A Qualitative Study of Friendship in Patients with Anorexia Nervosa and Possible Autism Spectrum Disorder

Difficulties in friendships have been reported both in people with Autism Spectrum Disorder (ASD) and in individuals with Anorexia Nervosa (AN). This small-scale qualitative study aimed to evaluate the friendship experiences of seven patients with AN who presented with possible ASD traits; to determine whether their experiences were reflective of those found in people with ASD, and whether any difficulties were present before the onset of their eating disorder. Participants were interviewed using the ADOS-G and the interviews were transcribed and analysed. Four principle themes emerged from the thematic analysis: limited social network, lack of contact or communication, difficulty understanding the concept of friendship, and focus of attention away from the self; which could not be explained by the state of starvation alone. The evidence presented here not only reflects the friendship experiences of individuals with AN as documented in the literature, but also the friendship difficulties which have been observed in people with ASD without a comorbid eating disorder. The findings provide evidence that friendship difficulties experienced by people with AN precede the onset of the eating disorder and therefore offer support for the idea of a shared phenotype between AN and ASD. This study also highlights the need to address friendship difficulties in treatment interventions for AN in order to promote recovery. Further research is warranted to better explore the friendship similarities between people with AN and ASD, and to develop friendship focused interventions for patients with AN. The two authors contributed equally to this study. Corresponding author.