J Treasure the Relationship of Eating Disorders to ASD

8/9/2019 J Treasure the Relationship of Eating Disorders to ASD

1/40

Prof. Janet TreasureProf. Janet Treasure

[email protected] [email protected]

www.eatingresearch.com

.The relationship of

eating disorders to

ASD


2/40

Overview

What are eating disorders

Links with ASD?

Cognition Set shiftingCognition Central Coherence

Social cognition


3/40

EDNOS

AN BN

OCD

spectrum

Autistic

spectrum

Bipolar

spectrum

Addiction

spectrum

ADHD

AffectiveDisorder

The comorbidity of Eating Disorders


4/40

AN as empathy disorder

•AN autistic spectrum

disorder

•Narrow interest, repetitivebehaviour

•Not understand family

distress•(Gillberg et al 1994, Wentz et al 2009)


5/40

Comorbidity AN & ASD

• Anorexia nervosa and autism co-segregatewithin families (Gillberg 1983, )

• 20% autistic spectrum disorder (ASD) of cohort

of AN ascertained from community at age 15.Continuing social impairments & poor outcome(Gillberg et al 1994, Wentz et al 2009).

• 26/ 30 (53%) adult female inpatients - childhood

onset neuropsychiatric diagnosis. (23% ASD,17% (ADHD), 27% tic disorder (Wentz et al 2005 ).


6/40

At Risk Population(Coombs et al 2010)

• Age: 13 . School children m=61 f=71

• ASD traits correlate EAT traits

• Attention to detail and communication

difficulties predict EAT score with socialskills protecting.


7/40

Broader Autism Phenotype

↑ Autism Traits

↑ Systematising Traits↓ Empathising

↑ Male Brain( Hambrook et al 2008, Baron-

Cohen et al 2011, Lopez et al 2011)


8/40

A gender comparison high function

ASD (Lai et al 2011)Male Female

ADIR = =

RME 22 22

AQ + ++

EQ/SQ = =

Sensory + ++

ADOS

Social

communication

+++ -


9/40

Cognitive overlaps AN &ASD

ASD behaviours related to three cognitive

domains/theories:

Executive dysfunction-set shifting.

Weak central coherence.

Poor theory of mind (low social cognition)


10/40

1

6 7 8 9 10

52 3 4


11/40

1

6 7 8 9 10

52 3 4


12/40

1

6 7 8 9 10

52 3 4


13/40

1

6 7 8 9 10

52 3 4


14/40

•.Difficulty in changing cognitiveset.

•Once a rule is learned it is

difficult to shift.

•Mastery at adhering to laws of

thermodynamics.•Linked to childhood OCPD

features

Tchanturia et al 2005,

2006

Roberts et al

2007

Rigidity


15/40

2. I want to keep and maintain a

specific weight and in order to do that

I know there are rules…I have to

control my intake

3. It’ s as if you have acalculator in your head

totting up the intake

and output. You are

scientific about these

laws of

thermodynamics what

things go in your rulesystem.

•4. Well there is the amount of exercise I

do but that gets addictive more and more.

•Walking at right angles rather than

curves

• The amount I sleep, I try to keep it short

as you use fewer calories.•I would restrict the amount of tooth paste

because fear of extra calories.

•Avoid smelling food, if you can smell it

there must be something there in your

body you could absorb

•If I cut my hair I would weigh that for my

calculations•If my watch broke I would have to put

something heavy on my wrist to

compensate

•If I lost a nose stud- I would have to have

a replacement

1. What is the worry about food?

The therapist

explores how detail

of the ANrules impacts on

eating


16/40

Embedded Figure Test


17/40

Fragmented Figure Task

0

1

2

3

4

5

6

ED Controls A v e r a g e f r a m e w h e n p i c t u r e i d e n t i f i e d ( o u t o f

Acute AN> BN > Recovered> HC : Correlation with BMI


18/40

•Inability to see bigger picture i.e.Not seeing the wood for the trees.

• Heightened perceptual

awareness.

