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**Please note that this paper has now been published - there are some minor changes following reviewer feedback, so we'd suggest accessing the final version if possible. Published DOI is here: 10.1016/j.rasd.2020.101531 **Alexithymia, a difficulty identifying and communicating one’s own emotions, affects socio-emotional processes, such as emotion recognition and empathy. Co-occurring alexithymia is prevalent in Autism Spectrum Disorder (ASD) and underlies some socio-emotional difficulties previously attributed to autism. Socio-emotional abilities are examined during behavioural diagnostic assessments of autism, yet the effect of alexithymia on these assessments is not known. In this study, two previously collected samples of Autism Diagnostic Observation Schedule (ADOS) assessments were used to examine the relationship between alexithymia and ADOS score. Participants included 96 women with anorexia, and 147 adolescents who were either high in autistic symptoms, or whose twin had high autistic symptoms. We examined 1) the impact of alexithymia on meeting the criteria for autism/ASD, 2) correlations between alexithymia and ADOS subscales, and 3) whether alexithymia predicted scores on specific ADOS items, selected a priori based on the literature. In the adolescent group, parent-reported (but not self-reported) alexithymia predicted autism/ASD diagnosis, correlated with both sub-scales, and predicted scores on ADOS items. Fewer associations were observed in the anorexic sample, but the presence of alexithymia predicted a near fourfold increase in the likelihood of meeting diagnostic criteria for autism/ASD in this sample.

BackgroundDespite a suggested link between anorexia nervosa (AN) and autism spectrum disorder (ASD), previous studies have used self-report or diagnostic criteria to assess for ASD in AN populations, rather than direct observation of symptom characteristic of ASD. The aim of this study was to use a standardised, clinical assessment of ASD, the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), to investigate the presence of autistic symptoms in a cross-sectional sample of women with AN.MethodsSixty women were recruited from inpatient or day-patient specialist eating disorder services. Each participant underwent the ADOS-2 assessment and completed a set of self-report questionnaires assessing eating disorder pathology and other psychiatric symptoms. IQ was also assessed.ResultsFourteen women (23.3%) scored above clinical cutoff for ASD on the ADOS-2. Only eight of these women displayed repetitive or restrictive behaviours, while all 14 had difficulties with social affect. Elevated ASD symptoms were associated with increased alexithymia and obsessive-compulsive symptoms, but not specific eating disorder pathology.ConclusionsASD symptoms are over-represented in women with severe AN and appear to be associated with other psychiatric symptoms, which warrant further investigation and consideration in treatment.

Supplemental material, AUT722431_Lay_Abstract for Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme by Kate Tchanturia, James Adamson, Jenni Leppanen and Heather Westwood in Autism

Background: Difficulties with social relationships have been implicated in both the development and maintenance of Anorexia Nervosa (AN) but the friendship experiences of individuals with AN have not been explored in depth.Method: Ten adults with AN took part in a semi-structured interview about their friendship experiences both before and since the onset of their illness.Results: Five principle themes were identified through thematic analysis: Social Concern; Impact of AN; Social Connectedness; Inflexibility and Preferred Social Activity. Difficulties with friendship were present prior to the onset of AN in all cases, with participants experiencing anxiety in relation to various aspects of their friendships. Participants described mixed experiences of how their AN has affected their friendships but most participants described having less contact with their friends since becoming unwell.Conclusion: This research highlights the role that social difficulties may play in the development of AN, whilst also emphasising the importance of addressing problems with friendship in the course of inpatient treatment.

This study aimed to explore the experiences of adults with Anorexia Nervosa who took part in a perfectionism group intervention in an inpatient setting. Thematic analysis was used to explore patient feedback collected in focus groups. Patient feedback was generally positive and centred around three main themes: perceived benefits of the group, the content of the group and suggested improvements. The findings suggest that a brief perfectionism group intervention is an acceptable treatment with a range of perceived benefits for patients with severe AN. Understanding patients’ experiences of the intervention can provide further important information to maximise therapeutic impact of the group in inpatient settings.

Background Difficulties with social relationships have been implicated in both the development and maintenance of Anorexia Nervosa (AN) but the friendship experiences of individuals with AN have not been explored in depth. Method Ten adults with AN took part in a semi-structured interview about their friendship experiences both before and since the onset of their illness. Results Five principle themes were identified through thematic analysis: Social Concern; Impact of AN; Social Connectedness; Inflexibility and Preferred Social Activity. Difficulties with friendship were present prior to the onset of AN in all cases, with participants experiencing anxiety in relation to various aspects of their friendships. Participants described mixed experiences of how their AN has affected their friendships but most participants described having less contact with their friends since becoming unwell. Conclusion This research highlights the role that social difficulties may play in the development of AN, whilst also emphasising the importance of addressing problems with friendship in the course of inpatient treatment.