Table 2.
Previous prevalence studies in patients with EDs (AN, BN, BED) and ASD.
| Study | Sample size | Diagnosis | Age in years (mean ± SD) |
Diagnostic tools | Results |
|---|---|---|---|---|---|
| a) ASD in ED | |||||
| 1. Westwood et al. (29) cross-sectional |
40 (100% females) |
AN | 15.58 ± 1.35 (n = 19 below cutoff ADOS-2) 14.86 ± 1.62 (n = 21 above cutoff ADOS-2) (12–18 years) |
AN: ICD-10, DSM-5, EDE-Q ASD: ADOS-2 Module 4, 3Di-Sv |
4 AN cases (10%) received ASD diagnosis; all of the restrictive type 21 AN cases (52.5%) scored above cut-off ADOS-2 |
| 2. Westwood et al. (30) cross-sectional |
60 (100% females) |
AN | 26.5 (n = 14 HAS) 23 (n = 24 SCAS) 22 (n = 23 NAS) (18–47 years) |
AN: DSM-5, EDE-Q ASD: ADOS-2 Module 4, RAADS-R |
14 AN cases (23.3%) scored above cut-off ADOS-2 |
| 3. Postorino et al. (26) cross-sectional |
30 35 (100% females) |
AN HC |
14.19 ± 1.56 13.6 ± 1.61 (10–17 years) |
AN: DSM-5; EAT-26; EDI-3 ASD: ADOS-2 Module 3 or 4, AQ |
3 AN cases (10%) scored above cut-off ADOS-2 |
| 4. Bentz et al. (34) cross-sectional |
43 28 41 (100% females) |
AN AN-RE HC |
16.1 ± 1.5 18.4 ± 1.6 17.7 ± 2.2 (14–22 years) |
AN: ICD-10, EDE ASD: ADOS-2 Module 4 |
7 AN cases (16%) scored above cut-off ADOS-2 6 AN-RE cases (21%) scored above cut-off ADOS-2 0 HC (0%) scored above cut-off ADOS-2 |
| 5. Koch et al. (23) retrospective cohort study |
5006 (93% females) |
AN | age at diagnosis <16: 2,336; ≥16: 2,670 |
AN: ICD-8, ICD-10 ASD: ICD-8, ICD-10 |
Probands with a first diagnosis of AN with elevated risk of receiving a second diagnosis of ASD (HR=15.08) 225 AN cases (4.5%) received ASD diagnosis |
| 6. Mandy and Tchanturia, (35) cross-sectional |
7 2 1 (100% females) |
AN EDNOS BN (pre-selected sample) |
26.4 ± 6.49 (19–38 years) |
ED: DSM-IV ASD: ADOS-2 Module 4 |
5 ED cases (50%) (pre-selected sample) scored above cut-off ADOS-2 |
| 7. Rhind et al. (28) cross-sectional |
87 56 1 1 5 (91% females) |
AN EDNOS-AN BN Possible ED No ED |
16.90 ± 2.13 (13–21 years) |
ED: DSM-IV, DAWBA ASD: DSM-IV, DAWBA, SAS, SDQ |
6 ED cases (4%) with a possible (n=5) or definite (n=1) ASD diagnosis |
| 8. Anckarsäter et al. (20) restrospective |
50 (96% females) 50 |
AN HC |
AN: DSM-III-R, DSM-IV ASD: DSM-IV, ASDI, AQ, TCI, neurocognitive tests |
14 (28%) AN cases met DSM-IV criteria for ASD (1 autistic disorder, 4 Asperger’s syndrome, 9 PDDNOS) as compared with 1 HC subject (PDDNOS) | |
| 9. Pooni et al. (25) cross-sectional |
22 24 20 (86.4%, 87.5% and 20% females) |
17 AN, 3 atypical AN, 1 BN, 1 FAED TD ASD |
13.0 ± 1.6 13.0 ± 2.4 11.6 ± 2.0 (8–16 years) |
ED: DSM-IV-TR, ICD-10 ASD: DSM-IV-TR, ICD-10, 3Di-sv, DAWBA, SDQ, RBS-R |
1 ED case (4.5%) received ASD diagnosis ASD diagnosis no more common in ED than in TD Repetitive and stereotyped behavior more often observed in ED compared with TD Trend toward greater autistic social impairment in ED |
| 10. Wentz et al. (3) cross-sectional |
30 (100% females) |
21 AN 9 BN |
27.4 ± 8.4 (18–56 years) |
ED: DSM-IV, SCID I, ASD: DSM-IV, ASD-I |
7 ED cases (23%) had ASD (all), 5 ED cases (17%) had AD/HD (all BED type) |
| 11. Råstam et al. (27) retrospective |
51 51 (94% females) |
AN HC |
21 24 |
AN: DSM-III-R, DSM-IV, SCID-I ASD: DSM-III-R and DSM-IV |
Study 2: 10 AN cases (20%) met ASD criteria Study 3: Nine AN (18%) subjects and 1 HC (2%) met the criteria for ASD |
