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Moraitopoulou G, Pickard H, Simonoff E, Pickles A, Bedford R, Carter Leno V. No association between alexithymia and emotion recognition or theory of mind in a sample of adolescents enhanced for autistic traits. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:2066-2079. [PMID: 38240268 PMCID: PMC11301953 DOI: 10.1177/13623613231221928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
LAY ABSTRACT Alexithymia is a sub-clinical condition characterised by difficulties identifying and describing one's own emotions, which is found in many, but not all autistic people. The alexithymia hypothesis suggests that certain aspects of socio-cognitive functioning typically attributed to autism, namely difficulties in emotion recognition, might be better explained by often co-occurring alexithymia. It is important to understand what is specific to autism and what is due to other co-occurring characteristics to develop appropriate support for autistic people. However, most research on this topic has been conducted in adults, which limits our knowledge about the relevance of this theory to younger autistic populations. This study tested whether difficulties in emotion recognition and theory of mind traditionally associated with autism might be better explained by alexithymia in a sample of adolescents with and without a diagnosis of autism. Results found that difficulties in emotion recognition and theory of mind were both associated with autistic traits, and this was not accounted for by individual differences in levels of alexithymia. This research suggests that more work is needed to understand the applicability of the alexithymia hypothesis in younger populations, but that at least in adolescents and when using parent-report measures, alexithymia may not account for emotion recognition or theory of mind difficulties associated with autistic traits.
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Affiliation(s)
- Georgianna Moraitopoulou
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Hannah Pickard
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of
Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Rachael Bedford
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Virginia Carter Leno
- Department of Biostatistics and Health Informatics, Institute of
Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
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Yan H, Zhou A, Li Q, Wu C. The association between emotional regulation dimensions and somatic symptom disorders: A systematic review and meta-analysis. Asian J Psychiatr 2024; 99:104151. [PMID: 39018700 DOI: 10.1016/j.ajp.2024.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/18/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
Clarifying the effect size of the association between somatic symptom disorders (SSDs) and defects in emotional regulation (ER) dimensions through a meta-analysis may improve ER-related treatment for SSD patients. SSDs exhibited a lower level of adaptive ER (overall Hedge's g = -0.618, 95 %CI [0.872, -0.365]; Hedge's g for ER dimensions of Awareness, Description, Clarity, Acceptance, Tolerance, Self-efficacy belief, and Cognitive Reappraisal ranged from -0.451 to -1.344). Maladaptive ER dimensions (catastrophizing and expressive inhibition) showed no significant associations with SSDs. Psychotherapy focusing on developing adaptive ER rather than reducing maladaptive ER may be a more promising approach for treating SSD patients.
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Affiliation(s)
- Huiru Yan
- Peking University School of Nursing, China
| | - Anqi Zhou
- Peking University School of Nursing, China
| | - Qiuhong Li
- Peking University School of Nursing, China
| | - Chao Wu
- Peking University School of Nursing, China.
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3
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Machado AS, Dias G, P Carvalho I. Disentangling the relationship between sensory processing, alexithymia and broad autism spectrum: A study in parents' of children with autism spectrum disorders and sensory processing disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 149:104742. [PMID: 38678875 DOI: 10.1016/j.ridd.2024.104742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/24/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Autistic features and sensory processing difficulties and their phenotypic co-expression with alexithymia share a transdiagnostic vulnerability. In this work, we explored whether the current concept of broad autism phenotype rather translates altered sensory processing (non-specific to autism), meaning that the characteristics of altered sensory processing should be overexpressed among individuals with heightened vulnerability to sensory processing atypicalities (parents of children with sensorial processing disorder, or SPD parents) and individuals with heightened vulnerability to autistic traits (parents of children with autism spectrum disorders, or ASD parents). In addition, the association between altered sensory processing and alexithymia was inspected. METHOD The Adolescent/Adult Sensory Profile, Autism Spectrum Quotient, and Toronto Alexithymia Scale were completed by 31 parents of children with ASD, 32 parents of children with SPD, and 52 parents of typically developed (TD) children. RESULTS Extreme sensory patterns were overexpressed both in parents of children with SPD and parents of children with ASD when compared to parents of TD children. In addition, extreme sensory patterns were significantly associated with alexithymia scores. Specifically, sensory avoidance, low registration, and sensory sensitivity were positively correlated with alexithymia. No significant differences were found regarding the proportion of autistic traits and alexithymia between ASD and SPD groups of parents. CONCLUSIONS These results challenge the specificity of broad autism phenotype and suggest a neurodevelopmental atypicity with roots in altered sensory and emotional processing.
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Affiliation(s)
- Ana Sofia Machado
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Psychiatry Service of São João University Hospital Center (CHUSJ), Porto, Portugal.
| | - Goretti Dias
- Child and Adolescence Psychiatry Service, Santo António University Hospital Center (CHUSA), Porto, Portugal
| | - Irene P Carvalho
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal
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Lee D, Kim SJ, Cheon J, Jung YC, Kang JI. Changes in interoceptive accuracy related to emotional interference in somatic symptom disorder. BMC Psychol 2024; 12:279. [PMID: 38755731 PMCID: PMC11100134 DOI: 10.1186/s40359-024-01778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE The somatic symptom disorder (SSD) is characterized by one or more distressing or disabling somatic symptoms accompanied by an excessive amount of time, energy and emotion related to the symptoms. These manifestations of SSD have been linked to alterations in perception and appraisal of bodily signals. We hypothesized that SSD patients would exhibit changes in interoceptive accuracy (IA), particularly when emotional processing is involved. METHODS Twenty-three patients with SSD and 20 healthy controls were recruited. IA was assessed using the heartbeat perception task. The task was performed in the absence of stimuli as well as in the presence of emotional interference, i.e., photographs of faces with an emotional expression. IA were examined for correlation with measures related to their somatic symptoms, including resting-state heart rate variability (HRV). RESULTS There was no significant difference in the absolute values of IA between patients with SSD and healthy controls, regardless of the condition. However, the degree of difference in IA without emotional interference and with neutral facial interference was greater in patients with SSD than in healthy controls (p = 0.039). The IA of patients with SSD also showed a significant correlation with low-frequency HRV (p = 0.004) and high-frequency HRV (p = 0.007). CONCLUSION SSD patients showed more significant changes in IA when neutral facial interference was given. These results suggest that bodily awareness is more affected by emotionally ambiguous stimuli in SSD patients than in healthy controls.
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Affiliation(s)
- Deokjong Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea
- Yonsei Empathy Psychiatry Clinic, Seoul, 07008, South Korea
| | - Se Joo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jooah Cheon
- Department of Medicine, Yonsei University Graduate School, Seoul, 03722, South Korea
| | - Young-Chul Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jee In Kang
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, South Korea.
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Xu J, Luo Y, Liu Y, Zhong L, Liu H, Zhang X, Cheng Q, Yang Z, Zhang Y, Weng A, Ou Z, Yan Z, Zhang W, Hu Q, Peng K, Liu G. Neural Correlates of Facial Emotion Recognition Impairment in Blepharospasm: A Functional Magnetic Resonance Imaging Study. Neuroscience 2023; 531:50-59. [PMID: 37709002 DOI: 10.1016/j.neuroscience.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
Selective impairment in recognizing facial expressions of disgust was reported in patients with focal dystonia several years ago, but the basic neural mechanisms remain largely unexplored. Therefore, we investigated whether dysfunction of the brain network involved in disgust recognition processing was related to this selective impairment in blepharospasm. Facial emotion recognition evaluations and resting-state functional magnetic resonance imaging were performed in 33 blepharospasm patients and 33 healthy controls (HCs). The disgust processing network was constructed, and modularity analyses were performed to identify sub-networks. Regional functional indexes and intra- and inter-functional connections were calculated and compared between the groups. Compared to HCs, blepharospasm patients demonstrated a worse performance in disgust recognition. In addition, functional connections within the sub-network involved in perception processing rather than recognition processing of disgust were significantly decreased in blepharospasm patients compared to HCs. Specifically, decreased functional connections were noted between the left fusiform gyrus (FG) and right middle occipital gyrus (MOG), the left FG and right FG, and the right FG and left MOG. We identified decreased functional activity in these regions, as indicated by a lower amplitude of low-frequency fluctuation in the left MOG, fractional amplitude of low-frequency fluctuation in the right FG, and regional homogeneity in the right FG and left MOG in blepharospasm patients versus HCs. Our results suggest that dysfunctions of the disgust processing network exist in blepharospasm. A deficit in disgust emotion recognition may be attributed to disturbances in the early perception of visual disgust stimuli in blepharospasm patients.
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Affiliation(s)
- Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yuhan Luo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Ying Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Linchang Zhong
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Huiming Liu
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiaodong Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Qinxiu Cheng
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhengkun Yang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Yue Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Ai Weng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zilin Ou
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Zhicong Yan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Weixi Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.
| | - Kangqiang Peng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Gang Liu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China.
