Anorexia nervosa in women may be caused by autism

[HuckleB]

Anorexia nervosa in women may be caused by autism

http://news.scotsman.com/health.cfm?id=713402005

"SEVERE cases of anorexia may be the result of undetected autism in women, a leading expert said yesterday.

Autism, characterised by defects in communication and social interaction, also makes many anorexic patients unresponsive to traditional treatments and may be responsible for anorexia's low recovery rates, according to Professor Christopher Gillberg, of the University of Strathclyde.

Although autism is thought to be a male problem, affecting up to four times more boys than girls, the disorder has been overlooked in women because their autistic traits present themselves differently, according to Prof Gillberg. An obsession with counting calories, for instance, may be an outward sign of autism.

"Our research has shown that a small but important minority of all teenage girls with anorexia nervosa in the general population meet diagnostic criteria for autistic disorder, Asperger syndrome or atypical autism. I've seen quite a number of cases where the anorexia has become completely entrenched because people haven't understood that underlying the eating disorder is autism."

..."


I'll definitely have to look into this more, as I have many questions about this theory, but it seems to warrant a longer look.

[freeplessinseattle]

1. Very interesting. makes sense too

the isolation and inwardness is one of the hallmarks of anorexia, plus oftentimes anorexics have, or have had OCD (obsessive compulsive disorder) which often involves an obsession with getting the "right" numbers, touching the light switch a certain number of times, etc. Plus those with Asperger's are often very intelligent, another hallmark of anorexia.

Thanks for this info, this is fascinating.

[Warpy]

52. I don't think you can label it "autism"

Since the sufferers do NOT express autistic behaviours.

Howevr, the same brain abnormality may be expressed differently in males and females, although I doubt that, also.

I've known male anorexics and female autistics, and there isn't a crossover between the behaviour sets.

I've also known an uncommonly high number of people with Asperger's, thanks to working at MIT, and none was anorexic, although they did tend to forget to eat when involved in a fascinating project.

[mzmolly]

2. I agree it makes sense, but I wonder why anorexia wouldn't be as prevalent

in men?

[bloom]

3. It could be a matter of the society

and the emphasis on looks/thinness for women.

Women who have a tendency to be compulsive might react this way - more likely than men would - men might be more likely to be compulsive about other things.

[mzmolly]

6. That's what I was thinking. Society must play a role in this disorder.

I like your explaination - it makes sense. I've heard that OCD is related to anorexia as well. I think we have many neuro issues that go undiagnosed.

[HuckleB]

9. The comorbidity of OCD and other anxiety spectrum disorders...

with anorexia and bulimia is rather high, but not all encompassing.

[mzmolly]

11. I think the areas effected in the brain must have some "cross over"

just as OCD is related to ADHD and Tourette Syndrome.

[K8-EEE]

25. Classic Autism Is More Prevalent In Males...

Maybe this particular type (like Fragile X) is more prevelent in females??

[mzmolly]

41. Could be.

:hi:

[Boomer]

4. This really hits home

>> I've seen quite a number of cases where the anorexia has become completely entrenched because people haven't understood that underlying the eating disorder is autism. <<

My mother had Asperger's Syndrome and a significant contributing cause to her death was an eating disorder. Year by year she lost weight until at her death she weighed just 74 lbs. (for a 5'7" height).

She wasn't anorexic in the classic definition of the term because she was painfully aware of how thin she was, and quite self-conscious about her emaciated figure. As my mother explained it, rationally she knew she had to eat to survive, but she was going through the motions without actually feeling the NEED to eat. She also developed phobias for specific foods, convinced that they were upsetting her digestion.

[Skittles]

7. may I ask

when yu say not feeling the need to eat, do you mean she literally did not get hungy? Meaning her Asperger symptons overrode her body's basic needs? This is the first I've heard that eating disorders may not be a mental disease. It certainly is a theory I would not be quick to dismiss.

[HuckleB]

12. What do you mean by "mental disease"? -eom-

On edit, an interesting recent research piece...

