1
|
Fantozzi P, Billeci L, Muratori P, Maestro S, Muratori F, Chakrabarti B, Calderoni S. Autistic traits and perspective taking in youths with anorexia nervosa: an exploratory clinical and eye tracking study. J Eat Disord 2024; 12:116. [PMID: 39143647 PMCID: PMC11325632 DOI: 10.1186/s40337-024-01075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Despite their apparent dissimilarity, Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD) share many features, especially in terms of social and emotional difficulties. In recent years, empathic abilities in AN have been frequently assessed using self-report measures. Otherwise, the director task (DT) has been used to investigate the ability to take the visual perspective of another individual in a communicative context, using eye-tracking technology. The aim of the current study was to test the presence of autism-relevant features in AN, through: (i) comparing self-reported autistic traits and empathic abilities in a group of young inpatients with AN and age/gender matched healthy controls (HC); (ii) comparing performance on the director paradigm. METHODS The participants were females in the age-range between 11 and 18 years: 24 with AN and 23 HC. Autistic traits, empathic abilities, and severity of the eating disorder were respectively measured using: the Autism Quotient (AQ), the Interpersonal Reactivity Index (IRI), and the Eating Disorder Inventory-3 (EDI-3). Both groups performed a computerized task in which a director instructed them to move objects placed on a set of shelves using a mouse, while their eye gaze was tracked. A total of 36 shelf configurations, divided into three categories (with dimensional distractor - with spatial distractor - control), were created. RESULTS Subjects with AN showed higher autistic traits than HC. Eye-tracking data revealed that subjects with AN took longer to decide which object to select and where to move it, both in distractor-trials and in control-trials. In the AN group, we found a significant negative correlation between the total score of the AQ and the number of fixations to the irrelevant object in the dimensional control condition -in which the subjects were asked to focus on dimensional aspects of the object (large-small)-. CONCLUSIONS Autistic traits were over-represented in a group of young inpatients with AN. Through the use of eye-tracking technology, this exploratory study documented some differences between AN inpatients and HC in their online processes during the perspective taking tasks, which could be considered a target of tailored intervention. A larger sample of patients is needed to confirm these preliminary findings.
Collapse
Affiliation(s)
- Pamela Fantozzi
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy
| | - Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | - Pietro Muratori
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy
| | - Sandra Maestro
- Residential Eating Disorder Treatment Center "Orti di Ada", Pisa, Italy
| | - Filippo Muratori
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy
| | - Bhismadev Chakrabarti
- Centre for Autism, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Sara Calderoni
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| |
Collapse
|
2
|
Mumtaz A, Addas A, Zhou W, Rehman S. Do changes in eating behaviors signal rising mental health concerns among Saudi high schoolers? BMC Psychol 2024; 12:424. [PMID: 39095929 PMCID: PMC11297746 DOI: 10.1186/s40359-024-01920-5] [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: 01/07/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Deteriorated eating attitudes have emerged as a prominent psychiatric illness with increasing prevalence in industrialized societies. This research endeavors to investigate the relationships between deteriorated eating patterns and mental health among Saudi high school students after the COVID-19 outbreak. METHODS A sample of 2817 students from two high schools in Jeddah, Saudi Arabia, completed a questionnaire about their demographic characteristics and symptoms of anxiety (GAD-7), depression (PHQ-9), and deteriorated eating patterns (Eating Attitudes Test 26) via convenience sampling technique. Multiple regression analysis was carried out to predict the potential associations between deteriorated eating patterns and levels of anxiety and depression among the study participants. RESULTS The findings demonstrated a moderate and statistically significant correlation between deteriorated eating patterns and levels of anxiety and depression among the participants in the study. In evaluating the three dimensions of deteriorated eating patterns through regression analysis, it is observed that dieting (anxiety: β = 0.275, depression: β = 0.287) exhibits the highest potential in predicting the levels of anxiety and depression, followed by oral control (anxiety: β = 0.240, depression: β = 0.232) and bulimia & food preoccupation (anxiety: β = 0.218, depression: β = 0.186). CONCLUSIONS The findings highlight the necessity to place additional emphasis on students displaying deteriorated eating patterns and symptoms, as these individuals may potentially be experiencing accompanying mental health concerns warranting further assessment.
Collapse
Affiliation(s)
- Ayesha Mumtaz
- School of Public Administration, Hangzhou Normal University, Hangzhou, China
| | - Abdullah Addas
- Department of Civil Engineering, College of Engineering, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
- Landscape Architecture Department, Faculty of Architecture and Planning, King Abdulaziz University, P.O. Box 8, Jeddah, 0210, 21589, Saudi Arabia
| | - Wusi Zhou
- School of Public Administration, Hangzhou Normal University, Hangzhou, China.
| | - Shazia Rehman
- Department of Psychiatry, National Center for Mental Disorders, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Medical Center for Mental Health, 410011, Changsha, Hunan, China
| |
Collapse
|
3
|
Mason TB, Lesser EL, Dolgon-Krutolow AR, Wonderlich SA, Smith KE. An updated transdiagnostic review of social cognition and eating disorder psychopathology. J Psychiatr Res 2021; 143:602-627. [PMID: 33190838 DOI: 10.1016/j.jpsychires.2020.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023]
Abstract
Existing data suggest that deficits in social cognitive functioning are transdiagnostic phenomena that are observed across various forms of psychopathology. The goal of the present review was to provide an updated systematic review of the literature on social cognitive functioning across eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Studies that assessed six areas of social cognition were included: theory of mind, social perception, social knowledge, attributional bias, emotion perception, and emotion processing. A systematic search identified 71 studies, the majority of which examined adult women with AN. Research typically focused on alexithymia, theory of mind, empathy, social processing, emotion recognition, or emotion processing. Results suggested some deficits in social cognition in EDs. AN had the most studies with some evidence for deficiencies in social cognition but a fair amount of variability. Research on BN and BED was limited and inconsistent, though there appear to be some deficits in social cognition. Together, the limited coverage across EDs and heterogeneous methodology preclude firm conclusions regarding general or ED-specific deficits, as well as understanding the role of social cognition in ED etiology and maintenance. Therefore, several key questions and future directions are outlined for research moving forward.