| 12. Nilsson et al. (24) retrospective |
51 51 |
AN HC |
24 |
AN: DSM-III-R, DSM-IV ASD: DSM-III-R, DSM-IV, ASDI |
9 AN cases (18%) and 1 HC met ASD criteria |
| 13. Nilsson et al. (36) retrospective |
51 51 (94% females) |
AN HC |
21 | AN: DSM-III-R, DSM-IV ASD: DSM-IV |
15 AN cases (29%) were diagnosed as having “empathy disorder” (defined by Gillberg et al.); 6 of these met DSM-IV criteria for Asperger’s disorder |
| 14. Gillberg et al. (22) retrospective |
51 51 (94% females) |
AN HC |
21 | AN: DSM-III-R, SCID ASD: DSM-III-R, criteria for Asperger’s syndrome by Gillberg (1989) |
15 AN (29%) had an empathy disorder (as compared with 4% in the HC group) 6 AN (12%) met criteria for Asperger’s syndrome 37% of the AN group had either a cluster C personality disorder or a diagnosis of ASD, as compared with 10% of the HC group |
| 15. Råstam et al. (37) cross-sectional |
51 51 |
AN HC |
16 | AN: DSM-III-R ASD: DSM-III-R |
1 AN (2%) diagnosed with Asperger’s syndrome, 1 girl with PDD, 2 girls had histories suggestive of HFA |
| b) EDs in ASD | |||||
| 1. Karjalainen et al. (12) cross-sectional |
74 45 109 (44% females) |
ASD ASD+ ADHD ADHD |
31.75 ± 9.29 (19–60 years) |
ED: SCID-I, EAT ASD: SCID-I DSM-IV |
18 cases (7.9%) had a current or previous ED [ASD: AN, n = 5 (6.7%); BN: n = 2 (2.7%); BED: n = 1 (1.4%); ADHD: AN: n = 2 (2.8%), BN, n = 0 (0.0%), BED, n = 7 (6.4%); ASD+ADHD: AN, n = 1 (2.2%)] |
| 2. Koch et al. (23) retrospective cohort study |
12606 (21% females) |
ASD | age at diagnosis: <16: 10,851; ≥16: 1,755 |
ED: ICD-8, ICD-10 ASD: ICD-8, ICD-10 |
Probands with a first diagnosis of ASD with elevated risk of having a second diagnosis of AN (HR = 5.3) |
| 3. Bölte et al. (21) cross-sectional |
71 32 (28% females) |
autism Asperger syndrome |
19.7 ± 7.8 (10.1–39.9 years) |
ED: clinical diagnosis, DSM-IV ASD: DSM-IV, ADI-R, ADOS |
28% of male individuals had a BMI in the 5th percentile or below A clinical diagnosis of AN was not met by any proband |
SD, standard deviation; HC, healthy controls; TD, typically developed; ED, eating disorder; AN, anorexia nervosa; BN, bulimia nervosa; BED, binge eating disorder; AN-RE, recovered from anorexia nervosa; EDNOS, eating disorder not otherwise specified; FAED, food avoidance emotional disorder; ASD, autism spectrum disorder; HFA, high-functioning autism; PDDNOS, pervasive developmental disorder not otherwise specified; ADHD, attention-deficit/hyperactivity disorder; BMI, body mass index; ADOS, Autism Diagnostic Observation Schedule (14); SCID, Structured Clinical Interview for DSM; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD, International Classification of Diseases; EDE, Eating Disorder Examination (38); EDE-Q, Eating Disorder Examination Questionnaire (39); 3Di-sv, Developmental Diagnostic Dimensional Interview-short version (16); RAADS-R, Ritvo Autism Asperger Diagnostic Scale—Revised (40); EAT, Eating Attitudes Test (41); EDI, Eating Disorder Inventory (42); DAWBA, Development and Well-Being Assessment (43); SAS, Social Aptitutes Scale (44); SDQ, Strengths and Difficulties Questionnaire (45); ASDI, Asperger Syndrome Diagnostic Interview (46); AQ, Autism Spectrum Quotient (47); TCI, Temperament and Character Inventory (48); RBS-R, Repetitive Behavior Scale—Revised (49); ADI-R,Autism Diagnostic Interview revised (50); HR, hazard ratio.