Researchers Find Evidence Of Anorexia Nervosa Genetic Susceptibility:
http://www.sciencedaily.com/releases/2002/03/020313075456.htm

[Skittles]

50. I meant in a kind of obsessive-compulsive way

for example, those suffering from anorexia "see" themselves as fat when in reality they have starved themselves skeletal.

[HuckleB]

51. Yes.

That's the delusional part of the disorder, especially when it continues after the person has been refed and the brain is no longer starving.

[MN ChimpH8R]

14. Autism, etc

Autists and Aspies tend to be creatures of habit, repetition and routine, not to mention obsessions. It's a part of the hard wiring. I know, because I am a diagnosed Asperger's. This sort of behavior is not at all inconsistent with OCD or autism.

It has long been thought that autism primarily affected males, but this lends a new perspective. Perhaps there's not so much of a gender imbalance after all, but the outward manifestations can be different as between the sexes.

Fascinating.

[Boomer]

16. I'm just speculating here...

...because it's so hard to get inside someone else's mind, but I greatly suspect that my mother simply didn't recognize hunger even when she felt it.

About ten years ago, during one of my visits home, my mother got up in the middle of the night and collapsed. Paramedics whisked her away and the ER checked her over, but determined she had collapsed from mild dehydration and stress (my father had just died).

She admitted that she wasn't feeling well that night and that her stomach hurt, which was what woke her. When I asked what she had eaten for dinner, she replied, "Half a bananna."

The "hurt" was obviously hunger pangs, yet she couldn't make the connection between that pain in her stomach and a lack of food.

[mikelgb]

29. i just got the flu and

I stop craving any kind of food, especially spicy food. i can only get myself to eat bland breads and cereals. I get "hungry" but i feel like anything ill eat will make me vomit

[Dear Maggie]

48. Was it the flu, really? Or a sign of a chemical poisoning?

The chemical exposure I've looked into usually starts with flu-like symptoms ... but's not the flu. What were you doing differently 15 minutes before the flu started, if anything?

[CAcyclist]

35. I Agree With That

Cats that don't eat because of whatever illness they are undergoing may often simply not start eating again and need to be stomach-tubed for many months to get them to eat again.

It is thought to be caused by a fatty liver syndrome whereby the liver breakdown proteins that rev up in times of starvation result in a lack of hunger but I have often wondered if something similar happens in women - whereby if they diet too much, they somehow go over a line and simply can no longer feel their hunger pangs.

I also remember one person who actually was poor and not anorexic and when she was interviewed she said when there was food in the house, she was hungry and when there wasn't food, she wasn't hungry.

I know that when I was training for mountain bike races, I would have to get up in the middle of the night to eat because my stomach demanded it but I wasn't hungry in the normal sense - I actually felt like my stomach was hungry, not me and I was feeding it to get it to shut up.

[bloom]

10. Some people have suggested

that people with autism ARE sensitive to milk and gluten and different things.

My daughter that I believe has Asperger's has always been a fussy eater. She won't eat milk that is older than 2 days for instance. She has missed meals for what seem like odd reasons to me. Has gotten more particular lately.

She has been getting thinner lately, also - so that worries me to hear about your mother. :hug:

[Boomer]

18. Ah! Very interesting!

My mother had a milk intolerance, so that item had been off her table since she was a child. I'd never thought of the gluten intolerance as a possibility as well.

Towards the last few months of her life, my partner and I had a very hard time getting her to eat because she complained that even the most bland food was too spicy. If she saw a dark speck anywhere on her food -- even if it was just a parsley flake -- she would push away the dish.

This reaction might have been her food compulsion gone berserk or it could have been sensory hallucinations due to a series of mini-strokes that were destroying her brain function (probably caused by her estrogen medication).

The good news I have to pass on, despite this rather morbid sounding tale, is that my mother lived to be 82 years old. So the weight problem was serious but not fatal until many decades had passed. She was alert and active until just the last 10 months of her life, when I think her body finally gave out under the strain of malnutrition.

So, I advise caution with your daughter's condition -- don't let this food issue fall under the radar -- but it's not a death knell. There were probably ways my mother's condition could have been managed if any of her doctor's had realized she had Asperger's, but I didn't make the diagnosis myself until after her death. I chanced upon an explanation of the symptoms and was astounded to see my "odd" mother described so completely.