Collapse
Affiliation(s)
- Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Anna R Dolgon-Krutolow
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen A Wonderlich
- Sanford Center for Bio-behavioral Research, Sanford Health, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
4
|
Blomberg M, Schlegel K, Stoll L, Febry H, Wünsch-Leiteritz W, Leiteritz A, Brockmeyer T. Reduced emotion recognition from nonverbal cues in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 29:868-878. [PMID: 34431168 DOI: 10.1002/erv.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/23/2021] [Accepted: 08/09/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recent models of anorexia nervosa (AN) emphasise the role of reduced emotion recognition ability (ERA) in the development and maintenance of the disorder. However, methodological limitations impede conclusions from prior research. The current study tries to overcome these limitations by examining ERA with an audio-visual measure that focuses strictly on multimodal nonverbal cues and allows to differentiate between ERA for different emotion categories. METHOD Forty women with AN and 40 healthy women completed the Geneva Emotion Recognition Test. This test includes 83 video clips in which 10 actors express 14 different emotions while saying a pseudo-linguistic sentence without semantic meaning. All clips contain multimodal nonverbal cues (i.e., prosody, facial expression, gestures, and posture). RESULTS Patients with AN showed poorer ERA than the healthy control group (d = 0.71), particularly regarding emotions of negative valence (d = 0.26). Furthermore, a lower body weight (r = 0.41) and longer illness duration (ρ = -0.32) were associated with poorer ERA in the AN group. CONCLUSIONS Using an ecologically valid instrument, the findings of the study support illness models emphasising poor ERA in AN. Directly addressing ERA in the treatment of AN with targeted interventions may be promising.
Collapse
Affiliation(s)
- Maximilian Blomberg
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Katja Schlegel
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Linda Stoll
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Hagen Febry
- Klinik Lueneburger Heide, Bad Bevensen, Germany
| | | | | | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| |
Collapse
|
5
|
Kerr-Gaffney J, Mason L, Jones E, Hayward H, Harrison A, Murphy D, Tchanturia K. Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa. J Autism Dev Disord 2021; 51:2077-2090. [PMID: 32910314 PMCID: PMC8124046 DOI: 10.1007/s10803-020-04686-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants' eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.
Collapse
Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Luke Mason
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Hannah Hayward
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
| | - Declan Murphy
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Ilia State University, Tbilisi, GA, USA
| |
Collapse
|
6
|
Inoue T, Otani R, Iguchi T, Ishii R, Uchida S, Okada A, Kitayama S, Koyanagi K, Suzuki Y, Suzuki Y, Sumi Y, Takamiya S, Tsurumaru Y, Nagamitsu S, Fukai Y, Fujii C, Matsuoka M, Iwanami J, Wakabayashi A, Sakuta R. Prevalence of autism spectrum disorder and autistic traits in children with anorexia nervosa and avoidant/restrictive food intake disorder. Biopsychosoc Med 2021; 15:9. [PMID: 34001197 PMCID: PMC8130445 DOI: 10.1186/s13030-021-00212-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) and feeding and eating disorders (FEDs) such as anorexia nervosa (AN) are strongly linked as evidenced by frequent comorbidity and overlapping traits. However, eating and social behaviors are shaped by culture, so it is critical to examine these associations in different populations. Moreover, FEDs are heterogeneous, and there has been no examination of autistic traits in avoidant/restrictive food intake disorder (ARFID). METHODS Therefore, we investigated the prevalence of ASD and autistic traits among Japanese children with AN (n = 92) or ARFID (n = 32) from a prospective multicenter cohort study using the Autism Spectrum Quotient Children's version (AQC) and Children's Eating Attitudes Test (ChEAT26). RESULTS ASD prevalence was high in both AN and ARFID (16.3 and 12.5%, respectively). The AN group exhibited significantly higher scores on all AQC subscales than an age-matched healthy control (HC) group, but there were no significant correlations between AQC scores and ChEAT26 scores. In the AFRID group, AQC scores did not differ from HCs, but significant correlations were found between total AQC and ChEAT26 scores and between several AQC and ChEAT26 subscales. CONCLUSIONS Both the AN and ARFID groups had high prevalence rates of ASD. The AN group showed a significantly higher degree of autistic traits than the HC group; however, no difference was found between the ARFID and HC groups. Clinicians need to be aware of these rates when working with children with ED.
Collapse
Affiliation(s)
- Takeshi Inoue
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan.
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Ryoko Otani
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan
| | - Toshiyuki Iguchi
- Department of Pediatrics, Hoshigaoka Maternity Hospital, Aichi, Japan
| | - Ryuta Ishii
- Department of Pediatrics and Child health, Kurume University School of Medicine, Fukuoka, Japan
| | - Soh Uchida
- Department of Pediatrics, Tachikawa Hospital, Tokyo, Japan
| | - Ayumi Okada
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Kenshi Koyanagi
- Nagasaki Prefectural Center of Medicine and Welfare for Children, Nagasaki, Japan
| | - Yuki Suzuki
- Department of Pediatrics, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Yuichi Suzuki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshino Sumi
- Mental and developmental clinic for children "Elm Tree", Hokaido, Japan
| | - Shizuo Takamiya
- Psychiatry Department, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
- Takamiya Psychiatry Clinic, Hyogo, Japan
| | - Yasuko Tsurumaru
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics and Child health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yoshimitsu Fukai
- Tokyo Metropolitan Children's Medical Center, Psychosomatic Medicine, Tokyo, Japan
| | - Chikako Fujii
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Michiko Matsuoka
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Junpei Iwanami
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan
| | | | - Ryoichi Sakuta
- Dokkyo Medical University Saitama Medical Center, Child Development and Psychosomatic Medicine Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama-Ken, 343-8555, Japan
| |
Collapse
|
7
|
Harrison A. Experimental Investigation of Non-Verbal Communication in Eating Disorders. Psychiatry Res 2021; 297:113732. [PMID: 33535088 DOI: 10.1016/j.psychres.2021.113732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
This study aimed to be the first to measure non-verbal communication in 25 eating disorder (ED) and 25 non-ED control participants during a naturalistic social interaction incorporating positive, negative and neutrally-valenced topics. The first hypothesis, that ED participants would show significantly reduced facial emotional expression than controls, was not supported. Supporting the second hypothesis of between-group differences in non-verbal behaviour, ED participants were less likely to lean in towards their interlocutor (d=.81) discussing negatively-valanced topics and were more likely to be positioned upright when discussing positively-valenced topics (d=.1.09) than controls. Irrespective of emotional valence, ED participants positioned their gaze on their interlocutor significantly less (d=.29) and spent more time looking down (d=.54), or away than controls (d=.63). ED participants moved their hands along with speech significantly less (d=.63) and gestured fewer real/hypothetical/imagined images/actions/objects) than controls (d=.57), irrespective of emotional valence. Instead, ED participants indicated discomfort in the social interaction, touching their nose (d=.89) or playing with their nails (d=.95) more often than controls. ED participants, regardless of emotional valence, showed significantly lowered electro-dermal activity (d=.60) than controls, supporting the exploratory hypothesis. People with EDs appear to make less efficient use of non-verbal communication than controls.
