(PS5-72) The Mediating Effect of Emotional Dysfunction on the Relationship Between Autism Spectrum Disorder and Anorexia Nervosa

Abstract Text: Autism spectrum disorder (ASD) is a neurodevelopmental condition defined by challenges with social communication and repetitive / restrictive behaviors (Restoy et al., 2024). Anorexia Nervosa (AN) is an eating disorder characterized by restriction of food intake and fear of gaining weight (Gaffney et al., 2020). ASD and AN often co-occur such that approximately 22% of individuals with AN also have an ASD diagnosis (Hall et al., 2023). When these disorders co-occur, treatment is less successful and clinical outcomes are poorer than when only one of these disorders affects an individual (Adams et al., 2024). For this reason, research into the mechanisms that underlie both disorders are necessary so that targets for intervention can be identified. Recent research suggests that emotional dysregulation (ED), which represents the inability to identify, manage and express one’s emotions (Codogi et al., 2024), may compel an individual to assume disordered eating habits as a way to cope with their emotional distress (Field et al., 2023). ED is characterized by two distinct domains, namely emotional dysphoria and reactivity (Mazefsky et al., 2021). Dysphoria represents a constellation of symptoms such as depressed mood and poor self-concept, while emotional reactivity describes changes in how emotions are experienced in light of significant situation (Lavi et al., 2019). The aim of this study was to determine the role of ED in the relationship between ASD and AN.

Parents of 121 youth (55% males, 57% autistic, ages 6-17, 48% White) reported on their child’s ASD traits on the Social Responsiveness Scale (SRS-2; Constantino & Gruber, 2012), ED using the Emotion Dysregulation Index (EDI; Mazefsky et al., 2021), and AN symptoms on the Child & Adolescent Symptom Inventory (CASI-5; Gadow & Sprafki, 2013). Group placement was determined by Autism Diagnostic Observation Schedule-2 (ADOS-2; Lord et al., 2013) by research-reliable examiners.

Autistic traits were correlated with AN severity (r = .297, p = .002) and ED dysphoria (r = .690, p < .001) and emotion reactivity (r = .598, p = .001). AN severity was also correlated with dysphoria (r = .395, p < .001) and emotion reactivity (r = .300, p = .002). Mediation analyses indicated that both emotional dysphoria (Bindirect = 0.374, p = 0.004) and emotional reactivity (Bindirect = 0.228, p = 0.029) fully mediated the relationship between autistic diagnostic status and AN symptoms.

The results indicate significant relationship between ASD traits and AN symptoms, with both dysphoria and emotional reactivity explaining this link. These findings highlight the role of emotional dysregulation in the relationship between autism and eating disorder symptoms, and suggest that emotional dysregulation may be an important target for intervention with individuals experiencing both ASD and AN. Clinically, targeting both emotional dysphoria and reactivity, such as through dialectical behavioral therapy or acceptance commitment therapy, may help reduce the risk for AN in autistic individuals. In this way, early identification and management of emotional dysregulation could be a key strategy in improving outcomes for those at risk.