[bloom]

22. My daughter

thought the food I made last night was "too spicy" - so I'm definitely going to be thinking about this - set her food aside before I spice it or something.

She's always loved garlic though. She uses garlic as aromatherapy.

----

DU is good for these things - I didn't start thinking about Asperger's until someone was describing his sister on here - and I was like dang - that sounds just like _____.

[freeplessinseattle]

34. wow! I'm very dairy intolerant, and have always been a fussy eater

spicy foods are an enemy too. I can eat the same thing day in and day out and be happy, but trying new foods is not that appealing. anxiety-provoking actually. I also remember I really disliked bread when I was a child, would flat out refuse to eat bread in any way shape or form. I'd eat cereal, but that was the only grain product.

[RobinA]

26. I Get This

eating disorder that your mother had as a form of autism, but not anorexia as a form of autism. One of the hallmarks of anorexia is that the person thinks they are fat, which is a world of difference from what your mother had.

Personally, I think that anorexia is a form of OCD. OCD, or what looks like OCD, can be comorbid with autism, but my bet is that OCD and autism are not the same thing and that what passes for OCD in autism is not really OCD. Just a hunch on my part.

[Boomer]

47. Exactly!

Whenever someone wondered whether my mother had anorexia, I firmly disagreed. She had none of the body image distortion that is the hallmark of traditional anorexia. She KNEW she was thin, and had no desire to stay that way. She wanted to gain weight -- theoreticaly -- she just couldn't muster enough sustained interest in food to stabilize her weight, much less increase it.

So her eating disorder was of another type, another origin. I don't think the word "anorexia" is appropriate, but I wouldn't be suprised if many doctors just slap the term on any female with an eating disorder and miss the subtle differences.

[Nikia]

53. I have developed anorexia

After not eating for a while, I didn't feel the need to eat. That had happened to me other times, like in times of illness or an attempted fast. Basically, if I didn't eat for 24 hours, I was no longer hungry. Even when I wasn't anorexic, it was hard for me to resume normal eating after not eating.
I don't know how her Asperger's syndrome affected her mind, but it is possible to eat even when you don't logically want to eat. We can logically do things that we don't want to do for a greater good, like survival.
Since I am trying to resume normal eating, I realize that I feel better when I eat. I don't feel hunger much like I used to, but the mental fogginess and headaches often do go away when I eat. I am trying to recognize these signals as the need for food, as the desire for food is often absent.

[HuckleB]

5. One of the unanswered questions, at this time.

Did Gilberg interact with people suffering from anorexia only when they were in a state of starvation, when brain function is going to be limited by the state of nutrition?

[bloom]

15. One thing for psychologists

I wish the psychologists/psychiatrists that my daughter saw got more of a history from me. She was diagnosed purely on symptoms she was having right then and I think it skewed the diagnosis. I could have told them what had been going on her whole life - which if I had known what to look for sooner - would have been a big help.

I know that some psychologists DO talk with family members to get a better view.

I recommend it.

[HuckleB]

17. If they don't get the entire history...

they're not doing their jobs.

[bloom]

24. They probably

asked her for a history.

She has her own ideas about things - and I think they just missed it.

One psychologist even did nearly her entire "treatment" through drawing (my daughter was in high school and didn't like talking to people).

I don't know what they thought - but ASD never came up. And it's possible/likely she has multiple things - so that could confuse them - but now she doesn't want to have anything to do with treatments of any sort and she doesn't care what I think either. For now - I'm just going with the flow as much as possible as long as things go Ok for her.

But it does help to be on the watch for the anorexia nervosa thing. I'm going to have to pay more attention.

[HuckleB]

27. Yeah, but that's not enough.

Initially, any therapist or psychiatric provider must meat with the entire family together/and separately, IMHO. Even then it's difficult to get a full grasp of all the family dynamics at play, and get a feel for as "true" a diagnostic picture as possible. And, yes, it is very difficult to tease out symptom clusters at any time in life, but even more so in childhood.

