Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Molecular Autism
Published in: Molecular Autism 1/2015

Open Access 01-12-2015 | Research

Effects of autism spectrum disorders on outcome in teenage-onset anorexia nervosa evaluated by the Morgan-Russell outcome assessment schedule: a controlled community-based study

Authors: Søren Nielsen, Henrik Anckarsäter, Carina Gillberg, Christopher Gillberg, Maria Råstam, Elisabet Wentz

Published in: Molecular Autism | Issue 1/2015

Login to get access

Abstract

Background

The purpose of the study was to evaluate time trends and effects of co-existing autism spectrum disorders (ASD) on outcome in an ongoing long-term follow-up study of anorexia nervosa (AN).

Methods

The Morgan-Russell Outcome Assessment Schedule (MROAS) was used at 6-, 10- and 18-year follow-up of a representative sample of 51 individuals with teenage-onset AN and a matched group of 51 healthy comparison cases. The full multinomial distribution of responses for the full scale and each of the subscales was evaluated using exact nonparametric statistical methods. The impact of diagnostic stability of ASD on outcome in AN was evaluated in a dose–response model.

Results

There were no deaths in either group. Food intake and menstrual pattern were initially poor in the AN group but normalised over time. MROAS ‘mental state’ was much poorer in the AN group and did not improve over time. The psychosexual MROAS domains ‘attitudes’ and ‘aims’ showed persistent problems in the AN group. In the MROAS socioeconomic domain, the subscales ‘personal contacts’, ‘social activities’ and ‘employment record’ all showed highly significant between-group differences at all three follow-ups. A statistically significant negative dose–response relationship was found between a stable diagnosis of ASD over time and the results on the subscales ‘mental state’, ‘psychosexual state’ and ‘socio-economic state’.