Collapse
Affiliation(s)
- A Harrison
- Associate Professor in Psychology, University College London, Institute of Education, Department of Psychology and Human Development.
| |
Collapse
|
8
|
Kerr-Gaffney J, Harrison A, Tchanturia K. Autism spectrum disorder traits are associated with empathic abilities in adults with anorexia nervosa. J Affect Disord 2020; 266:273-281. [PMID: 32056888 DOI: 10.1016/j.jad.2020.01.169] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/10/2019] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Social and emotional difficulties have been identified as key factors in the development and maintenance of anorexia nervosa (AN). However, few studies have investigated the influence of comorbid psychopathology on social cognition. The aim of the current study was to examine perception of nonverbal communication and empathy in AN using ecologically valid, performance-based measures, and to explore associations with comorbid psychopathology (anxiety, depression, autism spectrum disorder (ASD) traits, alexithymia, and social anxiety). METHODS In this cross-sectional study, the Multifaceted Empathy Test (MET) and the Mini Profile of Nonverbal Sensitivity (MiniPONS) were administered to 51 adults with AN, 51 recovered AN (REC), and 51 healthy controls (HCs). Comorbid psychopathological traits were assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule - 2nd edition (ADOS-2). RESULTS Individuals with AN showed reduced affective empathy to positive stimuli compared to HCs, and a trend towards lower vocal prosody recognition scores relative to REC. Around a quarter of AN and REC scored above the clinical cut-off for ASD on the ADOS-2, and high ASD symptoms predicted lower cognitive and affective empathy scores. LIMITATIONS The study is cross-sectional, future research would benefit from examining social-cognition performance and comorbid psychopathology longitudinally. CONCLUSIONS The findings highlight the importance of ASD symptoms in empathy dysfunction in those with a lifetime history of AN. Future research should explore whether treatment adaptations to accommodate for differences in social-cognitive abilities may be helpful in the treatment of AN.
Collapse
Affiliation(s)
- Jess Kerr-Gaffney
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom.
| | - Amy Harrison
- University College London, Department of Psychology and Human Development, London, United Kingdom; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom
| | - Kate Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom; Department of Psychology, Ilia State University, Tbilisi, Georgia
| |
Collapse
|
9
|
Isernia S, Sokolov AN, Fallgatter AJ, Pavlova MA. Untangling the Ties Between Social Cognition and Body Motion: Gender Impact. Front Psychol 2020; 11:128. [PMID: 32116932 PMCID: PMC7016199 DOI: 10.3389/fpsyg.2020.00128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 01/25/2023] Open
Abstract
We proved the viability of the general hypothesis that biological motion (BM) processing serves as a hallmark of social cognition. We assumed that BM processing and inferring emotions through BM (body language reading) are firmly linked and examined whether this tie is gender-specific. Healthy females and males completed two tasks with the same set of point-light BM displays portraying angry and neutral locomotion of female and male actors. For one task, perceivers had to indicate actor gender, while for the other, they had to infer the emotional content of locomotion. Thus, with identical visual input, we directed task demands either to BM processing or inferring of emotion. This design allows straight comparison between sensitivity to BM and recognition of emotions conveyed by the same BM. In addition, perceivers were administered a set of photographs from the Reading the Mind in the Eyes Test (RMET), with which they identified either emotional state or actor gender. Although there were no gender differences in performance on BM tasks, a tight link occurred between recognition accuracy of emotions and gender through BM in males. In females only, body language reading (both accuracy and response time) was associated with performance on the RMET. The outcome underscores gender-specific modes in visual social cognition and triggers investigation of body language reading in a wide range of neuropsychiatric disorders.
Collapse
Affiliation(s)
- Sara Isernia
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- CADITeR, IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Alexander N. Sokolov
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marina A. Pavlova
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| |
Collapse
|
10
|
Kucharska K, Kot E, Biernacka K, Zimowski J, Rogoza R, Rybakowski F, Kostecka B, Bednarska-Makaruk M. Interaction between polymorphisms of the oxytocinergic system genes and emotion perception in inpatients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:481-494. [PMID: 31385420 DOI: 10.1002/erv.2698] [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: 12/28/2018] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The empirical literature describes the role of the oxytocinergic system in emotion perception (EP). Variants in the oxytocin (OXT) and oxytocin receptor genes have been associated with mental disorders, including anorexia nervosa (AN), that are characterized by difficulties in socioemotional functioning. Our study aimed to examine whether variability within the genes related to OXT pathways may play a role in facial EP in inpatients with AN. METHOD Single nucleotide polymorphisms (SNPs) of the following genes: oxytocin receptor (rs2254298, rs53576), OXT (rs6133010), OXT-arginine-vasopressin (rs2740204), CD38 (rs6449197, rs3796863), and human leucyl/cystinylaminopeptidase (rs4869317) were genotyped in 60 AN female inpatients and 60 healthy control females (HCs). Associations between genetic polymorphisms and EP as well as clinical symptoms were examined. RESULTS The AN group showed decreased EP abilities compared with HCs. SNPs of rs2740204, rs6133010, and rs53576 were associated with differences in EP in women with AN and in HCs. The SNP of rs4869317 was associated with the level of eating disorders symptoms in HCs. CONCLUSIONS The OXT system may be involved in EP difficulties in AN. SNPs within genes related to OXT pathways may influence EP abilities. The leucyl/cystinylaminopeptidase rs4869317 SNP may be involved in the development of eating disorders psychopathology.
