Moseley R L, Atkinson C, Surman R, Greville-Harris M, May L, Vuillier L
Department of Psychology, Bournemouth University, Poole, UK.
Dorset Healthcare University NHS Foundation Trust, Poole, UK.
J Eat Disord. 2023 Feb 10;11(1):18. doi: 10.1186/s40337-023-00746-7.
A poorly understood relationship exists between eating disorders (ED) and autism spectrum conditions (ASC: henceforth 'autism'). ED are more prevalent in autistic people and people with high autistic traits, and autistic features are prognostic of longer illness. Aiming to understand what increases the risk of ED in relation to autism and autistic traits, previous research has implicated alexithymia as a causal mechanism in this relationship. These studies could not, however, disentangle whether alexithymia explains the relationship between ED pathology and autistic traits directly or through its impact on anxious/depressive symptoms, which in turn result in higher ED symptomatology. Moreover, despite evidence for sex differences in the aetiology of ED, little research has examined the impact of sex on these relationships.
Focusing on the association between autistic traits and ED psychopathology, we examined independent mediating effects of alexithymia and anxious/depressive symptoms, as well as sequential mediation effects where alexithymia affects ED psychopathology via its impact on anxious/depressive symptoms. Participants were 198 men and 265 women with formally diagnosed and suspected ED, who completed an online survey of standardised scales.
In men, higher autistic traits were associated with ED psychopathology sequentially via greater alexithymia and through that, greater depressive/anxious symptoms. In women, alexithymia mediated the relationship between autistic traits and ED psychopathology both directly and sequentially through its impact on anxious/depressive symptoms. Interestingly, depressive/anxious symptoms also mediated that relationship independently from alexithymia.
While cross-sectional, these findings suggest that the relationship between autistic traits and ED symptomatology is mediated by other variables. In support of its proposed role in the aetiology of ED, alexithymia was directly associated with ED symptoms in women. It also affected ED symptoms indirectly, in all participants, via its effect on depressive/anxious symptoms. Interventions focusing on alexithymia may facilitate recovery not only via their effect on ED, but via their effect on other forms of state psychopathology which contribute to the maintenance and development of ED. Sex differences, however, reflect that alternative therapeutic targets for men and women may be beneficial.
饮食失调（ED）与自闭症谱系障碍（ASC，以下简称“自闭症”）之间的关系尚不清楚。饮食失调在自闭症患者和具有高自闭症特征的人群中更为普遍，并且自闭症特征是疾病持续时间更长的预后因素。为了了解与自闭症和自闭症特征相关的饮食失调风险增加的原因，先前的研究认为述情障碍是这种关系中的一种因果机制。然而，这些研究无法区分述情障碍是直接解释饮食失调病理与自闭症特征之间的关系，还是通过其对焦虑/抑郁症状的影响来解释这种关系，而焦虑/抑郁症状反过来又导致更高的饮食失调症状。此外，尽管有证据表明饮食失调的病因存在性别差异，但很少有研究考察性别对这些关系的影响。
聚焦于自闭症特征与饮食失调心理病理学之间的关联，我们研究了述情障碍和焦虑/抑郁症状的独立中介效应，以及述情障碍通过其对焦虑/抑郁症状的影响来影响饮食失调心理病理学的顺序中介效应。参与者为198名男性和265名女性，他们被正式诊断或疑似患有饮食失调症，并完成了一项标准化量表的在线调查。
在男性中，较高的自闭症特征通过更强的述情障碍以及由此产生的更强的抑郁/焦虑症状，依次与饮食失调心理病理学相关。在女性中，述情障碍直接并通过其对焦虑/抑郁症状的影响，依次介导了自闭症特征与饮食失调心理病理学之间的关系。有趣的是，抑郁/焦虑症状也独立于述情障碍介导了这种关系。
虽然这些发现是横断面的，但它们表明自闭症特征与饮食失调症状之间的关系是由其他变量介导的。支持述情障碍在饮食失调病因学中所提出的作用，述情障碍在女性中与饮食失调症状直接相关。在所有参与者中，它还通过对抑郁/焦虑症状的影响间接影响饮食失调症状。专注于述情障碍的干预措施不仅可以通过其对饮食失调的影响促进康复，还可以通过其对有助于饮食失调维持和发展的其他形式的状态心理病理学的影响来促进康复。然而，性别差异表明，针对男性和女性的替代治疗靶点可能是有益的。
