Emotion recognition and alexithymia in females with non-clinical disordered eating

Abstract

Objectives

The aims were to determine if emotion recognition deficits observed in eating disorders generalise to non-clinical disordered eating and to establish if other psychopathological and personality factors contributed to, or accounted for, these deficits.

Design

Females with high (n = 23) and low (n = 22) scores on the Eating Disorder Inventory (EDI) were assessed on their ability to recognise emotion from videotaped social interactions. Participants also completed a face memory task, a Stroop task, and self-report measures of alexithymia, depression and anxiety.

Results

Relative to the low EDI group, high EDI participants exhibited a general deficit in recognition of emotion, which was related to their scores on the alexithymia measure and the bulimia subscale of the EDI. They also exhibited a specific deficit in the recognition of anger, which was related to their scores on the body dissatisfaction subscale of the EDI.

Conclusions

In line with clinical eating disorders, non-clinical disordered eating is associated with emotion recognition deficits. However, the nature of these deficits appears to be dependent upon the type of eating psychopathology and the degree of co-morbid alexithymia.

Introduction

Previous research has demonstrated that patients with clinically diagnosed eating disorders exhibit impaired recognition of emotion from faces (Kucharska-Pietura et al., 2004, Zonnevijlle-Bender et al., 2002). Furthermore, Bydlowski et al. (2005) reported that a sample of patients with eating disorders were significantly impaired in their ability to interpret a series of social vignettes. Despite the apparent reliability of these findings there have been a number of studies that have failed to report impaired emotion processing in patients with eating disorders (Kessler, Schwarze, Filipic, Traue, & von Wietersheim, 2006; Mendlewicz, Linkowski, Bazelmans, & Philippot, 2005). Given the variability of these findings it is evident that further research is required to elucidate the nature of the link between eating psychopathology and emotional processing.

An important avenue that has yet to be addressed concerns the extent to which individuals exhibiting sub-clinical eating psychopathology also show deficits in their processing of facially expressed emotion. The primary aim of the current research was to address this question. Given that the ability to accurately decode the emotional expressions of others is a vital aspect of successful social functioning. The presence of an emotion recognition deficit could have significant implications for these individuals. For example, it is plausible that a reduction in sensitivity to the emotional displays of others could lead to misunderstandings during social interactions and a weakening of important social bonds, which in turn could contribute to the development of more serious eating psychopathology. In line with this notion, a recent study reported that the presence of interpersonal problems was associated with increases in eating disturbance in female college students (Jackson, Weis, Lundquist, & Soderlind, 2005). Furthermore, McClintock and Evans (2001) reported that social support and a fear of being rejected by others both emerged as important factors in the development of eating psychopathology.

Previous research has reported that eating disorders are associated with significantly elevated depression (Bydlowski et al., 2005, Gilboa-Schechtman et al., 2006, Kucharska-Pietura et al., 2004) and alexithymia (Beales and Dolton, 2000, Berthoz et al., 2007). Alexithymia is a personality trait that is associated with a difficulty identifying and describing one's own feelings, with a difficulty in distinguishing between feelings and bodily sensations and with an externally focused, logical, thinking style (Sifneos, 1996). Given that both depression (Asthana et al., 1998, Persad and Polivy, 1993, Surguladze et al., 2004) and alexithymia (Lane et al., 1996, Lane et al., 2000, Mann et al., 1994, Parker et al., 1993) have been shown to impair emotion recognition it was considered important to examine the influence of these variables when conducting the current study.

To date, research into the influence of eating psychopathology on facial emotion recognition has been confined to using static images of facial expressions. Whilst, this does provide a measure of control over the presented stimuli it can be argued that these studies lack ecological validity. For example, in everyday social interactions facial expressions are actually dynamic and fleeting rather than static. Thus, in order to increase the ecological validity of the present study, a series of dynamic emotional stimuli were utilised in place of the traditional static images.

The aim of present study was to determine if the facial emotion recognition deficits that have been demonstrated in patients with eating disorders are also evident in participants exhibiting sub-clinical eating psychopathology. Further, given the evidence that Anorexia Nervosa (AN) and Bulimia Nervosa (BN) may be associated with different patterns of emotion recognition deficits (Kucharska-Pietura et al., 2004) as well as differences in emotion processing generally (Beales and Dolton, 2000, Gilboa-Schechtman et al., 2006) we aimed to establish which aspects of disordered eating are important in explaining any observed deficits in facial emotion recognition. Finally, we aimed to establish if these emotion recognition deficits were related to other psychopathological or personality variables that were present in these participants. To this end, individuals with and without significant eating psychopathology were presented with a series of video clips, each featuring one of the six primary emotions (and some neutral clips that featured no strong emotion), and were asked to identify (forced choice) the emotion portrayed. The presence and severity of alexithymia, depression and anxiety were established using validated self-report measures. It was predicted that individuals with high levels of eating psychopathology would correctly identify fewer emotional displays than would participants with lower levels. Based on previous work (Kucharska-Pietura et al., 2004) it was predicted that participants with high levels of eating psychopathology would exhibit a specific deficit in recognising negative emotion. Although variations in emotional processing have been reported between the different eating disorders no formal hypotheses were formulated concerning the role of different forms of eating psychopathology. Similarly, although depression and alexithymia have both been shown to influence emotional processing no formal hypotheses were proposed concerning the influence of these variables on facial emotion recognition.