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Bani M, Ardenghi S, Rampoldi G, Russo S, Strepparava MG. Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition. J Clin Psychol 2023; 79:1178-1191. [PMID: 36459660 PMCID: PMC9877818 DOI: 10.1002/jclp.23468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/04/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions. METHODS In this cross-sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self-perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2-Adult Faces including 24 faces representing anger, fear, sadness, and happiness. RESULTS Facemasks impaired the self-perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation. CONCLUSION Facemasks reduced clinicians' self-confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Stefano Ardenghi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Giulia Rampoldi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano-Bicocca, Monza (MB), Italy.,Department of Mental Health, Clinical Psychology Unit, San Gerardo Hospital, ASST-Monza, Monza (MB), Italy
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Robinson CSH, Claus ED, Calhoun V, Swartz M, Fokas K, Witkiewitz K. Association between empathy and drinking among a community sample of heavy drinkers: Sex differences and neural correlates. Addict Behav 2022; 132:107346. [PMID: 35533589 PMCID: PMC9547551 DOI: 10.1016/j.addbeh.2022.107346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Abstract
Alcohol use disorder (AUD) is a major health problem, yet most individuals with AUD do not perceive a need for formal treatment and do not receive treatment. The lack of treatment seeking among individuals with AUD may suggest a lack of self-awareness and insight into the seriousness of AUD related problems, as well as lack of empathy for the impact of one's drinking on others. Recent work has suggested that empathy may be impaired among individuals seeking treatment for AUD. Further these impairments may differ by sex such that males with lower empathy reported more drinking consequences and greater drinking intensity, but there was no association between empathy and drinking among females. The current study used regression analyses (alpha = 0.05) to examine the association between empathy (as measured by the four scales of the Interpersonal Reactivity Index), independent components of gray matter volume in regions associated with empathy, and drinking variables among non-treatment seeking drinkers with AUD (N = 136) and also examined these effects by sex. Results showed greater perspective taking was associated with less temporoparietal and frontotemporal gray matter volume (B(SE) = -0.912 (0.043), p = 0.034). An interaction between perspective taking and sex was associated with craving, such that higher perspective taking was associated with less craving for males only (B(SE) = -0.48 (0.243), p = 0.049; R2 = 0.087). Empathic concern was related to lower percent heavy drinking days for both males and females (B(SE) = -1.57 (0.743), p = 0.035; R2 = 0.11). The current study found empathy may be an important predictor of craving for males and frequency of heavy drinking for males and females. Future work should investigate whether empathy predicts treatment seeking.
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Affiliation(s)
- Charles S H Robinson
- The University of New Mexico, USA; The Mind Research Network, USA; The University of Chicago, USA.
| | - Eric D Claus
- The Mind Research Network, USA; The Pennsylvania State University, USA
| | - Vince Calhoun
- The Mind Research Network, USA; Georgia State University, USA
| | - Megan Swartz
- The University of New Mexico, USA; The Mind Research Network, USA
| | | | - Katie Witkiewitz
- The University of New Mexico, USA; The Mind Research Network, USA
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La Touche R, García-Salgado A, Cuenca-Martínez F, Angulo-Díaz-Parreño S, Paris-Alemany A, Suso-Martí L, Herranz-Gómez A. Alexithymia and facial emotion recognition in patients with craniofacial pain and association of alexithymia with anxiety and depression: a systematic review with meta-analysis. PeerJ 2021; 9:e12545. [PMID: 34909277 PMCID: PMC8638568 DOI: 10.7717/peerj.12545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background We aimed to determine the presence of alexithymia in patients with craniofacial pain (CFP) compared with asymptomatic individuals. Our secondary aims were to assess the relationship of alexithymia with anxiety and depression levels, as well as to assess the presence of facial emotion recognition deficit. Methods Medline, Scielo and Google Scholar were searched, with the last search performed in 8 September 2021. Standardized mean differences (SMDs) and 95% CIs were calculated for relevant outcomes and were pooled in a meta-analysis using the random effects model. In addition, meta-analyses of correlations and a meta-regression of alexithymia with depression and anxiety were performed. Results Regarding alexithymia, assessed through the Toronto Alexithymia Scale (TAS), the results showed significant differences, with higher values in patients compared with asymptomatic individuals, with a large clinical effect (SMD 0.46; 95% CI [0.22–0.71]; heterogeneity-Q 66.86; p < 0.001; inconsistency (I2) = 81%). We found statistically significant correlations with a small clinical effect of alexithymia with anxiety and depression. The meta-regression showed no significant association between the TAS and anxiety or depression. With respect to facial emotion recognition, the results showed statistically significant differences, with greater recognition difficulty in patients compared with asymptomatic individuals, with a large clinical effect (SMD −1.17; 95% CI [−2.01 to −0.33]; heterogeneity-Q 2.97; p = 0.080; I2 = 66%). Conclusions Patients with CFP showed alexithymia with moderate evidence. There was also moderate evidence indicating that these patients had significant deficits in facial emotion recognition compared with asymptomatic individuals. Furthermore, alexithymia showed statistically significant correlations with anxiety and depression levels.
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Affiliation(s)
- Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain.,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto García-Salgado
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ferran Cuenca-Martínez
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Santiago Angulo-Díaz-Parreño
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Departamento de Fisioterapia, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
| | - Aida Herranz-Gómez
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Cetin S, Sozeri Varma G, Toker Ugurlu T, Ozdel IO. Theory of Mind in Somatization and Depression: Is It Cause or Phenomenon? J Nerv Ment Dis 2021; 209:911-917. [PMID: 34310521 DOI: 10.1097/nmd.0000000000001399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although mentalization is important in somatic symptom disorder (SSD) and major depressive disorder (MDD), it is not fully understood. In this study, we aimed to investigate the relation between somatic and depressive symptoms with mentalization. A total of 48 patients diagnosed with SSD, 50 patients diagnosed with MDD, and 50 healthy individuals, participated the study. The Montgomery-Asperg Depression Scale, Symptom Checklist-90 Revised, and Reading the Mind in the Eyes Test (RMET) were applied to the participants. The patients with SSD showed significantly the lowest performance of theory of mind. There was no significant difference between MDD and healthy controls. High somatization score was found to be a predictor for low RMET scores (95% confidence interval, -0.339; p = 0.014). Mentalization deficit seems to be associated with somatization rather than depression.
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Affiliation(s)
| | - Gulfizar Sozeri Varma
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Tugce Toker Ugurlu
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ismail Osman Ozdel
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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10
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Macina C, Bendel R, Walter M, Wrege JS. Somatization and Somatic Symptom Disorder and its overlap with dimensionally measured personality pathology: A systematic review. J Psychosom Res 2021; 151:110646. [PMID: 34715494 DOI: 10.1016/j.jpsychores.2021.110646] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Difficulties in the assessments of Somatoform Disorders (SD) and Personality Disorders (PD) regarding operationalization, arbitrary thresholds, and reliability led to a shift from categorical to dimensional models in the DSM-5. Empirical research data postulates a continuous level of severity in both groups of diseases. The aim of this systematic review was to investigate the overlap between somatization and personality pathology. METHODS Until July 2020, we conducted a systematic literature search with PubMed, Web of Science and SCOPUS. We specifically reviewed current empirical data on the Alternative Model of Personality Disorders (AMPD) and Somatic Symptom Disorder (SSD) and SD. Data was drawn out using predefined data panels. Results were reflected in the context of the Hierarchical Taxonomy of Psychopathology (HiTOP) model. Risk of bias was assessed due to blinding, randomization, selective reporting, incomplete data, and attribution bias. RESULTS A total of eight studies (N = 2979) met the inclusion criteria. Whereas categorical measures revealed mixed results, positive correlations between SD/SSD and dimensionally measured personality functioning were present in four studies (N = 1741). In three studies (N = 2025) correlations between SD/SSD and neuroticism/negative affectivity (d = 0.22-1.041) were present. Moreover, harm avoidant (d = 0.526 - 0.826) and self-defeating traits (d = 0.892) revealed significant associations with somatization. CONCLUSIONS Dimensional personality assessments are highly neglected in patients with SSD and warrant further research. However, in line with the HiTOP model, there is tentative evidence that somatization can be described as an independent personality trait, which shows most striking overlaps with self-pathologies (Criterion A) and the trait of negative affectivity (Criterion B).
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Affiliation(s)
- Caroline Macina
- University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Rebecca Bendel
- University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Marc Walter
- University Psychiatric Clinics (UPK) Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
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Abstract
Facial emotion recognition (FER) is extensively investigated in psychological sciences in healthy individuals and clinical conditions. In this paper, we analyzed those studies in which FER was assessed in the case of obesity or fibromyalgia, in relation to the levels of alexithymia. Crucially, these two conditions frequently co-occur; however, no study has explored FER considering both fibromyalgia and obesity. Studies were identified using the electronic search engine of PubMed. The last research was run on 23 July 2021. Two independent lists were generated for the two clinical conditions. Six records were reviewed about obesity, while three records about fibromyalgia. The evidence relative to FER in obesity was not conclusive, whereas the evidence about an altered FER in fibromyalgia seemed more straightforward. Moreover, the role of alexithymia on FER in these clinical conditions was not extensively investigated. In our discussion, we highlighted those factors that should be carefully addressed in investigating FER in these clinical conditions. Moreover, we underlined methodological criticisms that should be overcome in future research.
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Renzi A, Mariani R, Di Trani M, Tambelli R. Giving words to emotions: the use of linguistic analysis to explore the role of alexithymia in an expressive writing intervention. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:452. [PMID: 33024722 PMCID: PMC7513612 DOI: 10.4081/ripppo.2020.452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/21/2020] [Indexed: 12/02/2022]
Abstract
Expressive writing techniques are methods focusing on written emotional expression that require people to write about traumatic or difficult experiences, with the objective of promoting an elaboration of these events. The general aim of the study is to investigate the influence of alexithymia, a deficit in emotional regulation processes, on the effects of an expressive writing intervention, analyzing the writing protocols through the use of the Linguistic Inquiry and Word Count (LIWIC) and Referential Process (RP) linguistic measures via IDAAP software. Thirty-five women undergoing an assisted reproductive treatment participated in the study and filled out a sociodemographic questionnaire, the 20-item Toronto Alexithymia Scale. They also underwent three session of writing, following a request that they write about their emotions regarding their current situation. The women enrolled were divided into two groups: low alexithymia and high alexithymia, comprising individuals with a TAS-20 total score lower or higher than the mean, respectively. Analyses within the groups during the three writing sessions revealed that the women with low alexithymia reported a greater number of words expressing affectivity, sadness and future perspective, whereas no significances in the high alexithymia group emerged. Moreover, when analysing differences between the groups, high-alexithymia women reported lower scores in RP indexes and fewer words expressing sadness, future perspectives and we verbal. In conclusion, these preliminary findings may confirm the hypothesis that alexithymia affects the effectiveness of expressive writing through a difficulty in becoming involved in the writing process and a lack of symbolizing processes.
