Socio-emotional cognition and autism spectrum disorder symptoms in anorexia nervosa

Student thesis: Doctoral ThesisDoctor of Philosophy


Anorexia nervosa (AN) is a severe eating disorder (ED) characterised by high mortality rates and substantial functional impairment. Theoretical models of AN have proposed that interpersonal difficulties are key to the development and maintenance of the disorder. However, the mechanisms underlying these social difficulties are poorly understood. While some research has demonstrated difficulties in empathy, understanding of nonverbal communication, and social attention in individuals with AN, evidence is inconsistent. At the same time, there is evidence to suggest a relationship between AN and autism spectrum disorder (ASD), with a significant proportion of individuals with AN showing high levels of ASD symptoms. Given that difficulties in social communication and understanding are core characteristics of ASD, it is possible that variations in ASD symptoms are associated with differences in social cognition in individuals with AN.

Thus, the overall aim of the thesis is to investigate the impact of ASD symptoms on socio-emotional cognition in adults in the acute and recovered stages of AN, compared to healthy controls (HCs). The first few studies focus on exploring comorbid ASD symptoms in AN, while the latter part of the thesis examines performance in a variety of socio-emotional domains, specifically empathy, perception of nonverbal communication, and social attention.

The findings demonstrate that around one quarter of individuals in the acute and recovered stages of AN display high levels of ASD symptoms, suggesting that ASD symptoms may be relatively independent from clinical state. Generally, only small differences in socio-emotional cognition were found in those with AN. Specifically, lower positive affective empathy and reduced attention to faces was found in individuals with AN compared to recovered AN and HCs. Overall, ASD symptoms were better predictors of socio-emotional abilities than ED status; high ASD symptoms predicted lower cognitive and affective empathy abilities, emotion recognition performance, and attention to faces, while controlling for group membership.

The results demonstrate the importance of clinical heterogeneity within the overall diagnosis of AN, suggesting that those with high ASD traits may show particular difficulties in socio-emotional cognition. Different treatment approaches or adaptations to treatment may be required for this subgroup of patients. Future work should directly compare indices of social cognition in individuals with AN to those with a diagnosis of ASD, in order to elucidate potential transdiagnostic factors responsible for social difficulties across disorders.
Date of Award1 Oct 2020
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorKate Tchanturia (Supervisor)

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