Neural Correlates of Autistic Individuals With Anorexia Nervosa

NCT07098156 | Recruiting

• 1 other identifier: 349220
• Study Type: observational
• Target: 50
• Locations: 1 country
• Sites: 2

Brief Summary

Masking is a behaviour or strategy used by many Autistic people to appear non-Autistic and blend in with a neurotypical society. The goal of this observational study is to understand the relationship between masking, anorexia nervosa symptoms and brain structure in Autistic people. The main questions this study aims to answer are:

• Do Autistic individuals with anorexia nervosa show differences in structure or function of the brain relation to Autistic individuals without anorexia nervosa?
• Do Autistic individuals with anorexia nervosa display higher levels of masking than Autistic individuals without anorexia nervosa?
• Are there indeed relationships between levels of masking, anorexia nervosa symptoms and brain structure in Autistic people? Researchers will compare Autistic people without anorexia nervosa to Autistic people with anorexia nervosa to see if there are differences between groups. Participants will:
• Complete a series of questionnaires focused on eating disorder symptoms, autistic traits, autistic masking and psychological well-being
• Undergo an MRI scan at the Aberdeen Royal Infirmary

Conditions

Autism; Anorexia Nervosa

Keywords

MRI; Magnetic Resonance Imaging

Outcome Measures

Primary Outcomes (3)

• Structural and Functional Brain Differences

  To examine whether Autistic individuals with anorexia nervosa exhibit differences in brain structure or function relative to Autistic individuals without anorexia nervosa via 2-sample t-tests. Brain structure will be measured using surface and subcortical parcellations (in mm\^3) acquired from Freesurfer. Brain functional connectivity at resting state will be measured using bivariate correlations of mean BOLD signal across pairs of regions of interest, converted to normally distributed scores using Fisher's transformation.

  From enrolment to single research visit (up to 30 weeks).

• Levels of Masking

  To determine whether Autistic individuals with anorexia nervosa exhibit higher masking behaviour than Autistic individuals without anorexia nervosa via 2-sample t-tests on total and subscale scores on the Camouflaging Autistic Traits Questionnaire. The Camouflaging Autistic Traits Questionnaire contains 25 statements relating to three subcategories of camouflaging (9 statements for the compensation subscale; 8 statements for the masking subscale; 8 statements for the assimilation subscale). All statements are scored on a scale of 1-7, and the scoring range on this measurement ranges from 25 to 175. Higher scores reflect greater camouflaging, with a threshold score of high camouflaging consisting of a score of 100 or greater.

  From enrolment to single research visit (up to 30 weeks).

• Associations Between Masking, Anorexic Symptoms and Brain Structure

  To determine if there are associations between the levels of masking, eating disorder symptomatology and brain structure in Autistic individuals via multiple 3-path mediation analysis established using generalised linear models. Levels of masking will comprise of total and scores on the Camouflaging Autistic Traits Questionnaire, which contains 25 statements. All statements are scored on a scale of 1-7, with a scoring range of 25-175. Higher scores reflect greater camouflaging, with a threshold score of consisting of 100 or greater. Levels of eating disorder symptomatology will comprise of the Eating Disorder Examination Questionnaire, which contains 28 statements. Total scores range from 0-6, with a clinical cut-off score of 2.8 for women, and 1.68 for men. Brain structure will be measured using surface and subcortical parcellations (in mm\^3) acquired from Freesurfer.

  From enrolment to single research visit (up to 30 weeks).

Study Arms (2)

Autistic Control

Autistic individuals with no history of an eating disorder

Other: Single Research Visit 3T MRI Research Scan; Other: Demographic and Behavioural Questionnaires

Autistic Patient

Autistic individuals acutely ill with anorexia nervosa

Other: Single Research Visit 3T MRI Research Scan; Other: Demographic and Behavioural Questionnaires

Interventions

Demographic and Behavioural Questionnaires OTHER

A series of demographic and behavioural questionnaires to be completed by participants, either online or during the single study visit. Questionnaires include the Eating Disorder Examination Questionnaire, Autism Spectrum Quotient, Monotropism Questionnaire, Camouflaging Autistic Traits Questionnaire, Hospital Anxiety and Depression Scale, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale, Work and Social Adjustment Scale, International Trauma Questionnaire and Leibowitz Social Anxiety Scale. These questionnaires will also include a demographic questionnaire to acquire measures such as age, BMI, co-occurring conditions, etc.

Autistic Control; Autistic Patient

Single Research Visit 3T MRI Research Scan OTHER

Single research visit scan performed with a 3T magnetic resonance imaging scanner.