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Affiliation(s)
- Alesia Renzi
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Rachele Mariani
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
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Di Tella M, Adenzato M, Catmur C, Miti F, Castelli L, Ardito RB. The role of alexithymia in social cognition: Evidence from a non-clinical population. J Affect Disord 2020; 273:482-492. [PMID: 32560944 DOI: 10.1016/j.jad.2020.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment. METHODS We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills. RESULTS Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states. LIMITATIONS The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships. CONCLUSIONS These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.
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Affiliation(s)
- Marialaura Di Tella
- Department of Psychology, University of Turin, via Verdi 10, Turin 10124, Italy
| | - Mauro Adenzato
- Department of Psychology, University of Turin, via Verdi 10, Turin 10124, Italy.
| | | | - Francesca Miti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, via Verdi 10, Turin 10124, Italy
| | - Rita B Ardito
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Henker J, Keller A, Reiss N, Siepmann M, Croy I, Weidner K. Early maladaptive schemas in patients with somatoform disorders and somatization. Clin Psychol Psychother 2019; 26:418-429. [PMID: 30836437 DOI: 10.1002/cpp.2363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/26/2022]
Abstract
Maladaptive schemas are stable relational patterns that develop through harmful childhood experiences with primary caregivers. Schemas within somatoform disorders are rarely explored even though these disorders are clinically important due to high prevalence, co-morbidity, and cost for the health care system. This study investigates schemas according to Young's schema theory in patients with somatoform disorders in comparison with healthy controls and patients with depressive or anxiety disorders. Further associations between schemas and somatization were explored. We included 134 patients with a somatoform disorder and 39 age-matched healthy controls, 83 patients with a unipolar depression, and 34 patients with an anxiety disorder. The clinical sample consists of day care patients, diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, but without a personality disorder. Primary measures were the Young Schema Questionnaire (YSQ-S2), the Screening for Somatoform Disorders (SOMS-7T), the Beck Depression Inventory, Second Edition, and the Childhood Trauma Questionnaire. Analyses of variance indicated that somatoform patients scored higher on almost all schemas than do healthy controls (p < 0.001, η2 = 0.148). The highest mean scores were reached for the schemas "self-sacrifice" and "unrelenting standards," with significant higher values in the patient sample. However, when compared with patients with depressive or anxiety disorders, somatoform patients scored equally or even lower. High somatization was associated with generally higher schema activation. This effect was to a great extent mediated by depressive symptoms. Only the schema "vulnerability to harm or illness" was exclusively related to somatization. These findings suggest that schemas should be systematically assessed within psychotherapy of somatoform patients.
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Affiliation(s)
- Jana Henker
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
| | - Andrea Keller
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
| | - Neele Reiss
- Institute for Psychotherapy in Mainz (ipsti-mz), Mainz, Germany
| | - Martin Siepmann
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany.,Psychosomatic Clinic, Rhön-Klinikum AG, Bad Neustadt, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Dresden, Dresden, Germany
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Pick S, Goldstein LH, Perez DL, Nicholson TR. Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. J Neurol Neurosurg Psychiatry 2019; 90:704-711. [PMID: 30455406 PMCID: PMC6525039 DOI: 10.1136/jnnp-2018-319201] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/20/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
Functional neurological disorder (FND) is a common and highly disabling disorder, but its aetiology remains enigmatic. Conceptually, there has been reduced emphasis on the role of psychosocial stressors in recent years, with a corresponding increase in neurobiological explanations. However, a wealth of evidence supports the role of psychosocial adversities (eg, stressful life events, interpersonal difficulties) as important risk factors for FND. Therefore, there is a need to integrate psychosocial (environmental) and neurobiological factors (eg, sensorimotor and cognitive functions) in contemporary models of FND. Altered emotional processing may represent a key link between psychosocial risk factors and core features of FND. Here, we summarise and critically appraise experimental studies of emotional processing in FND using behavioural, psychophysiological and/or neuroimaging measures in conjunction with affective processing tasks. We propose that enhanced preconscious (implicit) processing of emotionally salient stimuli, associated with elevated limbic reactivity (eg, amygdala), may contribute to the initiation of basic affective/defensive responses via hypothalamic and brainstem pathways (eg, periaqueductal grey). In parallel, affect-related brain areas may simultaneously exert a disruptive influence on neurocircuits involved in voluntary motor control, awareness and emotional regulation (eg, sensorimotor, salience, central executive networks). Limbic-paralimbic disturbances in patients with FND may represent one of several neurobiological adaptations linked to early, severe and/or prolonged psychosocial adversity. This perspective integrates neurobiological and psychosocial factors in FND and proposes a research agenda, highlighting the need for replication of existing findings, multimodal sampling across emotional response domains and further examination of emotional influences on sensorimotor and cognitive functions in FND populations.
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Affiliation(s)
- Susannah Pick
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David L Perez
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioural Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Peng W, Meng J, Lou Y, Li X, Lei Y, Yan D. Reduced empathic pain processing in patients with somatoform pain disorder: Evidence from behavioral and neurophysiological measures. Int J Psychophysiol 2019; 139:40-47. [DOI: 10.1016/j.ijpsycho.2019.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 01/09/2023]
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Abstract
OBJECTIVE Chronic pain disorder (CPD) has been associated with brain changes, especially in limbic circuits. However, in most patients with chronic pain, depression or anxiety is a common comorbidity. In this exploratory and naturalistic study, we investigated brain cortical thickness (CTh) differences between patients with CPD and healthy controls, with consideration of concurrent psychiatric symptoms. METHODS Twenty-three patients with CPD and 23 age- and sex-matched healthy volunteers were included in this study. CTh was estimated using Freesurfer on high-resolution three-dimensional T1-weighted images acquired with a 3T scanner. Group differences were investigated using an analysis of covariance model that included age, sex, and Beck Depression Inventory I and Trait Anxiety Inventory scores as covariates. The relationship between CTh and Toronto Alexithymia Scale (TAS-20) scores was also investigated in patients. Data were corrected for multiplicity using the False Discovery Rate approach (q < .05). RESULTS The comparison between groups using demographics and Beck Depression Inventory I scores as covariates showed thinner cortex in patients compared with controls, after correction for multiplicity in the left precentral (F(1,42) = 21.9, p < .05) and postcentral gyri (F(1,42) = 26.9, p < .05) and in the left inferior temporal sulcus (F(1,42) = 19.6, p < .05). Moreover, using the Trait Anxiety Inventory as covariate, a trend toward significance (p < .001 uncorrected) was seen for the left precentral gyrus (F(1,42) = 13.8), right middle frontal (F(1,42) = 14.3) and inferior parietal gyri (F(1,42) = 13.4), and right anterior temporal pole (F(1,42) = 15.9). CONCLUSIONS The results indicate that brain morphological differences between patients with chronic pain disorder and healthy controls are localized to regions that correspond to sensory as well as affective dimensions of pain processing.
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18
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Tella MD, Enrici I, Castelli L, Colonna F, Fusaro E, Ghiggia A, Romeo A, Tesio V, Adenzato M. Alexithymia, not fibromyalgia, predicts the attribution of pain to anger-related facial expressions. J Affect Disord 2018; 227:272-279. [PMID: 29127814 DOI: 10.1016/j.jad.2017.10.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/12/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fibromyalgia (FM) is a syndrome characterized by chronic, widespread musculoskeletal pain, occurring predominantly in women. Previous studies have shown that patients with FM display a pattern of selective processing or cognitive bias which fosters the encoding of pain-related information. The present study tested the hypothesis of an increased attribution of pain to facial expressions of emotions (FEE), in patients with FM. As previous studies have shown that alexithymia influences the processing of facial expressions, independent of specific clinical conditions, we also investigated whether alexithymia, rather than FM per se, influenced attribution of pain to FEE. METHODS One hundred and twenty-three women (41 with FM, 82 healthy controls, HC) were enrolled in this cross-sectional case-control study. We adopted two pain-attribution tasks, the Emotional Pain Estimation and the Emotional Pain Ascription, both using a modified version of the Ekman 60 Faces Test. Psychological distress was assessed using the Hospital Anxiety and Depression Scale, and alexithymia was assessed using the Toronto Alexithymia Scale. RESULTS Patients with FM did not report increased attribution of pain to FEE. Alexithymic individuals demonstrated no specific problem in the recognition of basic emotions, but attributed significantly more pain to angry facial expression. LIMITATIONS Our study involved a relatively small sample size. The use of self-reported instruments might have led to underestimation of the presence of frank alexithymia in individuals having borderline cut-off scores. CONCLUSIONS Alexithymia, rather than FM per se, plays a key role in explaining the observed differences in pain attribution to anger-related facial expressions.
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Affiliation(s)
| | - Ivan Enrici
- Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy; Neuroscience Institute of Turin, Turin, Italy.
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
| | - Fabrizio Colonna
- A.O.U. "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Enrico Fusaro
- A.O.U. "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Ada Ghiggia
- Department of Psychology, University of Turin, Turin, Italy
| | | | | | - Mauro Adenzato
- Department of Psychology, University of Turin, Turin, Italy; Neuroscience Institute of Turin, Turin, Italy
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19
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Del Río-Casanova L, González A, Páramo M, Van Dijke A, Brenlla J. Emotion regulation strategies in trauma-related disorders: pathways linking neurobiology and clinical manifestations. Rev Neurosci 2018; 27:385-95. [PMID: 26812780 DOI: 10.1515/revneuro-2015-0045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/29/2015] [Indexed: 01/30/2023]
Abstract
Emotion regulation impairments with traumatic origins have mainly been studied from posttraumatic stress disorder (PTSD) models by studying cases of adult onset and single-incident trauma exposure. The effects of adverse traumatic experiences, however, go beyond the PTSD. Different authors have proposed that PTSD, borderline personality, dissociative, conversive and somatoform disorders constitute a full spectrum of trauma-related conditions. Therefore, a comprehensive review of the neurobiological findings covering this posttraumatic spectrum is needed in order to develop an all-encompassing model for trauma-related disorders with emotion regulation at its center. The present review has sought to link neurobiology findings concerning cortico-limbic function to the field of emotion regulation. In so doing, trauma-related disorders have been placed in a continuum between under- and over-regulation of affect strategies. Under-regulation of affect was predominant in borderline personality disorder, PTSD with re-experiencing symptoms and positive psychoform and somatoform dissociative symptoms. Over-regulation of affect was more prevalent in somatoform disorders and pathologies characterized by negative psychoform and somatoform symptoms. Throughout this continuum, different combinations between under- and over-regulation of affect strategies were also found.