Collapse
Affiliation(s)
| | - Emilia Kot
- The Department of Neuroses, Personality Disorders and Eating Disorders, The Institute of Psychiatry and Neurology, Poland
| | - Katarzyna Biernacka
- The Department of Child and Adolescent Psychiatry, The Institute of Psychiatry and Neurology, Poland
| | - Janusz Zimowski
- The Department of Genetics, The Institute of Psychiatry and Neurology, Poland
| | - Radosław Rogoza
- Institute of Psychology, Cardinal Stefan Wyszyński University, Poland
| | - Filip Rybakowski
- The Department of Child and Adolescent Psychiatry, The Institute of Psychiatry and Neurology, Poland.,The Department of Adult Psychiatry, Poznan University of Medical Sciences, Poland
| | - Barbara Kostecka
- The Department of Neuroses, Personality Disorders and Eating Disorders, The Institute of Psychiatry and Neurology, Poland
| | | |
Collapse
|
11
|
Giombini L, Nesbitt S, Leppanen J, Cox H, Foxall A, Easter A, Tchanturia K. Emotions in play: young people's and clinicians' experience of 'Thinking about Emotions' group. Eat Weight Disord 2019; 24:605-614. [PMID: 30737647 PMCID: PMC6647864 DOI: 10.1007/s40519-019-00646-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/18/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Emotional difficulties in young people (YP) with anorexia nervosa (AN) are well recognised. Improved strategies are needed to support inpatients to tolerate group therapy and to help them to better identify and manage their emotions. Cognitive Remediation and Emotion Skills Training (CREST) for AN adults, aimed at improving emotional processing skills, has been found beneficial in adult AN groups. A case series of CREST was conducted in an inpatient ward for YP (CREST-YP) to evaluate its suitability for a younger population. METHODS A mixed-methods assessment was used. Thirty-two YP and 3 facilitators took part in qualitative interviews. YP (n = 32) also completed pre- and post-self-report questionnaires assessing emotional functioning. RESULTS Preliminary qualitative results showed that YP found it helpful to learn about emotion processes. More support is needed to clarify the link between emotions and AN. Quantitative results showed no significant changes in YP's self-perceived emotional functioning. Although no statistically significant changes were observed, a small increase in YP's use of both reappraisal (standardised mean changes scores, SMCC 0.22) and suppression (SMCC - 0.22) as a means to regulate their emotions was found. CONCLUSIONS Pilot findings suggest that CREST-YP is a suitable intervention for YP with AN. Age-appropriate adaptations are needed to improve YP's engagement in group CREST. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series.
Collapse
Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE58AF, UK.
| | - Sophie Nesbitt
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE58AF, UK
| | - Hannah Cox
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Anna Foxall
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Abigail Easter
- Research and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience Health Services, PO59 King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE58AF, UK
- Department of Psychology, Illia University, Tbilisi, Georgia
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Izydorczyk B, Sitnik-Warchulska K, Lizińczyk S, Lipiarz A. Psychological Predictors of Unhealthy Eating Attitudes in Young Adults. Front Psychol 2019; 10:590. [PMID: 30941079 PMCID: PMC6433833 DOI: 10.3389/fpsyg.2019.00590] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/04/2019] [Indexed: 01/24/2023] Open
Abstract
The objective of this study was to determine the predictive role of psychological risk factors for restrained and compulsive eating in young women and men. We examined the relationship between resilience, impulsivity, emotional intelligence and self-esteem, and restrained and compulsive eating. It was assumed that resilience and impulsivity can directly explain unhealthy eating attitudes (restrained and compulsive: both emotional eating and external eating). The study group comprised 211 individuals (105 men and 106 women) aged 20-29, all of whom were living in southern Poland. Measures included the Resilience Measurement Scale (SPP-25), the Eysenck's Impulsivity Inventory (IVE), the Multidimensional Self-Esteem Inventory (MSEI), the Emotional Intelligence Questionnaire (INTE), and the Polish adaptation of the Dutch Eating Behavior Questionnaire (DEBQ). The statistical analysis showed significant and positive correlations between emotional eating and general self-esteem, impulsivity, and weaker (but still significant) correlations with physical attractiveness. External eating was positively and significantly correlated with impulsivity and self-esteem (including physical attractiveness). Restrained eating was also positively and significantly correlated with general self-esteem. Both types of compulsive eating attitudes (emotional and external eating) were significantly and negatively correlated with resilience. Women showed a significantly higher positive correlation between impulsivity and external eating compared to men. The level of intensity of other measures proved similar across the entire study group regardless of sex. Impulsivity had the strongest and most direct significant influence on both emotional eating and external eating, and a negative effect on emotional intelligence. Resilience proved to have a significant impact on all three examined types of eating attitude (a direct negative effect on emotional eating and external eating, and positive direct effect on restrained eating), self-esteem, and emotional intelligence. An important psychological intervening variable in generating unhealthy eating attitudes proved to be self-esteem among both men and women. Emotional intelligence, which remains correlated with resilience, proved independent, with no effect on unhealthy eating attitudes. These results suggest that preventive treatment and educational programs implemented particularly among adolescents and young adults may support development of their psychological resources.
Collapse
Affiliation(s)
- Bernadetta Izydorczyk
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Katarzyna Sitnik-Warchulska
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Sebastian Lizińczyk
- Katowice Faculty of Psychology, SWPS University of Social Sciences and Humanities, Katowice, Poland
| | - Adrianna Lipiarz
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| |
Collapse
|
13
|
Oldershaw A, Startup H, Lavender T. Anorexia Nervosa and a Lost Emotional Self: A Psychological Formulation of the Development, Maintenance, and Treatment of Anorexia Nervosa. Front Psychol 2019; 10:219. [PMID: 30886593 PMCID: PMC6410927 DOI: 10.3389/fpsyg.2019.00219] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022] Open
Abstract
In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a 'lost sense of emotional self.' We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of 'emotional self.' Further, we discuss how, once established, AN becomes 'self-perpetuating' and the 'lost sense of emotional self' relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an 'emotional self' which can be flexibly and adaptively used to direct an individual's needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.