•Analytical, detailed focus.•Difficulty extracting gist.

Lopez et al 2008a,

2008b, 2008c,

2008d

Detail vs. Global Imbalance


19/40

Does your attention to detail have a negative side? For example are

you hyper-sensitive to slight errors or mistakes eg music off key,

flavours discordant, details off in some way?

So everyone has their own cereal, everyone likes different cereals, so we have somany, and um we all like different cereals, and at the moment I like wheetabix and

because everyone has two wheetabix’s and they are even because there are 24

wheetabix in the thing, because it is supposed to be even, because everyone is

supposed to have two and that’s what’s normal, which I am trying to be normal.

And, things that annoy me, it got down to the end one day and there was one left, I

took two and I was like ‘why is there one left?’ because I had two, because I am

the only one that eats this. And then I said to mum, obviously someone else hashad some wheetabix and I was like but that means they have only had one and

that’s not normal and so she was like maybe they had one wheetabix and some of

their cereal… She was trying to make me relax…. dad he sort of brought it up a

few days later, he goes, well I am worried that you start counting things………


20/40

Food and Exercise Rituals (Age 11 yrs)

• I exercised to relieve anxiety. I set myself daily

exercise goals that I had to achieve to prove tomyself that I was not a worthless person.

• Same exercise routine, same times of day,

sometimes more, but never less. If I didn’t achieve

my exercise goals I sometimes cut myself or sat in a

cold bath as ‘punishment’.• Cut out all ‘bad’ foods and made lists/plans of what I

‘could’ eat and what I ‘couldn’t’ eat.

• Made lists of calories, grams of fat, protein and

carbohydrate in all food consumed. Reading nutrition

charts became an enjoyable hobby.

• My food and exercise routines felt like my ‘life-plan’. If

I followed this plan precisely, everything would be

OK.


21/40

Cognitive overlaps AN &ASD

ASD behaviours related to three cognitive

domains/theories:

Executive dysfunction-set shifting.

Weak central coherence.

Poor theory of mind (low social cognition)


22/40

Baseline Low Social worth

Loneliness, shyness, and

inferiority in childhood and

adolescence (Fairburn et al 1999)Social anxiety (Penas lledo et al 2010)

Submissive and striving

behaviours (Connan et al.,20032007, Troop et al., 2008, Troop et al.,

2003).


23/40

Punish vs. reward

Attention bias tonegative

Attention bias Away from positive


24/40

Attention to Accepting/Rejecting faces

AB Accepting Rejecting faces T1

-25

-20

-15

-10

-5

0

5

10

15

20

ABRej ABAcc

ED

REC

HC

AB Accepting Rejecting faces T2

-20

-15

-10

-5

0

5

10

15

20

25

30

ABRej ABAcc

ED

REC

HC

Immediate Delay


25/40

Reduced Emotional Regulation

--

• ED longer to name the colour for faces.

• More distracted by non verbal emotional signalling of

threat and ambiguous faces

Large effect in acute state. Medium effect in recovered

Harrison et al 2009, 2010


26/40

Emotional Expression

Congruenceexpression/experience

ANHC

Attention

HC AN

H Davies

K

Tchanturia

U Schmidt


27/40

Impaired Reading Mind OthersOldershaw et al. (2010.)

OK

Moderate effects which other than eyes task improve after recovery


28/40

Understanding

how others think

not just what they

say

“Just back up little dear,

so you won’t cut my headoff”

About 20% of people

with anorexia nervosa

have some difficultywith this.

Tchanturia et al 2004,

2009.


29/40

Interpersonal Difficulties

• Age 8-9 yrs: traumatic events which confused meand made me feel that I was a ‘bad’ person.

• Age 9-11 yrs: bullied by a ‘pack’ of girls. Thisincreased my fear of other people and my sense of being ‘abnormal’ and worthless.

• Flirtatious comment by older male schoolteacher ledme to be terrified of ALL men.

• I felt different – as if I was ‘all wrong’. I felt I didn’t ‘fitin’ anywhere. I didn’t know who I was, and I wasterrified of the future.


