family are linked to the later development of an ED.
The objective of this study is to determine (a) if decision making
ability is impaired in patients with anorexia nervosa (AN) and in people
with good recovery from AN and (b) whether any impairment in decision
making is associated with alterations in skin conductance responses (SCR).
Patients with AN (n = 29), healthy controls comparable in age and
IQ (HC, n = 29), and women long term recovered from AN
(n = 14), completed the Iowa Gambling Task (IGT) while their SCR
were measured. AN patients performed poorly in the IGT compared to the HC
and to the recovered AN participants. AN patients had decreased
anticipatory SCR prior to choosing cards and reduced SCR after losses
compared to HC. IGT performance and the SCR of recovered AN participants
did not differ from the HC. Decision making ability is impaired in AN. It
is associated with a significantly attenuated SCR. Neither of these
features are found in recovered AN. The association between impaired
decision making ability and a decreased autonomic response is consistent
with the predictions of the Somatic Marker Hypothesis. (JINS,
2007, 13, 635–641.)
The aim was to critically appraise and synthesize the literature relating to set-shifting ability in eating disorders. PsycINFO, Medline, and Web of Science databases were searched to December 2005. Hand searching of eating-disorder journals and relevant reference sections was also undertaken.
The 15 selected studies contained both eating disorder and healthy control groups, and employed at least one of the following six neuropsychological measures of set-shifting ability; Trail Making Test (TMT), Wisconsin Card Sort Test (WCST), Brixton task, Haptic Illusion, CatBat task, or the set-shifting subset of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The outcome variable was performance on the set-shifting aspect of the task. Pooled standardized mean differences (effect sizes) were calculated.
TMT, WCST, CatBat and Haptic tasks had sufficient sample sizes for meta-analysis. These four tasks yielded acceptable pooled standardized effect sizes (0·36; TMT −1·05; Haptic) with moderate variation within studies (as measured by confidence intervals). The Brixton task showed a small pooled mean difference, and displayed more variation between sample results. The effect size for CANTAB set shifting was 0·17.
Problems in set shifting as measured by a variety of neuropsychological tasks are present in people with eating disorders.
The aim of this study was to determine if there are differences in
cognitive flexibility in anorexia nervosa and bulimia nervosa.
Fifty-three patients with an eating disorder (34 with anorexia nervosa
and 19 with bulimia nervosa) and 35 healthy controls participated in
the study. A battery of neuropsychological tests for cognitive
flexibility was used, including Trail Making B, the Brixton Test,
Verbal Fluency, the Haptic Illusion Test, a cognitive shifting task
(CatBat) and a picture set test. Using exploratory factor analysis,
four factors were obtained: 1: Simple Alternation; 2: Mental
Flexibility; 3: Perseveration; and 4: Perceptual Shift. Patients with
anorexia nervosa had abnormal scores on Factors 1 and 4. Patients with
bulimia nervosa showed a different pattern, with significant
impairments in Factors 2 and 4. These findings suggest that
differential neuropsychological disturbance in the domain of mental
flexibility/rigidity may underlie the spectrum of eating disorders.
(JINS, 2004, 10, 513–520.)
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