Autistic Control; Autistic Patient

Eligibility Criteria

• Age: 25 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)
• Sampling Method: Probability Sample

Study Population

The population for this study consists of Autistic individuals who both present or do not present with acute anorexia nervosa. Study population will be recruited from Scotland, primarily the NHS Grampian region.

You may qualify if:

• Healthy Autistic Individuals (Autistic Controls) must:
• Be aged 25-45 years
• Be Autistic (clinically diagnosed and/or have an Autism Quotient (AQ-10) score of ≥6)
• Be able to provide informed consent for the study
• Be able to read, understand and respond to questionnaires in English
• Have no history of an eating disorder
• Willing to have an MRI scan in Aberdeen
• Autistic Individuals with anorexia nervosa must:
• Be aged 25-45 years
• Be Autistic (clinically diagnosed and/or have an AQ-10 score of ≥6)
• Be able to provide informed consent to the study
• Be able to read, understand and respond to questionnaires in English
• Have a diagnosis of anorexia nervosa or a body mass index of \<18.5
• Willing to have an MRI scan in Aberdeen

You may not qualify if:

• Individuals are not eligible for the study if they:
• Are aged \<25 or \>45 years
• Are not Autistic or not clinically diagnosed as Autistic and have an AQ-10 score of \<6
• Are diagnosed with an eating disorder other than anorexia nervosa
• Have a history of brain injury (e.g., stroke)
• Be unable to provide informed consent for the study
• Have contraindications to MRI scanning, such has implantable cardiac devices
• Are unable to read, understand and respond to questionnaires in English
• As participants will need to consent to the study and complete questionnaires by themselves, individuals with intellectual disability will be excluded from this study

Sponsors & Collaborators

• NHS Grampian: collaborator
• University of Aberdeen: lead

Study Sites (2)

Lilian Sutton Building

Aberdeen, Aberdeen City, AB25 2ZD, United Kingdom

RECRUITING

NHS Grampian Eating Disorder Services

Aberdeen, Aberdeen City, AB25 2ZD, United Kingdom

RECRUITING

Related Publications (19)

• Hull L, Mandy W, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV. Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord. 2019 Mar;49(3):819-833. doi: 10.1007/s10803-018-3792-6.

  PMID: 30361940 BACKGROUND

• Leppanen J, Sedgewick F, Cardi V, Treasure J, Tchanturia K. Cortical morphometry in anorexia nervosa: An out-of-sample replication study. Eur Eat Disord Rev. 2019 Sep;27(5):507-520. doi: 10.1002/erv.2686. Epub 2019 Jun 6.

  PMID: 31172616 BACKGROUND

• Nickel K, Joos A, Tebartz van Elst L, Matthis J, Holovics L, Endres D, Zeeck A, Hartmann A, Tuscher O, Maier S. Recovery of cortical volume and thickness after remission from acute anorexia nervosa. Int J Eat Disord. 2018 Sep;51(9):1056-1069. doi: 10.1002/eat.22918. Epub 2018 Sep 13.

  PMID: 30212599 BACKGROUND

• Vijayakumar N, Allen NB, Youssef G, Dennison M, Yucel M, Simmons JG, Whittle S. Brain development during adolescence: A mixed-longitudinal investigation of cortical thickness, surface area, and volume. Hum Brain Mapp. 2016 Jun;37(6):2027-38. doi: 10.1002/hbm.23154. Epub 2016 Mar 4.

  PMID: 26946457 BACKGROUND

• Sader M, Williams JHG, Waiter GD. A meta-analytic investigation of grey matter differences in anorexia nervosa and autism spectrum disorder. Eur Eat Disord Rev. 2022 Sep;30(5):560-579. doi: 10.1002/erv.2915. Epub 2022 May 7.

  PMID: 35526083 BACKGROUND

• Alfano V, Mele G, Cotugno A, Longarzo M. Multimodal neuroimaging in anorexia nervosa. J Neurosci Res. 2020 Nov;98(11):2178-2207. doi: 10.1002/jnr.24674. Epub 2020 Aug 7.

  PMID: 32770570 BACKGROUND

• Doyle-Thomas KA, Kushki A, Duerden EG, Taylor MJ, Lerch JP, Soorya LV, Wang AT, Fan J, Anagnostou E. The effect of diagnosis, age, and symptom severity on cortical surface area in the cingulate cortex and insula in autism spectrum disorders. J Child Neurol. 2013 Jun;28(6):732-9. doi: 10.1177/0883073812451496. Epub 2012 Jul 25.