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20
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Chen R, Szaflarski JP. Dysfunction in emotion processing underlies functional (psychogenic) dystonia. Mov Disord 2018; 33:136-145. [PMID: 29124784 PMCID: PMC5767134 DOI: 10.1002/mds.27217] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/16/2017] [Accepted: 09/24/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to determine whether abnormalities in emotion processing underlie functional (psychogenic) dystonia, one of the most common functional movement disorders. METHODS Motor and emotion circuits were examined in 12 participants with functional dystonia, 12 with primary organic dystonia, and 25 healthy controls using functional magnetic resonance imaging at 4T and a finger-tapping task (motor task), a basic emotion-recognition task (emotional faces task), and an intense-emotion stimuli task. RESULTS There were no differences in motor task activation between groups. In the faces task, when compared with the other groups, functional dystonia patients showed areas of decreased activation in the right middle temporal gyrus and bilateral precuneus and increased activation in the right inferior frontal gyrus, bilateral occipital cortex and fusiform gyrus, and bilateral cerebellum. In the intense-emotion task, when compared with the other groups, functional dystonia patients showed decreased activation in the left insular and left motor cortices (compared to organic dystonia, they showed an additional decrease in activation in the right opercular cortex and right motor cortex) and increased activation in the left fusiform gyrus. CONCLUSIONS Functional dystonia patients exhibited stimulus-dependent altered activation in networks involved in motor preparation and execution, spatial cognition, and attentional control. These results support the presence of network dysfunction in functional dystonia. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alberto J. Espay
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
- Gardner Family Center for Parkinson’s disease and Movement Disorders, Cincinnati, Ohio
| | | | | | - Matthew M. Norris
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, Ohio
| | - James C. Eliassen
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, Ohio
| | - Erin Neefus
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Chen
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, University Health Network and the, University of Toronto, Toronto, Canada
| | - Jerzy P. Szaflarski
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Lang AE, Szaflarski JP. Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study. NEUROIMAGE-CLINICAL 2017; 17:179-187. [PMID: 29085776 PMCID: PMC5655406 DOI: 10.1016/j.nicl.2017.10.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/13/2017] [Accepted: 10/18/2017] [Indexed: 02/06/2023]
Abstract
Background Despite its high prevalence and associated disability, the neural correlates of emotion processing in patients with functional (psychogenic) tremor (FT), the most common functional movement disorder, remain poorly understood. Methods In this cross sectional functional magnetic resonance imaging (fMRI) study at 4T, 27 subjects with FT, 16 with essential tremor (ET), and 25 healthy controls (HCs) underwent a finger-tapping motor task, a basic-emotion task, and an intense-emotion task to probe motor and emotion circuitries. Anatomical and functional MRI data were processed with FSL (FMRIB Software Library) and AFNI (Analysis of Functional Neuroimages), followed by seed-to-seed connectivity analyses using anatomical regions defined from the Harvard-Oxford subcortical atlas; all analyses were corrected for multiple comparisons. Results After controlling for depression scores and correcting for multiple comparisons, the FT group showed increased activation in the right cerebellum compared to ET during the motor task; and increased activation in the paracingulate gyrus and left Heschl's gyrus compared with HC with decreased activation in the right precentral gyrus compared with ET during the basic-emotion task. No significant differences were found after adjusting for multiple comparisons during the intense-emotion task but increase in connectivity between the left amygdala and left middle frontal gyrus survived corrections in the FT subjects during this task, compared to HC. Conclusions In response to emotional stimuli, functional tremor is associated with alterations in activation and functional connectivity in networks involved in emotion processing and theory of mind. These findings may be relevant to the pathophysiology of functional movement disorders. Patients with functional tremor exhibit altered emotion processing circuitry. There is increased activation in the paracingulate gyrus after emotional stimuli. Increased connectivity between the left amygdala and middle frontal gyrus Functional disorders may be associated with disturbances in the theory of mind.
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Key Words
- AFNI, Analysis of Functional Neuroimages
- CPT-END, continuous performance task with emotional and neutral distracters
- Conversion disorder
- EPI, echo-planar imaging
- Emotion processing
- FSL, FMRIB Software Library
- FT, functional tremor
- Functional movement disorders
- Functional tremor
- HAM-A, Hamilton Anxiety Rating Scale
- HAM-D, Hamilton Depression Rating Scale
- MDEFT, modified equilibrium Fourier transform
- MINI, Mini International Neuropsychiatric Interview
- Psychogenic tremor
- fMRI
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Matthew M Norris
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - James C Eliassen
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - Erin Neefus
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anthony E Lang
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Erkic M, Bailer J, Fenske SC, Schmidt SNL, Trojan J, Schröder A, Kirsch P, Mier D. Impaired emotion processing and a reduction in trust in patients with somatic symptom disorder. Clin Psychol Psychother 2017; 25:163-172. [PMID: 29044807 DOI: 10.1002/cpp.2151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/18/2017] [Accepted: 09/13/2017] [Indexed: 01/10/2023]
Abstract
There is accumulating evidence for deficits in the perception and regulation of one's own emotions, as well as the recognition of others' emotions in somatic symptom disorder (SSD). However, investigations of SSD focusing on specific aspects of emotion processing and how these might interact are missing. We included 35 patients with SSD and 35 healthy controls who completed questionnaires on the perception and regulation of their own emotions, as well as experimental investigations of emotion recognition and trust. In line with previous studies, our results show that SSD patients in comparison to healthy controls have difficulties in the identification and description of own feelings (ηp2 = .381 and ηp2 = .315). Furthermore, we found that patients apply less cognitive reappraisal (ηp2 = .185) but tend to use more expressive suppression (ηp2 = .047). In contrast to previous studies, we found SSD patients to perform superior in emotion recognition, in particular for anger (d = 0.40). In addition, patients with SSD invested less in a trust game (d = 0.73). These results point to a higher sensitivity for negative emotions and less trust in others. Further, these findings suggest a dissociation between the ability to recognize one's own emotions versus others' emotions in SSD. Future interventions targeting emotion processing in SSD might focus on the identification of one's own emotions, prior to the training of emotion regulation.
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Affiliation(s)
- Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Sabrina C Fenske
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Stephanie N L Schmidt
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Jörg Trojan
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
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von Piekartz H, Lüers J, Daumeyer H, Mohr G. [Is kinesiophobia associated with changes in left/right judgment and emotion recognition during a persisting pain condition? : A cross-sectional study]. Schmerz 2017; 31:483-488. [PMID: 28536815 DOI: 10.1007/s00482-017-0220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study is to investigate the effects of kinesiophobia on emotion recognition and left/right judgement. MATERIALS AND METHODS A total of 67 patients with chronic musculoskeletal pain were tested. In all, 24 patients achieved a score >37 on the Tampa Scale of Kinesiophobia and were included in the study. The ability to recognize basic emotions coded through facial expression was assessed using the Facially Expressed Emotion Labeling (FEEL) test. Left/right judgement was evaluated using a special Face-mirroring Assessment and Treatment program. The Toronto Alexithymia Scale-26 (TAS-26) was used to assess if the patients showed signs of alexithymia. RESULTS The FEEL score of patients with kinesiophobia was significantly lower (p = 0.019). The recognition of the basic emotions fear (p = 0.026), anger (p = 0.027), and surprise (p = 0.014) showed significant differences in comparison to unaffected subjects. The basic emotion surprise was recognized more often by patients with kinesiophobia (p = 0.014). Only Scale 1 of the TAS-26 (identification problems of emotions) showed a significant difference between patients with kinesiophobia (p = 0.008) and healthy subjects. CONCLUSION The results show that kinesiophobic patients have altered recognition of emotions, problems in left/right judgement, and show signs of alexithymia.
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Affiliation(s)
- H von Piekartz
- Abt. Physiotherapie und Rehabilitationswissenschaften, Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland.
| | - J Lüers
- Abt. Physiotherapie und Rehabilitationswissenschaften, Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland
| | - H Daumeyer
- Abt. Physiotherapie und Rehabilitationswissenschaften, Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland
| | - G Mohr
- Hochschule Osnabrück, Abteilung Bewegungsstudien, Osnabrück, Deutschland
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Ghorbani F, Khosravani V, Ardakani RJ, Alvani A, Akbari H. The mediating effects of cognitive emotion regulation strategies on the relationship between alexithymia and physical symptoms: Evidence from Iranian asthmatic patients. Psychiatry Res 2017; 247:144-151. [PMID: 27898375 DOI: 10.1016/j.psychres.2016.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 10/19/2016] [Accepted: 11/05/2016] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic and episodic psychosomatic disease whose symptoms include coughing, wheezing, chest tightness, and shortness of breath. The present study aimed to investigate the effects of cognitive emotion regulation strategies (CERS) as mediators on the relationships between alexithymia subscales and physical symptoms (PS). 300 asthmatic patients (males=42.7%, females=57.3%, age range=16-65, mean age=29.40) and 100 normal controls participated in the study and completed the demographic questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), the Persian version of the Toronto Alexithymia Scale (FTAS-20), and the Powell & Enright Physical Symptoms Inventory (PSI). Asthmatic patients showed higher scores on all three alexithymia subscales including difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF), and externally oriented thinking (EOT) as well as non-adaptive CERS than normal controls. On the other hand, normal controls earned higher means in adaptive CERS. Results revealed that each of the three alexithymia subscales had indirect effects on PS through the non-adaptive cognitive emotion regulation strategy of catastrophizing. It is concluded that alexithymia can intensify PS through catastrophizing in asthmatic patients.
