Autism spectrum disorders in patients with anorexia nervosa and in their first- and second-degree relatives - a Danish nationwide register-based cohort-study
METHODS: All individuals born in Denmark from 5.1.1981-12.31.2008 were identified in the Danish Civil Registration System. Individuals in the study population, their parents, full and half siblings were linked with the Danish Psychiatric Central Research Register and the Danish National Patient Register, including complete data on admissions to Danish psychiatric and somatic inpatient, and since 1995 also to all outpatient, facilities. Hazard ratios (HR) for being diagnosed with AN or ASD were estimated using Cox regression. We included family history of major depression for comparison.
RESULTS: The study population consisted of 1,724,189 individuals of whom 5,006 had AN (358 males; 4,648 females) and 12,606 had ASD (10,012 males; 2,594 females). A family history of AN increased the risk for ASD (HR 1.80 (95% CI, 1.43-2.28) and 1.44 (95% CI, 0.94-2.21) when exposed to first- or second-degree relatives with AN). A family history of ASD increased the risk for AN (HR 1.45 (95% CI, 1.09-1.94) and HR 1.40 (95% CI, 0.89-2.20) when exposed to first- and second-degree relatives with ASD). However, the risk for AN was not significantly different in families with a history of unipolar depression (HR 1.34 (95% CI, 1.19-1.51) and HR 1.02 (95% CI, 0.73-1.43) when exposed to first- and second-degree relatives with depression).
CONCLUSIONS: The risk of being diagnosed with ASD is elevated if there is a family history of AN or vice versa, but not more than with a family history of major depression.