30/40

Conclusion

• Some of the social cognition deficits may

be secondary to the illness .

• Others such as extreme shyness, social

phobia may be innate


31/40

The patients voice:

• Despite being weight recovered, the obsessional eating, tendency for rituals and desire for control/predictability, rigidity and order are allthings I still struggle with.

• If I fail to eat a meal in a certain way I still panic - it feels 'wrong'. Thepanic is not linked to my weight or body image.

• I had rituals as a young child, long before the trauma that triggered

my anorexia nervosa. My father is the same.• The way that I reacted to the trauma of sexual abuse was to engage inexercise and food rituals, which seemed to contain my anxiety.

• I felt particularly bound by the exercise rituals, which I alwaysperformed at the same time of day, on the same treadmill in the gymand to the point of physical exhaustion.

• Any change of routine and I panicked. The panic also had 'meaning' as

well as feeling 'wrong' - e.g. 'I haven't managed to complete the usualnumber of minutes at a particular intensity and so I am a failure andnot worthy of existing'.


32/40

• Currently ill AN patients have impaired setshifting and detail/global balance similar degree

to those observed in ASD.

• Currently ill AN patients have impaired emotion

recognition and eToM ability similar degree tothose observed in ASD.

• .Recovery is associated with improvement in

some aspects of social emotional functioning

and more flexibility.

Summary of Findings


33/40

EDNOSAN BN

OCD

spectrum

Autistic

spectrum

Bipolar

spectrum

Addiction

spectrum

ADHD

AffectiveDisorder

The comorbidity of Eating Disorders


34/40

Conclusions

• All acute AN can have Pseudo ASD

features

• Also 20% may be high functioning female

Aspergers


35/40

The patients voice: post recovery

• I am 55 now and recovered from AN in my early 30safter 10 years of illness.

• However I have continued to struggle with episodes of depression and am now on long-term antidepressants.

• I continue to find life very difficult and keep getting intodifficulties with jobs - expecting people to be perfect, andrules to be logical.

• There seems to be no end to it although I try desperatelyto be tolerant and shrug my shoulders.

• I am also very socially isolated

• I am divorced with two lively teenage boys.


36/40

Final Conclusion

• AN & ASD share weak coherence and this maybe a risk factor possibly associated with OCPDtraits.

• Starvation increases rigidity & OCPD traits.

• Starvation decreases social cognition.• Starvation decreases emotional regulation.

• Starvation shifts reward from people onto foodalone.

• People with acute AN resemble ASD• People with ASD at risk of eating disorders


37/40

Acknowledgements

Nina Jackson (RIED), NIHR, BRC


38/40

‘Triad’ of three basic problems in

ASD (Wing and Gould)• i. Impairment of social interaction

• This refers to the marked reduction of non-verbal signsof interest in and pleasure from being with another person .

• ii. Impairment of social communication

• This refers to the decreased ability to ‘‘converse’’ non-verbally and verbally with another person, sharing ideasand interests or to negotiate in a positive friendly way.

• iii. Impairment of social imagination

• This is the decreased capacity to think about and predictthe consequences of one’s own actions for oneself andfor other people.


39/40

AQ: Short traits

• Detect small sound

• See details vs big picture

• Difficult to multi-task

• Not easy to get back task when interrupted

• Not find easy to read between lines• Not find easy to know someone listening to me bored.

• When read story difficult to know intentions

• Like collect information about categories eg birds, plants

• Not easy to know what people think via faces.

• Difficult to know peoples intentions.


40/40

Girls With Social and/or Attention

Deficits: N= 100, Age 7-16 Clinic Attenders

(Kopp et al 2010)

• Comorbidity of girls ASD

• 35% OCD

• 30% Social phobia

• 40% Specific Phobia• 35% > 2 anxiety disorders

• 5% Eating Disorder

• 40% Sleep Disorder

• 35% depression

J Treasure the Relationship of Eating Disorders to ASD

Documents

Transcript of J Treasure the Relationship of Eating Disorders to ASD