Effects of autism on 30-year outcome of anorexia nervosa

Nielsen, S., Dobrescu, S. R., Dinkler, L., Gillberg, C., Gillberg, C. , Råstam, M. and Wentz, E. (2022) Effects of autism on 30-year outcome of anorexia nervosa. Journal of Eating Disorders, 10(1), 4. (doi: 10.1186/s40337-021-00518-1) (PMID:35000620) (PMCID:PMC8744255)

Abstract

Background: Long-term consequences of comorbid autism spectrum disorder (ASD) in individuals with anorexia nervosa (AN) are inadequately investigated. Methods: In the 1980s, 51 adolescent-onset AN cases (AN group) and 51 matched controls (COMP group) were recruited from the community. They have been examined on five occasions. The four last assessments included the Morgan-Russell Outcome Assessment Schedule (MROAS) to assess eating disorder outcomes (weight, dieting, menstruation), and related problems including psychiatric, psychosexual and socioeconomic state. In the present study, at age 44, when 30 years had elapsed, MROAS data were compared with previous results. At age 16, 21, 24 and 32 years, all individuals had been assessed regarding ASD. At the 30-year follow-up, the impact of the ASD on the MROAS data was analysed. Results: In the AN group, all core anorectic symptoms (weight, dieting, menstruation) were on a par with the COMP group at the 30-year follow-up, but the positive outcomes were limited to those who had never had an ASD diagnosis. Psychiatric state was significantly worse in the AN group, particularly in the subgroup who had an ASD diagnosis assigned. The AN group—again particularly those with ASD—had a more negative attitude to sexual matters than the COMP group. The AN group had worse outcomes than the COMP group for ‘personal contacts’, ‘social contacts,’ and ‘employment record’ at the 30-year follow-up and the outcomes were worse the more often an ASD diagnosis had been assigned. Limitations: Rare data collection points throughout 30 years (only 5 assessments). ASD was assessed in the first four studies but was not assessed again at the 30-year follow-up. Conclusions: Mental health, psychosexual, and socioeconomic status were compromised up to 30 years after AN onset. Coexisting ASD contributed to the poor outcome. Core anorectic symptoms had “normalised” three decades after AN onset. Plain English summary: Some individuals with anorexia nervosa (AN) also suffer from autism. In this study we have investigated outcome of AN 30 years after the onset of AN and whether the presence of autism affects the outcome. Since the 1980s we have followed 51 individuals with teenage-onset AN and 51 healthy controls. They have been examined on five occasions, and an instrument that measures symptoms of AN (weight, dieting, body image), psychiatric symptoms, ability to work, and relationships with partner, family, and friends has been used to assess outcome. Autism was assessed in the first four studies. Symptoms of AN had normalised at 30-year follow-up, but only among those without autism. Psychiatric symptoms, ability to work, and relationships were issues that persisted after 30 years in the AN group, and those who had both autism and a history of AN had even more pronounced problems in these areas. The AN group had a more negative attitude to sexual matters than the control group, the outcome was worse the more often an autism diagnosis had been assigned. Conclusions: Mental health, psychosexual, and socioeconomic status are affected up to 30 years after AN onset, particularly among those with autism.

• Item Type: Articles
• Additional Information: Open access funding provided by University of Gothenburg. Dr. Wentz received support from the Jane and Dan Olsson Foundations (2015 and 2016-55), the Wilhelm and Martina Lundgren Foundation (vet2-73/2014, and 2017-1555), the Petter Silfverskiöld Memorial Foundation (2016-007), and Swedish State Support for Clinical Research (#ALFGBG-813401). Sandra Rydberg Dobrescu received support from the Royal and Hvitfeldt Foundation (2016), and the Foundation for Queen Silvia Children’s Hospital (2018). Lisa Dinkler was supported by Queen Silvia’s Jubilee Fund (2016) and the Samariten Foundation (2016-0150). Dr. Christopher Gillberg received grant support from the Swedish Research Council (521-2012-1754), the AnnMari and Per Ahlqvist Foundation, and Swedish State Support for Clinical Research. All authors except Søren Nielsen received research support from the Birgit and Sten A. Olsson Foundation for research into mental disabilities.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gillberg, Professor Christopher
• Authors: Nielsen, S., Dobrescu, S. R., Dinkler, L., Gillberg, C., Gillberg, C., Råstam, M., and Wentz, E.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Journal Name: Journal of Eating Disorders
• Publisher: BioMed Central
• ISSN: 2050-2974
• ISSN (Online): 2050-2974
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Journal of Eating Disorders 10(1):4
• Publisher Policy: Reproduced under a Creative Commons License