Neural Correlates of Autistic Individuals With Anorexia Nervosa

May 4, 2026 updated by: University of Aberdeen

Neuroanatomical Differences Associated With Anorexia Nervosa and Masking Behaviour in Autistic Individuals

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

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Autism is a neurodevelopmental condition and presents as a distinct neurotype, characterised by a wide range of social and behavioural differences, including divergences in cognitive thinking and methods of communication. Autism shares significant behavioural features with restrictive eating disorders (EDs) such as anorexia nervosa (AN). Those with AN exhibit significantly elevated levels of Autistic characteristics, ranging between 2%-53%. Importantly, a characteristic shown by some Autistic people is the presence of masking, a term describing a strategy used by Autistic people, whether conscious or unconscious, to 'blend in' with neurotypical peers. While initially overlooked, it is now well-known that masking behaviour can produce detrimental effects on Autistic individuals' mental health. The presence of masking behaviour has been associated with increased levels of physical and mental exhaustion, anxiety/depression, and importantly, an increased presence of EDs.

The Eating Disorder and Autism Collaborative (EDAC) used an arts-based method called Photovoice to capture the experiences of Autistic individuals with lived/living experience of an ED. Participants commented on the how an ED can serve as a means to mask or camouflage within a neurotypical world (e.g., an Autistic person may use restrictive eating or excessive exercise as a means with which to 'fit in' with their peers). Magnetic resonance imaging (MRI) research can assist in understanding which regions of the brain are associated with masking behaviour, and whether there are differences in brain function/structure in Autistic individuals with versus without an ED.

Structural magnetic resonance imaging (MRI) research reports similarities in brain structure between those with AN and Autistic individuals, reporting differential structure of the amygdala, cerebellum, insula, cingulate cortex, as well as orbitofrontal and frontal cortex in both groups. Shared differences extend to neuroanatomical parameters essential for brain development and connectivity, such as cortical thickness and surface area. Further, there are no studies investigation structural correlates with masking behaviour, or distinct aspects of social camouflage such as masking, assimilation and compensation. Further research is necessary to disentangle the complex relationship between Autistic characteristics and symptomatology associated with restrictive EDs.

The investigators believe that by further understanding the brain structure and function associated with ED symptomatology and masking behaviour in Autistic individuals can assist with the development of novel or tailored interventions for EDs in this community.

Study Type

Observational

Enrollment (Estimated)

50

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United Kingdom
    • Aberdeen City
      • Aberdeen, Aberdeen City, United Kingdom, AB25 2ZD
        • Recruiting
        • Lilian Sutton Building
        • Contact:
        • Principal Investigator:
          • Michelle Sader, PhD
      • Aberdeen, Aberdeen City, United Kingdom, AB25 2ZD
        • Recruiting
        • NHS Grampian Eating Disorder Services
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

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.

Description

Inclusion Criteria:

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

Exclusion Criteria:

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Autistic Control
Autistic individuals with no history of an eating disorder
Other: Single Research Visit 3T MRI Research Scan
Single research visit scan performed with a 3T magnetic resonance imaging scanner.
Other: Demographic and Behavioural Questionnaires
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 Patient
Autistic individuals acutely ill with anorexia nervosa
Other: Single Research Visit 3T MRI Research Scan
Single research visit scan performed with a 3T magnetic resonance imaging scanner.
Other: Demographic and Behavioural Questionnaires
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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Structural and Functional Brain Differences
Time Frame: From enrolment to single research visit (up to 30 weeks).
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
Time Frame: From enrolment to single research visit (up to 30 weeks).
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
Time Frame: From enrolment to single research visit (up to 30 weeks).

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).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Aberdeen

Collaborators

NHS Grampian

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 15, 2025

Primary Completion (Estimated)

July 31, 2026

Study Completion (Estimated)

July 31, 2026

Study Registration Dates

First Submitted

July 16, 2025

First Submitted That Met QC Criteria

July 24, 2025

First Posted (Actual)

August 1, 2025

Study Record Updates

Last Update Posted (Actual)

May 5, 2026

Last Update Submitted That Met QC Criteria

May 4, 2026

Last Verified

July 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 349220

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Our previous research with Autistic collaborators highlighted concerns regarding future use of their data for research that may harm Autistic identity. As such, IPD may only be available upon request from the principal investigators of this study and are subject to future ethical approval.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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