Autism & Anorexia, Genetics & Family

Think of a condition that was widely thought to be caused by parents and has since been proved to be neurological; biological?

And it's not autism (though that wouldn't be an incorrect answer).

It's anorexia nervosa, which has been called the "female Asperger's.

A new study in Clinical Psychology and Psychotherapy looks at emotional recognition and regulation in anorexia nervosa. 20 women with anorexia nervosa (AN) and 20 female healthy controls (HCs) were tested for emotion recognition (using the Reading the Mind in the Eyes (RME) task) and for emotion regulation (using the Difficulties in Emotion Regulation Scale (DERS) ). The researchers found:

Women with AN had significantly lower scores on RME and reported significantly more difficulties with emotion regulation than HCs. There was a significant negative correlation between total DERS score and correct answers from the RME. These results suggest that women with AN have difficulties with emotional recognition and regulation. It is uncertain whether these deficits result from starvation and to what extent they might be reversed by weight gain alone. These deficits may need to be targeted in treatment.

In view of these difficulties recognizing and regulating emotions, a link between anorexia and autism is posited.

In the June 19th Time Magazine, Janet Treasure, one of the researchers involved in the study and the director of the Maudsley Eating Disorders Unit in London, notes that

...... past research suggests that about 15% to 20% of patients with anorexia may also have Asperger's syndrome, an autism-spectrum disorder. Research also shows that the conditions occur together in families more often than they would by chance. It's possible, she says, that the same genetic predisposition for autism and anorexia may be expressed differently depending on gender.

About 15 times as many boys are given a diagnosis of Asperger's syndrome as are girls, and nearly 10 times as many girls develop anorexia as boys. It's easy to see how an outsized sense of perfectionism in a female might lead to an unhealthy obsession with thinness — given society's preoccupation with physical appearance — while a male might end up obsessing about cars or trains, which is typical in autistic boys. "The reason [Asperger's] is usually diagnosed less often in females may be because it takes a different form — anorexia may be just one of the forms," says [Simon] Baron-Cohen, adding that there are likely multiple routes leading to anorexia and that autistic features may not factor in all of them.

Treasure has found that starvation itself intensifies autistic characteristics like rigidity and obsession — a phenomenon that applies to all people, but particularly those with anorexia. "When they are underweight, people with anorexia get even more like people with autism," says Treasure. "They can't interpret other people's emotions, they can't regulate their own emotions, and they get overwhelmed when they are frightened or angry."

Baron-Cohen also notes that individuals on the autism spectrum and those with anorexia nervosa "share a narrow focus of attention, a resistance to change and excellent attention to detail." A tendency to repetitive behaviors and ways of thinking and to rigidness are characteristic of both autism and anorexia. Further, anorexia is "highly heritable" and "runs in families," according to Dr. Walter Kaye, director of the eating-disorders program at the University of California, San Diego. Dr. Kaye notes that "a cluster of [early life] vulnerabilities like anxiety and perfectionism" affect whether or not an individual may become anorexic, and suggests that these could be noted as "early risk factors" to look for in, one presumes, families in which a relative has a history of an anorexia diagnosis, just as people speak now of "early risk factors" for autism.

Parents of anorexics (see Eating With Your Anorexic, written by Laura Collins) have more and more advocated to have anorexia understood as a biologically based disorder. "'In the U.S., almost all treatment is predicated on blaming or marginalizing the parents,'" as Collins is quoted in the Time Magazine article. And,

While most American treatment providers blame perfection-seeking parents and the media's idealization of hollow-cheeked actresses for eating disorders (among other dysfunctional behaviors), researchers at Maudsley believe the root cause has little to do with social pressure. Rather, they think anorexia is better explained by heredity — perhaps by some of the same genes associated with autism.

Collins is an advocate for the Maudsley method of treating anorexia, which looks not to psychological therapy or "parent-ectomy," the removal of a child from the home, as treatment. Rather, "researchers encourage patients and families to regard food as medicine, and caregivers are instructed to use rewards and positive pressure to restore patients' weight"---patients are taught to eat again within a home setting, and by their parents. That is, parents are part of the treatment, rather than seen as those whom a child must be removed from, in order to get better; treatment is all "in the family."

And the difference in understanding that what one's child "has" is not a parent's "fault," not because you the parent did something "wrong"---that in itself can make a world of difference in how our culture thinks of anorexia (and autism).