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Affiliation(s)
- Fatemeh Ghorbani
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Vahid Khosravani
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran.
| | | | - Amin Alvani
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran.
| | - Hedayat Akbari
- Allergist & Asthma Specialist at Private Allergic Office, Shiraz, Iran.
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Luo Y, Yan C, Huang T, Fan M, Liu L, Zhao Z, Ni K, Jiang H, Huang X, Lu Z, Wu W, Zhang M, Fan X. Altered Neural Correlates of Emotion Associated Pain Processing in Persistent Somatoform Pain Disorder: An fMRI Study. Pain Pract 2016; 16:969-979. [PMID: 27641732 DOI: 10.1111/papr.12358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/11/2015] [Indexed: 12/11/2022]
Abstract
Patients with persistent somatoform pain disorder (PSPD) suffer from long-term pain and emotional conflicts. Recently, accumulating evidence indicated that emotion has a significant role in pain perception of somatoform pain disorder. To further understand the association between emotion and pain-related brain activities, functional activities of patients with PSPD fulfilling ICD-10 criteria and healthy controls were assessed using functional magnetic resonance imaging technology, while participants viewed a series of positive, neutral, or negative pictures with or without pinprick pain stimulation. Results showed that patients with PSPD had altered brain activities in the parietal gyrus, temporal gyrus, posterior cingulate cortex, prefrontal cortex, and parahippocampus in response to pinprick pain stimuli during different emotions compared with the healthy control group. Moreover, patients with PSPD consistently showed hyperactivities in the prefrontal, the fusiform gyrus and the insula in response to negative stimuli under pinprick pain vs. non-pain condition. The current findings provide some insights into the underlying relationship between emotion and pain-related brain activity in patients with PSPD, which is of both theoretical and clinical importance.
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Affiliation(s)
- Yanli Luo
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics (MOE & STCSM), East China Normal University, Shanghai, China
| | - Tianming Huang
- Mental Health Center of Changning District, Shanghai, China
| | - Mingxia Fan
- Department of Physics, East China Normal University, Shanghai, China
| | - Liang Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyong Zhao
- Department of Physics, East China Normal University, Shanghai, China
| | - Kaiji Ni
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Hong Jiang
- Department of Medical Imaging, Tongji Hospital of Tongji University, Shanghai, China
| | - Xiao Huang
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zheng Lu
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Wenyuan Wu
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Mingyuan Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoduo Fan
- Department of Psychiatry, University of Massachusetts Medical School, Massachusetts, USA
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van Dijke A, van ‘t Wout M, Ford JD, Aleman A. Deficits in Degraded Facial Affect Labeling in Schizophrenia and Borderline Personality Disorder. PLoS One 2016; 11:e0154145. [PMID: 27300727 PMCID: PMC4907495 DOI: 10.1371/journal.pone.0154145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/08/2016] [Indexed: 11/18/2022] Open
Abstract
Although deficits in facial affect processing have been reported in schizophrenia as well as in borderline personality disorder (BPD), these disorders have not yet been directly compared on facial affect labeling. Using degraded stimuli portraying neutral, angry, fearful and angry facial expressions, we hypothesized more errors in labeling negative facial expressions in patients with schizophrenia compared to healthy controls. Patients with BPD were expected to have difficulty in labeling neutral expressions and to display a bias towards a negative attribution when wrongly labeling neutral faces. Patients with schizophrenia (N = 57) and patients with BPD (N = 30) were compared to patients with somatoform disorder (SoD, a psychiatric control group; N = 25) and healthy control participants (N = 41) on facial affect labeling accuracy and type of misattributions. Patients with schizophrenia showed deficits in labeling angry and fearful expressions compared to the healthy control group and patients with BPD showed deficits in labeling neutral expressions compared to the healthy control group. Schizophrenia and BPD patients did not differ significantly from each other when labeling any of the facial expressions. Compared to SoD patients, schizophrenia patients showed deficits on fearful expressions, but BPD did not significantly differ from SoD patients on any of the facial expressions. With respect to the type of misattributions, BPD patients mistook neutral expressions more often for fearful expressions compared to schizophrenia patients and healthy controls, and less often for happy compared to schizophrenia patients. These findings suggest that although schizophrenia and BPD patients demonstrate different as well as similar facial affect labeling deficits, BPD may be associated with a tendency to detect negative affect in neutral expressions.
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Affiliation(s)
- Annemiek van Dijke
- Yulius-academy/ Yulius-COLK, Rotterdam-Dordrecht Area & Department of Clinical Psychology, VU University Amsterdam, Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail: ;
| | - Mascha van ‘t Wout
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, United States of America
| | - Julian D. Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, United States of America
| | - André Aleman
- Department of Neuroscience, University Medical Center Groningen, and Department of Psychology, University of Groningen, Groningen, the Netherlands
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Craparo G, Gori A, Dell'Aera S, Costanzo G, Fasciano S, Tomasello A, Vicario CM. Impaired emotion recognition is linked to alexithymia in heroin addicts. PeerJ 2016; 4:e1864. [PMID: 27069803 PMCID: PMC4824882 DOI: 10.7717/peerj.1864] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 03/09/2016] [Indexed: 11/20/2022] Open
Abstract
Several investigations document altered emotion processing in opiate addiction. Nevertheless, the origin of this phenomenon remains unclear. Here we examined the role of alexithymia in the ability (i.e., number of errors—accuracy and reaction times—RTs) of thirty-one heroin addicts and thirty-one healthy controls to detect several affective expressions. Results show generally lower accuracy and higher RTs in the recognition of facial expressions of emotions for patients, compared to controls. The hierarchical multivariate regression analysis shows that alexithymia might be responsible of the between groups difference with respect to the RTs in emotion detection. Overall, we provide new insights in the clinical interpretation of affective deficits in heroin addicts suggesting a role of alexithymia in their ability to recognize emotions.
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Affiliation(s)
- Giuseppe Craparo
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Alessio Gori
- Department of Human Sciences-Lumsa University of Rome, Italy; Department of Education and Psychology-University of Florence, Italy
| | | | - Giulia Costanzo
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Silvia Fasciano
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Antonia Tomasello
- Faculty of Human and Social Sciences, Kore University of Enna , Italy
| | - Carmelo M Vicario
- Wolfson Centre for Clinical and Cognitive Neuroscience, School of Psychology, Bangor University, Bangor, United Kingdom; School of Psychology, University of Tasmania, Tasmania, Australia
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Kleinstäuber M, Gottschalk J, Berking M, Rau J, Rief W. Enriching Cognitive Behavior Therapy with Emotion Regulation Training for Patients with Multiple Medically Unexplained Symptoms (ENCERT): Design and implementation of a multicenter, randomized, active-controlled trial. Contemp Clin Trials 2016; 47:54-63. [DOI: 10.1016/j.cct.2015.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 11/27/2022]
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Öztürk A, Kiliç A, Deveci E, Kirpinar İ. Investigation of facial emotion recognition, alexithymia, and levels of anxiety and depression in patients with somatic symptoms and related disorders. Neuropsychiatr Dis Treat 2016; 12:1047-53. [PMID: 27199559 PMCID: PMC4857827 DOI: 10.2147/ndt.s106989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The concept of facial emotion recognition is well established in various neuropsychiatric disorders. Although emotional disturbances are strongly associated with somatoform disorders, there are a restricted number of studies that have investigated facial emotion recognition in somatoform disorders. Furthermore, there have been no studies that have regarded this issue using the new diagnostic criteria for somatoform disorders as somatic symptoms and related disorders (SSD). In this study, we aimed to compare the factors of facial emotion recognition between patients with SSD and age- and sex-matched healthy controls (HC) and to retest and investigate the factors of facial emotion recognition using the new criteria for SSD. PATIENTS AND METHODS After applying the inclusion and exclusion criteria, 54 patients who were diagnosed with SSD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and 46 age- and sex-matched HC were selected to participate in the present study. Facial emotion recognition, alexithymia, and the status of anxiety and depression were compared between the groups. RESULTS Patients with SSD had significantly decreased scores of facial emotion for fear faces, disgust faces, and neutral faces compared with age- and sex-matched HC (t=-2.88, P=0.005; t=-2.86, P=0.005; and t=-2.56, P=0.009, respectively). After eliminating the effects of alexithymia and depressive and anxious states, the groups were found to be similar in terms of their responses to facial emotion and mean reaction time to facial emotions. DISCUSSION Although there have been limited numbers of studies that have examined the recognition of facial emotion in patients with somatoform disorders, our study is the first to investigate facial recognition in patients with SSD diagnosed according to the DSM-5 criteria. Recognition of facial emotion was found to be disturbed in patients with SSD. However, our findings suggest that disturbances in facial recognition were significantly associated with alexithymia and the status of depression and anxiety, which is consistent with the previous studies. Further studies are needed to highlight the associations between facial emotion recognition and SSD.