Conclusions

Outcome of teenage-onset AN is favourable with respect to mortality and persisting eating disorder, but serious problems remain in the domains ‘mental state’, ‘psychosexual function’ and ‘socioeconomic state’. Outcome is considerably worse if ASD is present. Treatment programmes for AN need to be modified so as to accommodate co-existing ASD.
Literature
1.
Steinhausen H-C. Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am. 2009;18(1):225–42.CrossRefPubMed
2.
Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724.CrossRefPubMed
3.
Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry. 2007;164(8):1259–65.CrossRefPubMed
4.
Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14(4):406–14.CrossRefPubMedCentralPubMed
5.
Ratnasuriya RH, Eisler I, Szmukler GI, Russell GF. Anorexia nervosa: outcome and prognostic factors after 20 years. Br J Psychiatry. 1991;158:495–502.CrossRefPubMed
6.
Lowe B, Zipfel S, Buchholz C, Dupont Y, Reas DL, Herzog W. Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol Med. 2001;31(5):881–90.PubMed
7.
Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Reproductive health outcomes in eating disorders. Int J Eat Disord. 2013;46(8):826–33.CrossRefPubMed
8.
Hjern A, Lindberg L, Lindblad F. Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9- to 14-year follow-up. Br J Psychiatry. 2006;189:428–32.CrossRefPubMed
9.
10.
Happe FG. Annotation: current psychological theories of autism: the “theory of mind” account and rival theories. J Child Psychol Psychiatry. 1994;35(2):215–29.CrossRefPubMed
11.
Happe FG. An advanced test of theory of mind: understanding of story characters’ thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. J Autism Dev Disord. 1994;24(2):129–54.CrossRefPubMed
12.
Tchanturia K, Happé F, Godley J, Bara-Carill N, Treasure J, Schmidt U. Theory of mind in AN. Eur Eat Disord Rev. 2004;12:361–6.CrossRef
13.
Zucker NL, Losh M, Bulik CM, LaBar KS, Piven J, Pelphrey KA. Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychol Bull. 2007;133(6):976–1006.CrossRefPubMed
14.
Rastam M. Eating disturbances in autism spectrum disorders with focus on adolescent and adult years. Clinical Neuropsychiatry. 2008;5(1):31–42.
15.
Wentz E, Lacey JH, Waller G, Rastam M, Turk J, Gillberg C. Childhood onset neuropsychiatric disorders in adult eating disorder patients. A pilot study. Eur Child Adolesc Psychiatry. 2005;14(8):431–7.CrossRefPubMed
16.
Oldershaw A, Treasure J, Hambrook D, Tchanturia K, Schmidt U. Is anorexia nervosa a version of autism spectrum disorders? Eur Eat Disord Rev. 2011;19(6):462–74.CrossRefPubMed
17.
Huke V, Turk J, Saeidi S, Kent A, Morgan JF. Autism spectrum disorders in eating disorder populations: a systematic review. Eur Eat Disord Rev. 2013;21(5):345–51.CrossRefPubMed
18.
Gillberg IC, Billstedt E, Wentz E, Anckarsater H, Rastam M, Gillberg C. Attention, executive functions, and mentalizing in anorexia nervosa eighteen years after onset of eating disorder. J Clin Exp Neuropsychol. 2010;32(4):358–65.CrossRefPubMed
19.
Anckarsater H, Hofvander B, Billstedt E, Gillberg IC, Gillberg C, Wentz E,Rastam M. The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study. Psychol Med. 2011; 1–11.
20.
Rastam M, Gillberg C, Garton M. Anorexia nervosa in a Swedish urban region. A population-based study. Br J Psychiatry. 1989;155:642–6.PubMed
21.
Gillberg IC, Rastam M, Gillberg C. Anorexia nervosa outcome: six-year controlled longitudinal study of 51 cases including a population cohort. J Am Acad Child Adolesc Psychiatry. 1994;33(5):729–39.CrossRefPubMed
22.
Wentz E, Gillberg C, Gillberg IC, Rastam M. Ten-year follow-up of adolescent-onset anorexia nervosa: psychiatric disorders and overall functioning scales. J Child Psychol Psychiatry. 2001;42(5):613–22.CrossRefPubMed
23.
Rastam M, Gillberg C, Wentz E. Outcome of teenage-onset anorexia nervosa in a Swedish community-based sample. Eur Child Adolesc Psychiatry. 2003;12 Suppl 1:I78–90.PubMed
24.
Wentz E, Gillberg IC, Anckarsater H, Gillberg C, Rastam M. Reproduction and offspring status 18 years after teenage-onset anorexia nervosa - a controlled community-based study. Int J Eat Disord. 2009;42(6):483–91.CrossRefPubMed
25.
Wentz E, Gillberg IC, Anckarsater H, Gillberg C, Rastam M. Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry. 2009;194(2):168–74.CrossRefPubMed
26.
Nilsson EW, Gillberg C, Rastam M. Familial factors in anorexia nervosa: a community-based study. Compr Psychiatry. 1998;39(6):392–9.CrossRefPubMed