Collapse
Affiliation(s)
- Anna Oldershaw
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
- Kent and Medway All Age Eating Disorder Service, North East London NHS Foundation Trust, London, United Kingdom
| | - Helen Startup
- Sussex Eating Disorders Service and Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Tony Lavender
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
| |
Collapse
|
14
|
Harrison A, Watterson SV, Bennett SD. An experimental investigation into the use of eye-contact in social interactions in women in the acute and recovered stages of anorexia nervosa. Int J Eat Disord 2018; 52:61-70. [PMID: 30578634 DOI: 10.1002/eat.22993] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/11/2018] [Accepted: 11/15/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE People with anorexia nervosa (AN) report significant difficulties in social functioning and a growing literature is beginning to explain some of the differences in social skills that might underlie the social challenges experienced by patients. One vital area of social functioning that has been largely neglected to date is how eye-contact is used in the context of social stimuli and in social situations. METHODS This cross-sectional, experimental study used eye-tracking to measure the frequency and duration of eye-contact made with the eye region of interest (ROI) of (1) static social stimuli (man and woman Ekman faces displaying basic emotions); (2) moving social stimuli (a video of two actors conversing); and (3) during a real-life social interaction in 75 women (25 with AN, 25 recovered from AN, and 25 non-AN controls; mean age = 27.18, SD = 6.19). RESULTS Participants showed greater eye-contact during a real-life social interaction than when viewing static social stimuli. Those with AN made contact with the eye ROI of the static and moving social stimuli and during a real-life social interaction significantly less often and for significantly less time than non-AN controls. Those recovered from AN showed greater eye-contact than the acute group but significantly less eye-contact with the eye ROI across the static and moving social stimuli and during the real-life social interaction than non-AN controls. DISCUSSION These findings contribute new knowledge regarding the types of social skills that people with AN may need additional support with to allow them to make greater use of social support in their recovery.
Collapse
Affiliation(s)
- Amy Harrison
- University College London, Institute of Education, London, United Kingdom
- School of Psychotherapy and Psychology, Regent's University London, London, United Kingdom
| | - Stephanie V Watterson
- School of Psychotherapy and Psychology, Regent's University London, London, United Kingdom
| | - Samuel D Bennett
- School of Psychotherapy and Psychology, Regent's University London, London, United Kingdom
| |
Collapse
|
15
|
Okruszek Ł. It Is Not Just in Faces! Processing of Emotion and Intention from Biological Motion in Psychiatric Disorders. Front Hum Neurosci 2018; 12:48. [PMID: 29472852 PMCID: PMC5809469 DOI: 10.3389/fnhum.2018.00048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/26/2018] [Indexed: 01/29/2023] Open
Abstract
Social neuroscience offers a wide range of techniques that may be applied to study the social cognitive deficits that may underlie reduced social functioning—a common feature across many psychiatric disorders. At the same time, a significant proportion of research in this area has been conducted using paradigms that utilize static displays of faces or eyes. The use of point-light displays (PLDs) offers a viable alternative for studying recognition of emotion or intention inference while minimizing the amount of information presented to participants. This mini-review aims to summarize studies that have used PLD to study emotion and intention processing in schizophrenia (SCZ), affective disorders, anxiety and personality disorders, eating disorders and neurodegenerative disorders. Two main conclusions can be drawn from the reviewed studies: first, the social cognitive problems found in most of the psychiatric samples using PLD were of smaller magnitude than those found in studies presenting social information using faces or voices. Second, even though the information presented in PLDs is extremely limited, presentation of these types of stimuli is sufficient to elicit the disorder-specific, social cognitive biases (e.g., mood-congruent bias in depression, increased threat perception in anxious individuals, aberrant body size perception in eating disorders) documented using other methodologies. Taken together, these findings suggest that point-light stimuli may be a useful method of studying social information processing in psychiatry. At the same time, some limitations of using this methodology are also outlined.
Collapse
Affiliation(s)
- Łukasz Okruszek
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| |
Collapse
|
16
|
Dell'Osso L, Carpita B, Gesi C, Cremone IM, Corsi M, Massimetti E, Muti D, Calderani E, Castellini G, Luciano M, Ricca V, Carmassi C, Maj M. Subthreshold autism spectrum disorder in patients with eating disorders. Compr Psychiatry 2018; 81:66-72. [PMID: 29268154 DOI: 10.1016/j.comppsych.2017.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022] Open
Abstract
AIM Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours. METHODS 138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R). RESULTS participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs. CONCLUSIONS Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged.
Collapse
Affiliation(s)
- L Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - B Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - C Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - I M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - D Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Calderani
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - G Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - M Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| |
Collapse
|
17
|
Okruszek Ł, Pilecka I. Biological motion processing in schizophrenia - Systematic review and meta-analysis. Schizophr Res 2017; 190:3-10. [PMID: 28285029 DOI: 10.1016/j.schres.2017.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/24/2017] [Accepted: 03/05/2017] [Indexed: 10/20/2022]
Abstract
CONTEXT Patients with schizophrenia show impairments in processing of biological motion. This is especially important since deficits in domains of social cognition has been associated with functional outcome and everyday functioning in this population. OBJECTIVES We conducted a systematic review and meta-analysis of studies which have used point-light displays to present whole-body motion to patients with schizophrenia and healthy controls, to evaluate the magnitude of differences between these groups in biological motion processing. METHOD Firstly, relevant publications were identified by a systematic search of Google Scholar and PubMed databases. Secondly, we excluded non-relevant studies for the meta-analysis according to our exclusion criteria. Effect sizes were expressed as standardized mean difference (SMD). RESULTS 15 papers reporting results of 14 different experiments with 571 patients and 482 controls were included in the meta-analysis. The results for the general biological motion perception analysis revealed that patients with schizophrenia (compared with healthy controls) present reduced biological motion processing capacity with the effect size (SMD) of 0.66 (95% CI, -0.79 to -0.54; p<0.001). The results for the specific biological motion-based tasks were also statistically significant with SMD of 0.72 for Basic Biological Motion task (95% CI: -0.94 to -0.51; p<0.001) and SMD of 0.61 for Emotion in Biological Motion task, (95% CI: -0.79 to -0.43; p<0.001) respectively. CONCLUSION The findings from our meta-analysis highlight abnormalities in general and specific domains of biological motion perception in schizophrenia patients as compared with healthy controls.