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Affiliation(s)
- Ahmet Öztürk
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alperen Kiliç
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Erdem Deveci
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - İsmet Kirpinar
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Air T, Weightman MJ, Baune BT. Symptom severity of depressive symptoms impacts on social cognition performance in current but not remitted major depressive disorder. Front Psychol 2015; 6:1118. [PMID: 26300814 PMCID: PMC4523699 DOI: 10.3389/fpsyg.2015.01118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022] Open
Abstract
The aim of the present study was to investigate the social cognitive functioning of participants with depression when compared with healthy controls, and to assess the impact of symptom severity. One hundred and eight patients with depression (66 remitted and 42 current) and 52 healthy controls were assessed using the Wechsler Advanced Clinical Solutions: Social Perception Subtest, measuring facial affect recognition in isolation and in combination with prosody and body language interpretation. When healthy controls, remitted depression and currently depressed groups were compared, no associations were found on any of the social cognition subscales. Severity of depressive and anxious symptoms predicted performance on all social cognition subscales in currently depressed participants, controlling for age, gender, education and psychotropic medication. Affective depressive symptoms were inversely related to ACS Pairs and Prosody subscales, while somatic symptoms were inversely related to the ACS Affect Recognition and Total scores. There was no association between severity and the WAIS ACS in remitted depression participants. People with MDD exhibiting more severe depressive and anxious symptoms and a cluster of affective symptoms have greater difficulty undertaking complex social cognitive tasks. Given the state like nature to these deficits, these impairments may cause problems with day to day functioning and have implications in targeted therapeutic interventions.
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Affiliation(s)
- Tracy Air
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia
| | - Michael J Weightman
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, The University of Adelaide Adelaide, SA, Australia
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The Clinical Implications and Neurophysiological Background of Useing Self-Mirroring Technique to Enhance the Identification of Emotional Experiences: An Example with Rational Emotive Behavior Therapy. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2015. [DOI: 10.1007/s10942-015-0205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Di Tella M, Castelli L, Colonna F, Fusaro E, Torta R, Ardito RB, Adenzato M. Theory of mind and emotional functioning in fibromyalgia syndrome: an investigation of the relationship between social cognition and executive function. PLoS One 2015; 10:e0116542. [PMID: 25594169 PMCID: PMC4296933 DOI: 10.1371/journal.pone.0116542] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/10/2014] [Indexed: 12/14/2022] Open
Abstract
Background Fibromyalgia (FM) is a syndrome primarily characterised by chronic, widespread musculoskeletal pain. In the aetiology of this syndrome a crucial role is played by complex interactions among biological, genetic, psychological, and socio-cultural factors. Recently, researchers have started to explore emotional functioning in FM, with their attention focused on alexithymia, a personality construct that affects the regulation of a person’s own emotions. On the other hand, the detection and experience of emotional signals from other people have only been sparsely investigated in FM syndrome and no studies have investigated the ability to represent other people’s mental states (i.e. Theory of Mind, ToM) in these patients. Here we present the first study investigating a large set of social-cognitive abilities, and the possible relationships between these abilities and the performance on executive-function tasks, in a homogenous sample of patients with FM. Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study. Social cognition was assessed with a set of validated experimental tasks. Measures of executive function were used to test the correlations between this dimension and the social-cognitive profile of patients with FM. Relationships between social-cognitive abilities and demographic, clinical and psychological variables were also investigated. Principal Findings Patients with FM have impairments both in the regulation of their own affect and in the recognition of other’s emotions, as well as in representing other people’s mental states. No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analysed. Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice.
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Affiliation(s)
- Marialaura Di Tella
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
| | - Lorys Castelli
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
- * E-mail:
| | - Fabrizio Colonna
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, “Città della Salute e della Scienza” University Hospital of Turin, Turin, Italy
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin, Italy
| | - Rita B. Ardito
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
| | - Mauro Adenzato
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
- Neuroscience Institute of Turin, Turin, Italy
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Brewer R, Cook R, Cardi V, Treasure J, Bird G. Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia. ROYAL SOCIETY OPEN SCIENCE 2015; 2:140382. [PMID: 26064585 PMCID: PMC4448790 DOI: 10.1098/rsos.140382] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/20/2014] [Indexed: 05/22/2023]
Abstract
Previous research has yielded inconsistent findings regarding the ability of individuals with eating disorders (EDs) to recognize facial emotion, making the clinical features of this population hard to determine. This study tested the hypothesis that where observed, emotion recognition deficits exhibited by patients with EDs are due to alexithymia, a co-occurring condition also associated with emotion recognition difficulties. Ability to recognize facial emotion was investigated in a sample of individuals with EDs and varying degrees of co-occurring alexithymia, and an alexithymia-matched control group. Alexithymia, but not ED symptomology, was predictive of individuals' emotion recognition ability, inferred from tolerance to high-frequency visual noise. This relationship was specific to emotion recognition, as neither alexithymia nor ED symptomology was associated with ability to recognize facial identity. These findings suggest that emotion recognition difficulties exhibited by patients with ED are attributable to alexithymia, and may not be a feature of EDs per se.
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Affiliation(s)
- Rebecca Brewer
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London WC2R 2LS, UK
- Author for correspondence: Rebecca Brewer e-mail:
| | - Richard Cook
- Department of Psychology, City University London, London EC1R 0JD, UK
| | - Valentina Cardi
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, King's College London, London WC2R 2LS, UK
| | - Janet Treasure
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, King's College London, London WC2R 2LS, UK
| | - Geoffrey Bird
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London WC2R 2LS, UK
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AR, UK
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von Piekartz H, Wallwork SB, Mohr G, Butler DS, Moseley GL. People with chronic facial pain perform worse than controls at a facial emotion recognition task, but it is not all about the emotion. J Oral Rehabil 2014; 42:243-50. [PMID: 25483874 DOI: 10.1111/joor.12249] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/26/2022]
Abstract
Alexithymia, or a lack of emotional awareness, is prevalent in some chronic pain conditions and has been linked to poor recognition of others' emotions. Recognising others' emotions from their facial expression involves both emotional and motor processing, but the possible contribution of motor disruption has not been considered. It is possible that poor performance on emotional recognition tasks could reflect problems with emotional processing, motor processing or both. We hypothesised that people with chronic facial pain would be less accurate in recognising others' emotions from facial expressions, would be less accurate in a motor imagery task involving the face, and that performance on both tasks would be positively related. A convenience sample of 19 people (15 females) with chronic facial pain and 19 gender-matched controls participated. They undertook two tasks; in the first task, they identified the facial emotion presented in a photograph. In the second, they identified whether the person in the image had a facial feature pointed towards their left or right side, a well-recognised paradigm to induce implicit motor imagery. People with chronic facial pain performed worse than controls at both tasks (Facially Expressed Emotion Labelling (FEEL) task P < 0·001; left/right judgment task P < 0·001). Participants who were more accurate at one task were also more accurate at the other, regardless of group (P < 0·001, r(2) = 0·523). Participants with chronic facial pain were worse than controls at both the FEEL emotion recognition task and the left/right facial expression task and performance covaried within participants. We propose that disrupted motor processing may underpin or at least contribute to the difficulty that facial pain patients have in emotion recognition and that further research that tests this proposal is warranted.
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Weiß S, Winkelmann A, Duschek S. Recognition of facially expressed emotions in patients with fibromyalgia syndrome. Behav Med 2014; 39:146-54. [PMID: 24236812 DOI: 10.1080/08964289.2013.818932] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The study investigated the ability to identify facially expressed emotions in fibromyalgia syndrome (FMS) and its association with clinical parameters. Thirty-five FMS patients and 35 healthy controls accomplished a face recognition task. Additionally, pain severity, alexithymia, depression, anxiety, psychiatric co-morbidity and medication use were assessed. The patients displayed reduced task performance in terms of more misclassifications of emotional expressions than controls. Pain severity, alexithymia, depression and anxiety were inversely related to recognition performance, with pain severity accounting for the largest portion of test score variance. Psychiatric co-morbidity and medication had no impact on performance. The study documented impaired emotion recognition in FMS, which may contribute to the interpersonal difficulties and reduced social functioning related to this condition. As potential mechanisms mediating the occurrence of the deficits, altered affective processing due to interoceptive impairment as well as interference of central nervous nociceptive activity with cognitive and emotional processing are discussed.
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Jongen S, Axmacher N, Kremers NA, Hoffmann H, Limbrecht-Ecklundt K, Traue HC, Kessler H. An investigation of facial emotion recognition impairments in alexithymia and its neural correlates. Behav Brain Res 2014; 271:129-39. [DOI: 10.1016/j.bbr.2014.05.069] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/16/2014] [Accepted: 05/17/2014] [Indexed: 12/21/2022]
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The first step is the hardest - emotion recognition in patients with somatoform disorders. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2014; 59:385-90. [PMID: 24307338 DOI: 10.13109/zptm.2013.59.4.385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aetiology of somatoform disorders is assumed to consist of several factors, as alexithymia, dysfunctional cognitions and emotion regulation. As a consequence of somatoform disorders social withdrawal is discussed. Several studies prove connections between mental problems, emotion recognition, and functioning social relationships. METHODS A sample of 35 patients suffering from a somatoform disorder and a sample of 73 persons without any somatoform symptoms were investigated according to their ability to identify emotional facial expressions (computer-assisted presentation of photos). RESULTS Our results demonstrate significant differences in the ability to decode others' emotional states between people with or without somatoform disorders. In all six tests the patients achieved significantly worse results. CONCLUSIONS Our results suggest that psychotherapeutic treatment of patients with somatoform disorders should also focus on the recognition of emotions and deal with them.