  PMID: 22832774 BACKGROUND

• Sydnor LM, Aldinger KA. Structure, Function, and Genetics of the Cerebellum in Autism. J Psychiatr Brain Sci. 2022;7:e220008. doi: 10.20900/jpbs.20220008. Epub 2022 Oct 25.

  PMID: 36425354 BACKGROUND

• Fonville L, Giampietro V, Williams SC, Simmons A, Tchanturia K. Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration. Psychol Med. 2014 Jul;44(9):1965-75. doi: 10.1017/S0033291713002389. Epub 2013 Sep 27.

  PMID: 24074139 BACKGROUND

• Wronski ML, Geisler D, Bernardoni F, Seidel M, Bahnsen K, Doose A, Steinhauser JL, Gronow F, Boldt LV, Plessow F, Lawson EA, King JA, Roessner V, Ehrlich S. Differential alterations of amygdala nuclei volumes in acutely ill patients with anorexia nervosa and their associations with leptin levels. Psychol Med. 2023 Oct;53(13):6288-6303. doi: 10.1017/S0033291722003609. Epub 2022 Dec 5.

  PMID: 36464660 BACKGROUND

• Schumann CM, Bauman MD, Amaral DG. Abnormal structure or function of the amygdala is a common component of neurodevelopmental disorders. Neuropsychologia. 2011 Mar;49(4):745-59. doi: 10.1016/j.neuropsychologia.2010.09.028. Epub 2010 Oct 13.

  PMID: 20950634 BACKGROUND

• Duffy F, Gillespie-Smith K, Sharpe H, Buchan K, Nimbley E, Maloney E, Sader M, Kettley S, Kerr-Gaffney J, Waiter G, Tchanturia K. Eating Disorder and Autism Collaborative project outline: promoting eating disorder research embedded in a neurodiversity-affirming culture. BJPsych Bull. 2025 Aug;49(4):272-277. doi: 10.1192/bjb.2024.61.

  PMID: 39113248 BACKGROUND

• Cassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism. 2018 Jul 31;9:42. doi: 10.1186/s13229-018-0226-4. eCollection 2018.

  PMID: 30083306 BACKGROUND

• Beck JS, Lundwall RA, Gabrielsen T, Cox JC, South M. Looking good but feeling bad: "Camouflaging" behaviors and mental health in women with autistic traits. Autism. 2020 May;24(4):809-821. doi: 10.1177/1362361320912147.

  PMID: 32429817 BACKGROUND

• Bargiela S, Steward R, Mandy W. The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. J Autism Dev Disord. 2016 Oct;46(10):3281-94. doi: 10.1007/s10803-016-2872-8.

  PMID: 27457364 BACKGROUND

• Leppanen J, Sedgewick F, Halls D, Tchanturia K. Autism and anorexia nervosa: Longitudinal prediction of eating disorder outcomes. Front Psychiatry. 2022 Sep 21;13:985867. doi: 10.3389/fpsyt.2022.985867. eCollection 2022.

  PMID: 36213911 BACKGROUND

• Nickel K, Maier S, Endres D, Joos A, Maier V, Tebartz van Elst L, Zeeck A. Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. Front Psychiatry. 2019 Oct 10;10:708. doi: 10.3389/fpsyt.2019.00708. eCollection 2019.

  PMID: 31649563 BACKGROUND

• Westwood H, Tchanturia K. Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review. Curr Psychiatry Rep. 2017 Jul;19(7):41. doi: 10.1007/s11920-017-0791-9.

  PMID: 28540593 BACKGROUND

• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013

  BACKGROUND

MeSH Terms

Conditions

Autistic Disorder; Anorexia Nervosa

Interventions

Demography

Condition Hierarchy (Ancestors)

Autism Spectrum Disorder; Child Development Disorders, Pervasive; Neurodevelopmental Disorders; Mental Disorders; Feeding and Eating Disorders

Intervention Hierarchy (Ancestors)

Population Characteristics; Epidemiologic Measurements; Public Health; Environment and Public Health

Central Study Contacts

Michelle Sader, PhD

CONTACT

+441224438365; michelle.sader3@abdn.ac.uk

Gordon Waiter, PhD

CONTACT

+441224438365; g.waiter@abdn.ac.uk

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 16, 2025
• First Posted: August 1, 2025
• Study Start: July 15, 2025
• Primary Completion (Estimated): July 31, 2026
• Study Completion (Estimated): July 31, 2026
• Last Updated: May 5, 2026

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

GB (2)