Collapse
Affiliation(s)
- Łukasz Okruszek
- Clinical Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
| | - Izabela Pilecka
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| |
Collapse
|
18
|
Geary DC. Evolution of Human Sex-Specific Cognitive Vulnerabilities. QUARTERLY REVIEW OF BIOLOGY 2017. [DOI: 10.1086/694934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
19
|
Treasure J, Cardi V. Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch's Foundation Lecture? EUROPEAN EATING DISORDERS REVIEW 2017; 25:139-147. [PMID: 28402069 DOI: 10.1002/erv.2511] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 12/13/2022]
Abstract
Hilde Bruch's foundation lecture in 1982 is a milestone from which to survey current theory and treatment for anorexia nervosa. Bruch described problems in body perception, emotion processing and interpersonal relationships as core theoretical aspects of the illness and built her theory of psychopathology on these aspects, as well as on animal studies on attachment. She also noted that many psychological problems result as consequence of starvation. In the first part of this paper, we parse Bruch's clinical descriptions into elements of psychopathology (disturbances in body perception, attachment, emotion expression, perception and regulation, social comparison, interpersonal, and family and therapeutic relationships), in order to assemble and update the theoretical evidence for a model of the illness. In the second part, we describe and extend her description of three core targets of treatment: family relationships, patient's inner confusion and nutritional restoration. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Collapse
Affiliation(s)
- Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Valentina Cardi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| |
Collapse
|
20
|
Investigation of Autism Spectrum Disorder and Autistic Traits in an Adolescent Sample with Anorexia Nervosa. J Autism Dev Disord 2017; 47:1051-1061. [PMID: 28120263 DOI: 10.1007/s10803-016-3023-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study aimed to examine the presence of Autism Spectrum Disorder (ASD) in a sample of female adolescents with Anorexia Nervosa (AN) during the acute phase of illness. We also compare the level of autistic traits, social perception skills and obsessive-compulsive symptoms in four groups: AN, ASD, and two gender- and age-matched control groups. Of the 30 AN participants, only three scored above the conventional ADOS-2 threshold for ASD. The AN participants were similar to their controls on autistic trait measures, and to the ASD group on obsessive-compulsive measures, and on theory of mind ability and affect recognition measures. Further longitudinal studies are needed in order to determine the association between these conditions.
Collapse
|
21
|
Dapelo MM, Surguladze S, Morris R, Tchanturia K. Emotion Recognition in Face and Body Motion in Bulimia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 25:595-600. [DOI: 10.1002/erv.2554] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/13/2017] [Accepted: 08/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Robin Morris
- Department of Psychology, IoPPN; King's College London (KCL); UK
| | - Kate Tchanturia
- Psychological Medicine, IoPPN; King's College London (KCL); UK
- Ilia State University Tbilisi; Georgia
| |
Collapse
|
22
|
Seike K, Nakazato M, Hanazawa H, Ohtani T, Niitsu T, Ishikawa SI, Ayabe A, Otani R, Kawabe K, Horiuchi F, Takamiya S, Sakuta R. A questionnaire survey regarding the support needed by Yogo teachers to take care of students suspected of having eating disorders (second report). Biopsychosoc Med 2016; 10:28. [PMID: 27708695 PMCID: PMC5041275 DOI: 10.1186/s13030-016-0079-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The lowering of the age of onset and chronicity have been key problems related to eating disorders (EDs). As the proportion of teens in the estimated onset ages has increased, it has become important to detect students with EDs and to clarify how they can be supported. Though epidemiological surveys of Yogo teachers (school nurse/health science teachers) have been conducted to inquire about the number of such students, none of these were done according to ED type based on DSM-5. Thus, we conducted a wide area survey in Japan with the goal of proposing a better framework of support for Yogo teachers in their efforts to care for students with EDs. METHODS A questionnaire survey organized by ED type (based on DSM-5) was administered to Yogo teachers working at elementary/junior high/senior high/special needs schools in four prefectures of Japan in 2015, and 1,886 responses were obtained. Based on the results, the encounter rates (the proportion of Yogo teachers who had encountered a student with an ED) were calculated, and factors that could affect the rates were examined by logistic regression analysis. RESULTS The order of the encounter rates of the ED types was as follows: Anorexia Nervosa (AN) > Bulimia Nervosa (BN) > Avoidant/Restrictive Food Intake Disorder (ARFID) > Binge Eating Disorder (BED) > Others. The factors significantly affecting the rates were "location, school type, number of students, experience years, and AN knowledge" for AN, "school type, experience years, and BN knowledge" for BN, "school type, experience years, and BED knowledge" for BED, "location, experience years, and ARFID knowledge" for ARFID, and "school type, experience years, and Others knowledge" for Others. CONCLUSIONS Because the encounter rate of AN was the highest, providing support for AN would be the most effective. Moreover, one factor that affected the encounter rate of all ED types was ED knowledge. In addition to this, senior high schools had the highest encounter rates for AN, BN and BED, and special needs schools had the highest rates for Others. These findings imply that, in order to detect and support ED students at an early stage, it is necessary to offer knowledge of the most prevalent ED types to Yogo teachers at the corresponding school type.