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Schönenberg M, Mares L, Smolka R, Jusyte A, Zipfel S, Hautzinger M. Facial affect perception and mentalizing abilities in female patients with persistent somatoform pain disorder. Eur J Pain 2014; 18:949-56. [PMID: 24395204 DOI: 10.1002/j.1532-2149.2013.00440.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Numerous studies have demonstrated a robust link between alexithymic traits and somatic complaints in patients suffering from psychosomatic disorders, while less is known about disease-related impairments in the processing of affective social information. Deficits in emotion recognition can lead to misinterpretations of social signals and induce distress in interpersonal interactions. This, in turn, might contribute to somatoform symptomatology in affected individuals. The aim of the present study was to investigate basal facial affect recognition as well as higher-order cognitive mind-reading skills in order to further clarify the association between alexithymia and the processing of social affective information in a homogenous sample of patients suffering from somatoform pain. METHODS We employed a series of animated morph clips that gradually displayed the onset and development of the six basic emotional expressions to investigate facial affect perception in a female sample of patients diagnosed with persistent somatoform pain disorder (PSPD) and matched healthy controls. In addition, all participants were presented with the Movie for the Assessment of Social Cognition to explore mind-reading abilities. RESULTS Specifically impaired mentalizing skills and increased alexithymic traits were observed in PSPD, while emotional facial expression recognition appeared to be intact in these patients. CONCLUSIONS PSPD subjects tend to overattribute inappropriate affective states to others, which could be the consequence of the inability to adequately experience and express their own emotional reactions. This cognitive bias might lead to the experience of poor psychosocial functioning and has the potential to negatively impact the course and outcome of this psychopathology.
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Affiliation(s)
- M Schönenberg
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Germany
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Tominaga T, Choi H, Nagoshi Y, Wada Y, Fukui K. Relationship between alexithymia and coping strategies in patients with somatoform disorder. Neuropsychiatr Dis Treat 2014; 10:55-62. [PMID: 24403835 PMCID: PMC3883553 DOI: 10.2147/ndt.s55956] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE A multidimensional intervention integrating alexithymia, negative affect, and type of coping strategy is needed for the effective treatment of somatoform disorder; however, few studies have applied this approach to the three different dimensions of alexithymia in patients with somatoform disorder. The purpose of this study was to determine the relationship between type of coping strategy and three different dimensions of alexithymia expressed in patients. PATIENTS AND METHODS A total of 196 patients with somatoform disorder completed the 20-item Toronto Alexithymia Scale, the Zung Self-Rating Depression Scale, the Spielberger State-Trait Anxiety Inventory, the Somatosensory Amplification Scale, and the Lazarus Stress Coping Inventory. The relationships between alexithymia (Toronto Alexithymia Scale - 20 score and subscales), demographic variables, and psychological inventory scores were analyzed using Pearson's correlation coefficients and stepwise multiple regression analysis. RESULTS The mean Toronto Alexithymia Scale - 20 total score (56.1±10.57) was positively correlated with the number of physical symptoms as well as with psychopathology scores (Self-Rating Depression Scale, State-Trait Anxiety Inventory trait, state, and Somatosensory Amplification Scale), but negatively correlated with planful problem solving, confrontive coping, seeking social support, and positive reappraisal coping scores. With respect to coping strategy, multiple regression analyses revealed that "difficulty in identifying feelings" was positively associated with an escape-avoidance strategy, "difficulty in describing feelings" was negatively associated with a seeking social support strategy, and "externally oriented thinking" was negatively associated with a confrontive coping strategy. CONCLUSION Alexithymia was strongly associated with the number of somatic symptoms and negative affect. Patients with high "difficulty in describing feelings" tend to rely less on seeking social support, and patients with high "externally oriented thinking" tend to rely less on confrontive coping strategies. The coping skills intervention implemented should differ across individuals and should be based on the alexithymia dimension of each patient.
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Affiliation(s)
- Toshiyuki Tominaga
- Health Management Doctor's Office (Mental Health), Salary, Personnel Health, and Welfare Division, Kyoto Prefecture, Japan ; Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hyungin Choi
- Department of Psychiatry, Iwakura Hospital, Kyoto, Japan
| | - Yasuhide Nagoshi
- Department of Psychiatry (Psychosomatic Medicine), Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Yoshihisa Wada
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Fukui
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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de Greck M, Bölter AF, Lehmann L, Ulrich C, Stockum E, Enzi B, Hoffmann T, Tempelmann C, Beutel M, Frommer J, Northoff G. Changes in brain activity of somatoform disorder patients during emotional empathy after multimodal psychodynamic psychotherapy. Front Hum Neurosci 2013; 7:410. [PMID: 23966922 PMCID: PMC3744921 DOI: 10.3389/fnhum.2013.00410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 07/11/2013] [Indexed: 11/25/2022] Open
Abstract
Somatoform disorder patients show a variety of emotional disturbances including impaired emotion recognition and increased empathic distress. In a previous paper, our group showed that several brain regions involved in emotional processing, such as the parahippocampal gyrus and other regions, were less activated in pre-treatment somatoform disorder patients (compared to healthy controls) during an empathy task. Since the parahippocampal gyrus is involved in emotional memory, its decreased activation might reflect the repression of emotional memories (which—according to psychoanalytical concepts—plays an important role in somatoform disorder). Psychodynamic psychotherapy aims at increasing the understanding of emotional conflicts as well as uncovering repressed emotions. We were interested, whether brain activity in the parahippocampal gyrus normalized after (inpatient) multimodal psychodynamic psychotherapy. Using fMRI, subjects were scanned while they shared the emotional states of presented facial stimuli expressing anger, disgust, joy, and a neutral expression; distorted stimuli with unrecognizable content served as control condition. 15 somatoform disorder patients were scanned twice, pre and post multimodal psychodynamic psychotherapy; in addition, 15 age-matched healthy control subjects were investigated. Effects of psychotherapy on hemodynamic responses were analyzed implementing two approaches: (1) an a priori region of interest approach and (2) a voxelwise whole brain analysis. Both analyses revealed increased hemodynamic responses in the left and right parahippocampal gyrus (and other regions) after multimodal psychotherapy in the contrast “empathy with anger”—“control.” Our results are in line with psychoanalytical concepts about somatoform disorder. They suggest the parahippocampal gyrus is crucially involved in the neurobiological mechanisms which underly the emotional deficits of somatoform disorder patients.
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Affiliation(s)
- Moritz de Greck
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine Mainz Mainz, Germany ; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Leipzig Leipzig, Germany
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Bird G, Cook R. Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism. Transl Psychiatry 2013; 3:e285. [PMID: 23880881 PMCID: PMC3731793 DOI: 10.1038/tp.2013.61] [Citation(s) in RCA: 317] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/02/2013] [Accepted: 05/25/2013] [Indexed: 12/22/2022] Open
Abstract
It is widely accepted that autism is associated with disordered emotion processing and, in particular, with deficits of emotional reciprocity such as impaired emotion recognition and reduced empathy. However, a close examination of the literature reveals wide heterogeneity within the autistic population with respect to emotional competence. Here we argue that, where observed, emotional impairments are due to alexithymia-a condition that frequently co-occurs with autism-rather than a feature of autism per se. Alexithymia is a condition characterized by a reduced ability to identify and describe one's own emotion, but which results in reduced empathy and an impaired ability to recognize the emotions of others. We briefly review studies of emotion processing in alexithymia, and in autism, before describing a recent series of studies directly testing this 'alexithymia hypothesis'. If found to be correct, the alexithymia hypothesis has wide-reaching implications for the study of autism, and how we might best support subgroups of autistic individuals with, and without, accompanying alexithymia. Finally, we note the presence of elevated rates of alexithymia, and inconsistent reports of emotional impairments, in eating disorders, schizophrenia, substance abuse, Parkinson's Disease, multiple sclerosis and anxiety disorders. We speculate that examining the contribution of alexithymia to the emotional symptoms of these disorders may bear fruit in the same way that it is starting to do in autism.
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Affiliation(s)
- G Bird
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, London, UK.
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Neural correlates of deficits in pain-related affective meaning construction in patients with chronic pain disorder. Psychosom Med 2013; 75:124-36. [PMID: 23362496 DOI: 10.1097/psy.0b013e31827e60f3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Psychological and neural mechanisms of the affective dimension of pain are known to be disturbed in patients with chronic pain disorder. The aim of this functional magnetic resonance imaging study was to assess the neurofunctional and behavioral measures underlying the ability to construct pain-related affective meaning in a painful situation by comparing 21 clinically and psychometrically well-characterized patients with persistent non-nociceptive somatoform pain with 19 healthy controls. METHODS The functional magnetic resonance imaging task involved viewing pictures depicting human hands and feet in different painful and nonpainful situations. Participants were asked to estimate the perceived pain intensity. These data were correlated with behavioral measures of depression, alexithymia, and general cognitive and emotional empathy. RESULTS In a hypothesis-driven region-of-interest analysis, the healthy control group exhibited greater activation of the left perigenual anterior cingulate cortex than patients with pain (Montreal Neurological Institute coordinates (x y z)=-8 38 0; cluster extent=54 voxels; T=4.28; p=.006 corrected for multiple comparisons at cluster level). No group differences in the activation of the anterior insular cortex were found. Scores on self-assessment instruments (Beck Depression Inventory I, Interpersonal Reactivity Index, and 20-item Toronto Alexithymia Scale) did not influence neuroimaging results. CONCLUSIONS Our results suggest that patients with chronic medically unexplained pain have an altered neural pain perception process owing to decreased activation of empathetic-affective networks, which we interpret as a deficit in pain-related affective meaning construction. These findings may lead to a more specific and detailed neurobiological understanding of the clinical impression of disturbed affect in patients with chronic pain disorder.