Best to you.

[lumberjack_jeff]

8. My son has ASD...

... (somewhere between Asbergers and High function classical autism) and I find it very believable, given autism's typical taste/texture aversion as well as physiological differences often found in the digestive systems of autistics.

Malnutrition is not uncommon among autistics - boys too.

[mzmolly]

13. Very interesting. Perhaps the medical community is more likely

to diagnose "Malnutrition" among boys vs. "Anorexia" among girls? :shrug: Especially given the disorder appears differently in girls.

[loyalsister]

36. I agree

It has to do with social roles. This suggestion is an interesting one that begs many questions.
Whether there is anything to it or not, it calls attention to the very real possibility that clinicians give in to assumptions based on preconceived gender expectations.

[HuckleB]

19. A video overview of childhood anorexia.

http://www.kartiniclinic.com/streaming_video.asp

[sendero]

20. I think...

... this is very interesting. I have a son who has been diagnosed "autism-spectrum". He has, in addition to other challenges, real problems with food. He hates anything crunchy, has tons of food allergies and in general is hard to feed.

And the kid is skin and bones and we're always trying to get him to eat but he really just doesn't like to eat. But it's not like he's counting calories or anything like that.

[LiberalEsto]

21. extremely interesting

A friend of mine has a 25-year-old daughter who has been battling anorexia for years. The daughter's 3-year-old son has Asperger's syndrome. It makes me wonder if there is some hereditary brain chemistry glitch.

[HuckleB]

23. My personal anecdotes.

I am a pediatric and psychiatric nurse practitioner, whose main current employment is focused on eating disorders. I currently work with an adolescent boy diagnosed with autism at an early age, who now suffers from binge-purge anorexia. I've also worked through the last winter to treat an adolescent girl diagnosed with autism at an early age, who wnet through an extremely severe food phobia. Further, the number of patients we see (and we see the most severe eating disorder cases, with most of our patients beginning care in the hospital) with pervasive developmental disorder spectrum traits seems high compared a more general psychiatric population. As noted above, there is little doubt that OCD and other anxiety spectrum disorders have a very high comorbidity with eating disorders. Certainly, IMHO, this possible PDD/Eating Disorders connection warrants more initial research, at the very least.

Salud.

[RobinA]

28. I Think

that more attention needs to be given to food issues period. As it is, we call practically everything that involves not eating "anorexia" almost without distinction. We ignore the possibily very different reasons/purposes/causes of what we see has a patient not eating.

I mean, I have a problem saying that at autistic teenager who binges and purges has the same thing going on as Karen Carpenter, who willfully starved herself until she died, and then we have people like Boomer's mother. We need to be able to make finer distictions here.

[HuckleB]

31. More attention does need to be paid to food issues, indeed.

However, no one that I work with calls "practically everything that involves not eating "anorexia" almost without distinction. There are many distinctions, in fact, and each individual is treated differently depending on the symptoms displayed and the etiology understood (as best as it can be).

[Karenina]

30. This is indeed very interesting...

n/t

[KamaAina]

32. Dr. Gillberg has a tendency to exaggerate possible links like this

Back when I was working with the Yale Child Study Center on the Asperger's field trial, Dr. Gillberg (then with the Karolinska Institut in Stockholm) claimed that all people with autism also had a skin condition called tuberous sclerosis.

Well, I don't have tuberous sclerosis; the counterexample debunks that theory.

An obsession with counting calories, for instance, may be an outward sign of autism.

Um, sounds more like OCD to me. There may well be a complex involving OCD, autism spectrum diroder, and eating disorder (Eric Hollander at Mt. Sinai in NYC switched fields from OCD to autism) -- but that's not what Gillberg said; once again, he went for the sweeping generalization involving autism.

I am, however, now thinking about my friend back in NY who exhibits traits of all three conditions; in addition to being quite attractive, she is a supremely talented composer and keyboardist. It'd sure be nice if we could find out how to keep all this stuf from holding her back!

[HuckleB]

33. I'm not shocked to read your post.

This does seem to be exaggerated, especially his assertion regarding boys with anorexia, which does not match my experience at all, anecdotal though it is.