Collapse
Affiliation(s)
- Kaoru Seike
- United Graduate School of Child Development, Osaka University, 2 Yamadaoka, Suita-city, Osaka Prefecture 565-0871 Japan ; Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan
| | - Michiko Nakazato
- United Graduate School of Child Development, Osaka University, 2 Yamadaoka, Suita-city, Osaka Prefecture 565-0871 Japan ; Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan
| | - Hisashi Hanazawa
- Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan ; Faculty of Education, Chiba University, 1-33 Yayoi, Inage-ku, Chiba-city, Chiba Prefecture 263-0022 Japan
| | - Toshiyuki Ohtani
- Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan ; Safety and Health Organization, Chiba University, 1-33 Yayoi, Inage-ku, Chiba-city, Chiba Prefecture 263-0022 Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan
| | - Shin-Ichi Ishikawa
- Department of Psychiatry, Nishi-Kobe Medical Center, Kobe, 5-7-1 Koujidai, Nishi-ku, Kobe-city, Hyogo Prefecture 651-2273 Japan ; Kishibe Psychiatry Clinic, 1-24-1 Kishibe Minami, Suita-city, Osaka Prefecture 564-0011 Japan
| | - Atsuko Ayabe
- Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-koshigaya, Koshigaya-city, Saitama Prefecture 343-0845 Japan
| | - Ryoko Otani
- Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-koshigaya, Koshigaya-city, Saitama Prefecture 343-0845 Japan
| | - Kentaro Kawabe
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa Toon-City, Ehime Prefecture 791-0204 Japan ; Center for Child Health, Behavior and Development, Ehime University Hospital, Shitsukawa Toon-City, Ehime Prefecture 791-0204 Japan
| | - Fumie Horiuchi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa Toon-City, Ehime Prefecture 791-0204 Japan ; Center for Child Health, Behavior and Development, Ehime University Hospital, Shitsukawa Toon-City, Ehime Prefecture 791-0204 Japan
| | - Shizuo Takamiya
- Department of Psychiatry, Nishi-Kobe Medical Center, Kobe, 5-7-1 Koujidai, Nishi-ku, Kobe-city, Hyogo Prefecture 651-2273 Japan ; Takamiya Mental Clinic, Akashi, Marunouchi Bldg 5F, 2-5-2 Marunouchi, Akashi-city, Hyogo Prefecture 673-0016 Japan
| | - Ryoichi Sakuta
- Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-koshigaya, Koshigaya-city, Saitama Prefecture 343-0845 Japan
| |
Collapse
|
23
|
Westwood H, Eisler I, Mandy W, Leppanen J, Treasure J, Tchanturia K. Using the Autism-Spectrum Quotient to Measure Autistic Traits in Anorexia Nervosa: A Systematic Review and Meta-Analysis. J Autism Dev Disord 2016; 46:964-77. [PMID: 26542816 PMCID: PMC4746216 DOI: 10.1007/s10803-015-2641-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interest in the link between Autism Spectrum Disorder (ASD) and Anorexia Nervosa (AN) has led to estimates of the prevalence of autistic traits in AN. This systematic review and meta-analysis assessed the use of the Autism-Spectrum Quotient (AQ) or abbreviated version (AQ-10) to examine whether patients with AN have elevated levels of autistic traits. Seven studies were identified and subsequent meta-analysis indicated that those with AN appear to have significant difficulties of a manner characteristic of ASD, relative to controls. Whilst this analysis supports previous indications of higher prevalence of ASD in AN, the aetiology of these traits remains unclear. Studies using more robust clinical measures of ASD within AN are needed to confirm what self-report measures appear to show.
Collapse
Affiliation(s)
- Heather Westwood
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK
| | - Ivan Eisler
- Child and Adolescent Eating Disorders Service, Maudsley Hospital, London, SE5 8AZ, UK
- Department of Psychology, IoPPN, King's College London (KCL), London, UK
| | - William Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Jenni Leppanen
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK
| | - Janet Treasure
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK
| | - Kate Tchanturia
- Psychological Medicine, IoPPN, King's College London (KCL), PO59, London, SE5 8AF, UK.
- Child and Adolescent Eating Disorders Service, Maudsley Hospital, London, SE5 8AZ, UK.
- Ilia State University, Tbilisi, Georgia.
| |
Collapse
|
24
|
Seike K, Hanazawa H, Ohtani T, Takamiya S, Sakuta R, Nakazato M. A Questionnaire Survey of the Type of Support Required by Yogo Teachers to Effectively Manage Students Suspected of Having an Eating Disorder. Biopsychosoc Med 2016; 10:15. [PMID: 27168762 PMCID: PMC4862230 DOI: 10.1186/s13030-016-0065-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022] Open
Abstract
Background Many studies have focused on the decreasing age of onset of eating disorders (EDs). Because school-age children with EDs are likely to suffer worse physical effects than adults, early detection and appropriate support are important. The cooperation of Yogo teachers is essential in helping these students to find appropriate care. To assist Yogo teachers, it is helpful to clarify the encounter rates (the proportion of Yogo teachers who have encountered ED students) and kinds of requested support (which Yogo teachers felt necessary to support ED students). There are no studies that have surveyed the prevalence rates of ED children by ED type as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), nor were we able to find any quantitative study surveying the kinds of support Yogo teachers feel helpful to support ED students. Methods A questionnaire survey was administered to 655 Yogo teachers working at elementary/junior high/senior high/special needs schools in Chiba Prefecture. The questionnaire asked if the respondents had encountered students with each of the ED types described in DSM-5 (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other types of EDs (Others)), and the kinds of support they felt necessary to support these students. The encounter rates and the kinds of requested were obtained and compared, taking their confidence intervals into consideration. Results The encounter rates for AN, BN, BED, ARFID, and Others were 48.4, 14.0, 8.4, 10.7, and 4.6 %, respectively. When classified by school type, AN, BN, BED, and ARFID had their highest encounter rates in senior high schools. Special needs schools had the highest rate for Others. The support most required for all ED types was “a list of medical/consultation institutions.” Conclusions Our results have clarified how to support Yogo teachers in the early detection and support of ED students. We found that the encounter rate of AN was the highest, and that it is effective to offer “a list of medical/consultation institutions” to junior and senior high schools where the encounter rates for AN are high.