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Haas J, Eichhammer P, Traue HC, Hoffmann H, Behr M, Crönlein T, Pieh C, Busch V. Alexithymic and somatisation scores in patients with temporomandibular pain disorder correlate with deficits in facial emotion recognition. J Oral Rehabil 2012; 40:81-90. [PMID: 23137311 DOI: 10.1111/joor.12013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2012] [Indexed: 01/05/2023]
Abstract
Current studies suggest dysfunctional emotional processing as a key factor in the aetiology of temporomandibular disorder (TMD). Investigating facial emotion recognition (FER) may offer an elegant and reliable way to study emotional processing in patients with TMD. Twenty patients with TMD and the same number of age-, sex- and education-matched controls were measured with the Facially Expressed Emotion Labelling (FEEL) test, the 26-item Toronto Alexithymia Scale (TAS-26), the Screening for Somatoform Symptoms (SOMS-2a), the German Pain Questionnaire and the 21-item Hamilton Depression Rating Scale (HAMD). The patients had significantly lower Total FEEL Scores (P = 0·021) as compared to the controls, indicating a lower accuracy of FER. Furthermore, we were able to demonstrate significant group differences with respect to the following issues: patients were more alexithymic (P = 0·006), stated more somatoform symptoms (P < 0·004) and had higher depressive scores in the HAMD (P < 0·003). The factors alexithymia and somatisation could explain 31% (adjusted 27%) of the variance of the FEEL Scores in the sample. The estimation of the standardised regression coefficients suggests an equivalent influence of TAS-26 and SOMS-2a on the FEEL Scores, whereas 'group' (patients versus healthy controls) and depressive symptoms did not contribute significantly to the model. Our findings highlight FER deficits in patients with TMD, which are partially explained by concomitant alexithymia and somatisation. As suggested previously, impaired FER in patients with TMD may further point to probable aetiological proximities between TMD and somatoform disorders.
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Affiliation(s)
- J Haas
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany.
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de Greck M, Scheidt L, Bölter AF, Frommer J, Ulrich C, Stockum E, Enzi B, Tempelmann C, Hoffmann T, Han S, Northoff G. Altered brain activity during emotional empathy in somatoform disorder. Hum Brain Mapp 2012; 33:2666-85. [PMID: 21998038 PMCID: PMC6870370 DOI: 10.1002/hbm.21392] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 05/28/2011] [Accepted: 05/31/2011] [Indexed: 12/30/2022] Open
Abstract
Somatoform disorder patients suffer from impaired emotion recognition and other emotional deficits. Emotional empathy refers to the understanding and sharing of emotions of others in social contexts. It is likely that the emotional deficits of somatoform disorder patients are linked to disturbed empathic abilities; however, little is known so far about empathic deficits of somatoform patients and the underlying neural mechanisms. We used fMRI and an empathy paradigm to investigate 20 somatoform disorder patients and 20 healthy controls. The empathy paradigm contained facial pictures expressing anger, joy, disgust, and a neutral emotional state; a control condition contained unrecognizable stimuli. In addition, questionnaires testing for somatization, alexithymia, depression, empathy, and emotion recognition were applied. Behavioral results confirmed impaired emotion recognition in somatoform disorder and indicated a rather distinct pattern of empathic deficits of somatoform patients with specific difficulties in "empathic distress." In addition, somatoform patients revealed brain areas with diminished activity in the contrasts "all emotions"-"control," "anger"-"control," and "joy"-"control," whereas we did not find brain areas with altered activity in the contrasts "disgust"-"control" and "neutral"-"control." Significant clusters with less activity in somatoform patients included the bilateral parahippocampal gyrus, the left amygdala, the left postcentral gyrus, the left superior temporal gyrus, the left posterior insula, and the bilateral cerebellum. These findings indicate that disturbed emotional empathy of somatoform disorder patients is linked to impaired emotion recognition and abnormal activity of brain regions responsible for emotional evaluation, emotional memory, and emotion generation.
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Affiliation(s)
- Moritz de Greck
- Department of Psychology, Peking University, 5 Yiheyuan Road, Beijing 100871, China.
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Grynberg D, Chang B, Corneille O, Maurage P, Vermeulen N, Berthoz S, Luminet O. Alexithymia and the processing of emotional facial expressions (EFEs): systematic review, unanswered questions and further perspectives. PLoS One 2012; 7:e42429. [PMID: 22927931 PMCID: PMC3426527 DOI: 10.1371/journal.pone.0042429] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/09/2012] [Indexed: 01/12/2023] Open
Abstract
Alexithymia is characterized by difficulties in identifying, differentiating and describing feelings. A high prevalence of alexithymia has often been observed in clinical disorders characterized by low social functioning. This review aims to assess the association between alexithymia and the ability to decode emotional facial expressions (EFEs) within clinical and healthy populations. More precisely, this review has four main objectives: (1) to assess if alexithymia is a better predictor of the ability to decode EFEs than the diagnosis of clinical disorder; (2) to assess the influence of comorbid factors (depression and anxiety disorder) on the ability to decode EFE; (3) to investigate if deficits in decoding EFEs are specific to some levels of processing or task types; (4) to investigate if the deficits are specific to particular EFEs. Twenty four studies (behavioural and neuroimaging) were identified through a computerized literature search of Psycinfo, PubMed, and Web of Science databases from 1990 to 2010. Data on methodology, clinical characteristics, and possible confounds were analyzed. The review revealed that: (1) alexithymia is associated with deficits in labelling EFEs among clinical disorders, (2) the level of depression and anxiety partially account for the decoding deficits, (3) alexithymia is associated with reduced perceptual abilities, and is likely to be associated with impaired semantic representations of emotional concepts, and (4) alexithymia is associated with neither specific EFEs nor a specific valence. These studies are discussed with respect to processes involved in the recognition of EFEs. Future directions for research on emotion perception are also discussed.
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Affiliation(s)
- Delphine Grynberg
- Research Institute for Psychological Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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Domes G, Grabe HJ, Czieschnek D, Heinrichs M, Herpertz SC. Alexithymic traits and facial emotion recognition in borderline personality disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 80:383-5. [PMID: 21968640 DOI: 10.1159/000325828] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 02/17/2011] [Indexed: 11/19/2022]
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Autonomic imbalance is associated with reduced facial recognition in somatoform disorders. J Psychosom Res 2011; 71:232-9. [PMID: 21911100 DOI: 10.1016/j.jpsychores.2011.03.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 02/25/2011] [Accepted: 03/31/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Somatoform disorders are characterized by the presence of multiple somatic symptoms. While the accuracy of perceiving bodily signal (interoceptive awareness) is only sparely investigated in somatoform disorders, recent research has associated autonomic imbalance with cognitive and emotional difficulties in stress-related diseases. This study aimed to investigate how sympathovagal reactivity interacts with performance in recognizing emotions in faces (facial recognition task). METHODS Using a facial recognition and appraisal task, skin conductance levels (SCLs), heart rate (HR) and heart rate variability (HRV) were assessed in 26 somatoform patients and compared to healthy controls. Interoceptive awareness was assessed by a heartbeat detection task. RESULTS We found evidence for a sympathovagal imbalance in somatoform disorders characterized by low parasympathetic reactivity during emotional tasks and increased sympathetic activation during baseline. Somatoform patients exhibited a reduced recognition performance for neutral and sad emotional expressions only. Possible confounding variables such as alexithymia, anxiety or depression were taken into account. Interoceptive awareness was reduced in somatoform patients. CONCLUSIONS Our data demonstrate an imbalance in sympathovagal activation in somatoform disorders associated with decreased parasympathetic activation. This might account for difficulties in processing of sad and neutral facial expressions in somatoform patients which might be a pathogenic mechanism for increased everyday vulnerability.
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de Greck M, Scheidt L, Bölter AF, Frommer J, Ulrich C, Stockum E, Enzi B, Tempelmann C, Hoffmann T, Northoff G. Multimodal psychodynamic psychotherapy induces normalization of reward related activity in somatoform disorder. World J Biol Psychiatry 2011; 12:296-308. [PMID: 21198419 DOI: 10.3109/15622975.2010.539269] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Somatoform disorder patients demonstrate a disturbance in the balance between internal and external information processing, with a decreased focus on external stimulus processing. We investigated brain activity of somatoform disorder patients, during the processing of rewarding external events, paying particular attention to the effects of inpatient multimodal psychodynamic psychotherapy. METHODS Using fMRI, we applied a reward task that required fast reactions to a target stimulus in order to obtain monetary rewards; a control condition contained responses without the opportunity to gain rewards. Twenty acute somatoform disorder patients were compared with twenty age-matched healthy controls. In addition, 15 patients underwent a second scanning session after participation in multimodal psychodynamic psychotherapy. RESULTS Acute patients showed diminished hemodynamic differentiation between rewarding and non rewarding events in four regions, including the left postcentral gyrus and the right ventroposterior thalamus. After multimodal psychodynamic psychotherapy, both regions showed a significant normalization of neuronal differentiation. CONCLUSION Our results suggest that diminished responsiveness of brain regions involved in the processing of external stimuli underlies the disturbed balance of internal and external processing of somatoform disorder patients. By providing new approaches to cope with distressing events, multimodal psychodynamic psychotherapy led to decreased symptoms and normalization of neuronal activity.
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Affiliation(s)
- Moritz de Greck
- Department of Psychology, Peking University, 5 Yiheyuan Road, Beijing 100871, China.
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Alexithymia and impaired facial affect recognition in multiple sclerosis. J Neurol 2011; 258:1683-8. [DOI: 10.1007/s00415-011-6002-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 02/22/2011] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
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Campbell DW, McKeen NA. Alexithymia tendencies and mere exposure alter social approachability judgments. J Pers 2011; 79:335-58. [PMID: 21395591 DOI: 10.1111/j.1467-6494.2010.00687.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
People have a fundamental motivation for social connection and social engagement, but how do they decide whom to approach in ambiguous social situations? Subjective feelings often influence such decisions, but people vary in awareness of their feelings. We evaluated two opposing hypotheses based on visual familiarity effects and emotional awareness on social approachability judgments. These hypotheses differ in their interpretation of the familiarity or mere exposure effect with either an affective or cognitive interpretation. The responses of our 128-student sample supported the cognitive interpretation. Lower emotional awareness or higher alexithymia was associated with higher approachability judgments to familiarized faces and lower approachability judgments to novel faces. These findings were independent of the Big Five personality factors. The results indicate that individual differences in emotional awareness should be integrated into social decision-making models. The results also suggest that cognitive-perceptual alterations may underlie the poorer social outcomes associated with alexithymia.
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Affiliation(s)
- Darren W Campbell
- John Buhler Research Centre, Psychiatric Neuroimaging, University of Manitoba, Winnipeg.
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