27.
Nielsen S, Bára-Carrill N. Family, burden of care and social consequences. In: Treasure J, Schmidt U, van Furth E, editors. Handbook of eating disorders. Chichester: John Wiley & Sons; 2003. p. 191–206.
28.
Morgan HG, Russell GF. Value of family background and clinical features as predictors of long-term outcome in anorexia nervosa: four-year follow-up study of 41 patients. Psychol Med. 1975;5(4):355–71.CrossRefPubMed
29.
Morgan HG, Hayward AE. Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule. Br J Psychiatry. 1988;152:367–71.CrossRefPubMed
30.
APA. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington DC: American Psychiatric Press; 1987. DSM-III-R.
31.
APA. Diagnostic and statistical manual of mental disorders. 4th ed. Washington DC: American Psychiatric Press; 1994. DSM-IV.
32.
Rastam M. Anorexia nervosa in 51 Swedish adolescents: premorbid problems and comorbidity. J Am Acad Child Adolesc Psychiatry. 1992;31(5):819–29.CrossRefPubMed
33.
Siegel S, Castellan NJ. Nonparametric statistics for the behavioral sciences. 2nd ed. New York: McGraw-Hill; 1988.
34.
Agresti A. Categorical data analysis. 2nd ed. New York: John Wiley & Sons; 2002.CrossRef
35.
Mantel N, Byar DP. Marginal homogeneity, symmetry and independence. Communication in Statistics. 1978;A7:953–76.CrossRef
36.
Landis R, Heyman ER, Koch GG. Average partial association in three-way contingency tables: a review and discussion of alternative tests. Communication in Statistics. 1978;46:237–54.
37.
Inc. C. StatXact8 user manual. Cambridge MA: Cytel Inc; 2007.
38.
Sullivan PF, Bulik CM, Fear JL, Pickering A. Outcome of anorexia nervosa: a case–control study. Am J Psychiatry. 1998;155(7):939–46.CrossRefPubMed
39.
Lundstrom S, Chang Z, Rastam M, Gillberg C, Larsson H, Anckarsater H, et al. Autism spectrum disorders and autistic like traits: similar etiology in the extreme end and the normal variation. Arch Gen Psychiatry. 2012;69(1):46–52.CrossRefPubMed
40.
Bulik CM, Thornton LM, Root TL, Pisetsky EM, Lichtenstein P, Pedersen NL. Understanding the relation between anorexia nervosa and bulimia nervosa in a Swedish national twin sample. Biol Psychiatry. 2010;67(1):71–7.CrossRefPubMedCentralPubMed
41.
Schulte-Ruther M, Mainz V, Fink GR, Herpertz-Dahlmann B, Konrad K. Theory of mind and the brain in anorexia nervosa: relation to treatment outcome. J Am Acad Child Adolesc Psychiatry. 2012;51(8):832–41. e11.CrossRefPubMed
42.
Dewey M. Living with Asperger’s syndrome. In: Frith U, editor. Autism and Asperger syndrome. Cambridge, England: Cambridge University Press; 1991. p. 184–206.CrossRef
43.
Gillberg IC, Gillberg C. Asperger syndrome - some epidemiological considerations: a research note. J Child Psychol Psychiatry. 1989;30(4):631–8.CrossRefPubMed
44.
Gillberg C, Rastam M, Wentz E. The Asperger Syndrome (and high-functioning autism) Diagnostic Interview (ASDI): a preliminary study of a new structured clinical interview. Autism. 2001;5(1):57–66.CrossRefPubMed
45.
Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001;31(1):5–17.CrossRefPubMed
Metadata
Title
Effects of autism spectrum disorders on outcome in teenage-onset anorexia nervosa evaluated by the Morgan-Russell outcome assessment schedule: a controlled community-based study
Authors
Søren Nielsen
Henrik Anckarsäter
Carina Gillberg
Christopher Gillberg
Maria Råstam
Elisabet Wentz
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Molecular Autism / Issue 1/2015
Electronic ISSN: 2040-2392
DOI
https://doi.org/10.1186/s13229-015-0013-4

Other articles of this Issue 1/2015

Molecular Autism 1/2015 Go to the issue

Research

Hypomethylation of miR-142 promoter and upregulation of microRNAs that target the oxytocin receptor gene in the autism prefrontal cortex

Research

Sex differences in structural organization of motor systems and their dissociable links with repetitive/restricted behaviors in children with autism

Erratum

Erratum: Measuring autistic traits in the general population: a systematic review of the Autism-Spectrum Quotient (AQ) in a nonclinical population sample of 6,900 typical adult males and females

Research

Is impaired joint attention present in non-clinical individuals with high autistic traits?

Research

Visuo-tactile integration in autism: atypical temporal binding may underlie greater reliance on proprioceptive information

Research

Hypersensitive pupillary light reflex in infants at risk for autism