Original Articles

The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study

H. Anckarsäter^a1a2 c1, B. Hofvander^a2, E. Billstedt^a1a3, I. C. Gillberg^a3, C. Gillberg^a3, E. Wentz^a3a4 and M. Råstam^a3a5

^a1 Forensic Psychiatry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

^a2 Forensic Psychiatry, Department of Clinical Sciences, Lund University, Malmö, Sweden

^a3 Child and Adolescent Psychiatry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

^a4 Vårdal Institute, Swedish Institute for Health Sciences, Lund, Sweden

^a5 Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden

Abstract

Background A subgroup of persons with anorexia nervosa (AN) have been proposed to have sociocommunicative problems corresponding to autism spectrum disorders [ASDs, i.e. DSM-IV pervasive developmental disorders (PDDs): autistic disorder, Asperger's disorder, PDD not otherwise specified (NOS)]. Here, clinical problems, personality traits, cognitive test results and outcome are compared across 16 subjects (32%) with teenage-onset AN who meet or have met ASD criteria (AN+ASD), 34 ASD-negative AN subjects and matched controls from a longitudinal Swedish study including four waves of independent assessments from the teens to the early thirties.

Method The fourth wave included the Structured Clinical Interview for DSM-IV (SCID)-I and the SCID-II (cluster C, i.e. ‘anxious’ PDs) interviews, the Asperger Syndrome Diagnostic Interview, self-assessments by the Autism Spectrum Quotient and the Temperament and Character Inventory, neurocognitive tests by subscales from the Wechsler scales, continuous performance tests, Tower of London, and Happé's cartoons.

Results The ASD assessments had substantial inter-rater reliability over time (Cohen's κ between 0.70 and 0.80 with previous assessments), even if only six subjects had been assigned a diagnosis of an ASD in all four waves of the study, including retrospective assessments of pre-AN neurodevelopmental problems. The AN+ASD group had the highest prevalence of personality disorders and the lowest Morgan–Russell scores. The non-ASD AN group also differed significantly from controls on personality traits related to poor interpersonal functioning and on neurocognitive tests.

Conclusions A subgroup of subjects with AN meet criteria for ASDs. They may represent the extreme of neurocognitive and personality problems to be found more generally in AN.

(Received September 21 2010)

(Revised November 04 2011)

(Accepted November 17 2011)

(Online publication December 20 2011)

Key Words:

• Anorexia nervosa;
• autism spectrum disorder;
• cognition;
• personality;
• social interaction;

Correspondence:

^c1 Address for correspondence: H. Anckarsäter, M.D., Ph.D., Lillhagsparken 3, 422 50 Hisings Backa, Sweden. (Email: henrik.anckarsater@neuro.gu.se)