Thanks for sharing.

Salud.

[President Jesus]

37. yeah, vanity has nothing to do with it.

[HuckleB]

38. Please educate yourself.

Here's a short, educational video:
http://www.kartiniclinic.com/streaming_video.asp

And a short piece on one study looking at genetic susceptibility:
http://www.sciencedaily.com/releases/2002/03/020313075456.htm

[HuckleB]

39. Research Points To Anxiety As A Key Risk Trait For Eating Disorders

University Of Pittsburgh Research Points To Anxiety As A Key Risk Trait For Eating Disorders:
http://www.sciencedaily.com/releases/2004/12/041206204923.htm

[bloom]

40. I think it's quite possible

That they are not looking for /testing for Asperger's or ASD - esp. reading this:


"The strength of the bond between anxiety and eating disorders is bolstered by the fact that nearly all women with eating disorders report having certain anxiety traits, such as harm avoidance, generalized anxiety and perfectionism, even if they do not have a diagnosable illness.

The researchers used standard psychiatric tests to assess anxiety. They discovered that rates of anxiety were similar for each of the three subtypes of eating disorders – anorexia nervosa, bulimia nervosa and anorexia nervosa comorbid with bulimia nervosa. Two anxiety disorders appeared more often than the others – 41 percent of the participants had a history of obsessive compulsive disorder (OCD) and 20 percent had social phobia."

[AngryAmish]

43. This is very interesting

I have to confess near total ignorence on this subject so if I get a lot of facts wrong don't kill me.

Anyway, the few anorexics I have known have been very high acheivers but it seemed more from fear of doing something incorrect. So, they studied compulsively, worked out compulsively (I'm not even sure I am using the term compulsively correctly. They studied and worked out a lot). They would dress the way everyone was dressing at the same time in their social group.

Could this behavior be explained as an anxiety disorder or OCD? I don't know.

[bloom]

45. As far as autism spectrum disorder goes

From what I know - dressing like everyone - does not fit. (It's possible it could get drilled into some people - I don't know).

If anything - not going along with the usual social "norms" would be more usual. So that is a problem as far as any assumption that ASD people might be obsessively concerned about looks/thinness. Might not fit.

It seems more possible to me that people might assume that all anorexics have this compulsion about looks - when maybe some - the aspies - are just more sensitive to tastes and smells and other problems that they find with foods.

[HuckleB]

44. Perhaps.

However, I have spent most of my adult life working with PDD spectrum folks, and only moved to eating disorders a few years ago. I'm quite well-versed and experienced in diagnosing PDD spectrum, and am probably too quick to wonder about it as a possibility, if anything. During the time I've been working with eating disordered adolescents, I've met a large percentage who meet diagnostic criteria for anxiety disorders but do not do so for PDD spectrum disorders. Further, I have sent many whom I suspected as possibly falling within the PDD spectrum on for further neuropsychological testing, and that has led to about a 40/60 diagnosis of PDD spectrum/anxiety-depression. So, while I suspect there is a connection in many cases, I do think that there is a strong possibility that this British researcher overstated his case.

[HuckleB]

42. I think I'm giving up on DU.

Why was this moved from LBN? It's a late-breaking news story from today. It's getting lots of conversation compared to most pieces posted in LBN. But it's about health, so it gets shunted away to a dead end board? I am tired of this. Earlier today, a science piece was moved from LBN to The Lounge of all places.

Sheesh. I give up! LBN is turning into drama central, the local news, where trauma is the only thing that sells. Ugh.

[bloom]

46. I thought that was pretty odd, as well...

I would often miss these stories unless I caught it on the "Latest" page - like I did today.

[Dear Maggie]

49. Autism may be metabolic ... and autoimmune

Two things that I would suspect 2-butoxyethanol exposure to cause

Autism as a Metabolic Disorder!
http://osiris.sunderland.ac.uk/autism/hplc.htm UK research

http://www.valdezlink.com/pages/autoimmune.htm#autism

http://www.valdezlink.com/pages/autism-mercury.htm#auto