Collapse
Affiliation(s)
- Kaoru Seike
- United Graduate School of Child Development, Osaka University, 2 Yamadaoka Suita-city, Osaka, Prefecture 565-0871 Japan ; Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan
| | - Hisashi Hanazawa
- Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan ; Faculty of Education, Chiba University, 1-33 Yayoi, Inage-ku, Chiba-city, Chiba Prefecture 263-0022 Japan
| | - Toshiyuki Ohtani
- Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan ; Safety and Health Organization, Chiba University, 1-33 Yayoi, Inage-ku, Chiba-city, Chiba Prefecture 263-0022 Japan
| | - Shizuo Takamiya
- Department of Psychiatry, Nishi-Kobe Medical Center, 5-7-1 Koujidai, Nishi-ku, Kobe-city, Hyogo, Prefecture 651-2273 Japan
| | - Ryoichi Sakuta
- Center for Child Development and Psychosomatic Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-koshigaya, Koshigaya-city, Saitama Prefecture 343-0845, Japan
| | - Michiko Nakazato
- United Graduate School of Child Development, Osaka University, 2 Yamadaoka Suita-city, Osaka, Prefecture 565-0871 Japan ; Research Center for Child Mental Development Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba Prefecture 260-8670 Japan
| |
Collapse
|
25
|
Jewell T, Collyer H, Gardner T, Tchanturia K, Simic M, Fonagy P, Eisler I. Attachment and mentalization and their association with child and adolescent eating pathology: A systematic review. Int J Eat Disord 2016; 49:354-73. [PMID: 26691270 DOI: 10.1002/eat.22473] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Insecure attachment and mentalizing difficulties have been associated with eating pathology in adulthood. However, it is unclear whether eating pathology is associated with attachment or mentalization in children. The aim of this study is to systematically review the literature in this emerging field. METHOD Electronic databases were used to search for articles. RESULTS Twenty-two studies were identified. In the 15 studies investigating attachment, an association with eating pathology was found in all studies. Mentalizing difficulties and eating pathology were found to be correlated in the seven studies which examined their association. DISCUSSION In keeping with the adult literature, cross-sectional studies of children and adolescents consistently report associations with eating pathology. There is some evidence from prospective studies that insecure attachment may be a risk factor for the development of eating pathology in adolescence. The literature on mentalization and eating pathology suggests that adolescents with anorexia nervosa may have difficulties in recognizing emotions. Further research using clinical samples and well-validated measures of attachment and mentalization are required to shed further light on this area.
Collapse
Affiliation(s)
- Tom Jewell
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Hannah Collyer
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Tessa Gardner
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Mima Simic
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Ivan Eisler
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, United Kingdom
| |
Collapse
|
26
|
Dalmaso M, Castelli L, Scatturin P, Carli L, Todisco P, Palomba D, Galfano G. Altered social attention in anorexia nervosa during real social interaction. Sci Rep 2016; 6:23311. [PMID: 26984784 PMCID: PMC4794739 DOI: 10.1038/srep23311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/29/2016] [Indexed: 11/09/2022] Open
Abstract
The capacity to devote attentional resources in response to body-related signals provided by others is still largely unexplored in individuals with Anorexia Nervosa (AN). Here, we tested this capacity through a novel paradigm that mimics a social interaction with a real partner. Healthy individuals (Experiment 1) and individuals with AN (Experiment 2) completed a task with another person which consisted in performing, alternatively, rapid aiming movements to lateralised targets. Generally, this task leads to a form of Inhibition of Return (IOR), which consists of longer reaction times when an individual has to respond to a location previously searched by either himself (individual IOR) or by the partner (social IOR) as compared to previously unexplored locations. IOR is considered as an important attentional mechanism that promotes an effective exploration of the environment during social interaction. Here, healthy individuals displayed both individual and social IOR that were both reliable and of the same magnitude. Individuals with AN displayed a non-significant individual IOR but a reliable social IOR that was also significantly stronger than individual IOR. These results suggest the presence of a reduced sensitivity in processing body-related stimuli conveyed by oneself in individuals with AN which is reflected in action-based attentional processes.
Collapse
Affiliation(s)
- Mario Dalmaso
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di Padova, Italy
| | - Luigi Castelli
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di Padova, Italy.,Centro di Neuroscienze Cognitive, Università di Padova, Italy
| | - Pietro Scatturin
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di Padova, Italy
| | - Lorenza Carli
- Centro per i Disturbi del Comportamento Alimentare, Casa di Cura Villa Margherita, Arcugnano, Italy
| | - Patrizia Todisco
- Centro per i Disturbi del Comportamento Alimentare, Casa di Cura Villa Margherita, Arcugnano, Italy
| | - Daniela Palomba
- Dipartimento di Psicologia Generale, Università di Padova, Italy.,Centro di Neuroscienze Cognitive, Università di Padova, Italy
| | - Giovanni Galfano
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di Padova, Italy.,Centro di Neuroscienze Cognitive, Università di Padova, Italy
| |
Collapse
|
27
|
Lang K, Larsson EEC, Mavromara L, Simic M, Treasure J, Tchanturia K. Diminished facial emotion expression and associated clinical characteristics in Anorexia Nervosa. Psychiatry Res 2016; 236:165-172. [PMID: 26778369 DOI: 10.1016/j.psychres.2015.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/30/2015] [Accepted: 12/04/2015] [Indexed: 11/25/2022]
Abstract
This study aimed to investigate emotion expression in a large group of children, adolescents and adults with Anorexia Nervosa (AN), and investigate the associated clinical correlates. One hundred and forty-one participants (AN=66, HC= 75) were recruited and positive and negative film clips were used to elicit emotion expressions. The Facial Activation Coding system (FACES) was used to code emotion expression. Subjective ratings of emotion were collected. Individuals with AN displayed less positive emotions during the positive film clip compared to healthy controls (HC). There was no significant difference between the groups on the Positive and Negative Affect Scale (PANAS). The AN group displayed emotional incongruence (reporting a different emotion to what would be expected given the stimuli, with limited facial affect to signal the emotion experienced), whereby they reported feeling significantly higher rates of negative emotion during the positive clip. There were no differences in emotion expression between the groups during the negative film clip. Despite this individuals with AN reported feeling significantly higher levels of negative emotions during the negative clip. Diminished positive emotion expression was associated with more severe clinical symptoms, which could suggest that these individuals represent a group with serious social difficulties, which may require specific attention in treatment.
Collapse
Affiliation(s)
- Katie Lang
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Emma E C Larsson
- King's College London (KCL), Mental Health Studies Programme, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Liza Mavromara
- King's College London (KCL), Mental Health Studies Programme, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Mima Simic
- Child & Adolescent Eating Disorder Team, South London & Maudsley NHS Trust, UK
| | - Janet Treasure
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Kate Tchanturia
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, UK; King's College London (KCL), Mental Health Studies Programme, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, UK; Illia University Tbilisi, Department of Psychology, Georgia.
| |
Collapse
|