Prevalence and Clinical Correlates of Autistic Traits Across Eating Disorder Diagnoses: A Retrospective Analysis of Clinical Service Data

Background: Autistic traits are overrepresented among individuals with anorexia nervosa (AN) and are associated with greater eating disorder (ED) psychopathology, psychological distress, and work and social functioning difficulties in this population. However, less is known about the prevalence and clinical associations of autistic traits in other ED presentations, such as bulimia nervosa (BN). This study examined the prevalence of autistic traits and their associations with ED psychopathology, psychological distress, and work and social functioning difficulties in a transdiagnostic ED sample. Methods: A retrospective cross-sectional analysis was conducted using routinely collected clinical data of adults attending a specialist ED service with restrictive AN (AN-R), binge–purge AN (AN-BP), BN, binge eating disorder (BED), atypical AN (A-AN), or avoidant/restrictive food-intake disorder (ARFID). Prevalence rates of elevated autistic traits (AQ-10 ≥6) were described across diagnoses. Multiple linear-regression analyses examined associations between autistic traits and measures of eating disorder psychopathology, psychological distress, and work and social functioning difficulties. Results: Elevated autistic traits were reported by 40.0% of patients with ARFID, 34.2% with AN-BP, 31.9% with AN-R, 27.0% with BN, 26.4% with A-AN, and 16.7% with BED. Higher AQ-10 scores were significantly associated with greater ED psychopathology, psychological distress, and work and social functioning difficulties across the AN-R, BN, and full samples. In the AN-R and full samples, the associations remained significant across all models after controlling for age, gender, and ED duration. In the BN sample, all associations remained significant following adjustment except for ED psychopathology, which was no longer significant after controlling for ED duration. Conclusions: Autistic traits are elevated across multiple ED diagnoses and are associated with greater clinical severity. The findings support the clinical relevance of autistic traits across ED presentations and support the need for further investigation of autism-informed approaches across transdiagnostic ED services.