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

The impact of oxytocin on emotion recognition and trust: Does disordered eating moderate these relationships?

OBJECTIVES

The current study aimed to investigate the impact of oxytocin on emotion recognition, trust, body image, affect, and anxiety and whether eating disorder (ED) symptoms moderated any of these relationships.

METHOD

Participants (n = 149) were female university students, who were randomly allocated to receive in a double-blind nature, a single dose of oxytocin intranasal spray (n = 76) or a placebo (saline) intranasal spray (n = 73). Participants were asked to complete an experimental measure of emotion recognition and an investor task aimed to assess trust.

RESULTS

The oxytocin group exhibited better overall performance on the emotion recognition task (especially with recognising positive emotions), and a decline in state positive affect than the control group at post-intervention. However, these effects were not moderated by ED symptom severity, nor were effects found for state anxiety, negative affect, body image and recognising negative emotions in the emotion recognition task.

CONCLUSION

The current findings contribute to the growing literature on oxytocin, emotion recognition and positive affect and suggest that ED pathology does not moderate these relationships. Future research would benefit from examining the efficacy of an oxytocin intervention using a within-subjects, cross-over design, in those with sub-clinical and clinical EDs, as well as healthy controls.

Exploring the relationship between emotion regulation, inhibitory control, and eating psychopathology in a non-clinical sample

OBJECTIVE

The present study aimed to explore the relationship between difficulties in emotion regulation and deficits in inhibitory control, and the role of these processes in eating psychopathology in a non-clinical sample. We also explored the specificity in which deficits in inhibitory control may underlie eating psychopathology, namely whether they can be conceptualised as context specific or more extensive in nature.

METHOD

Participants were 107 healthy individuals recruited at a major Portuguese university, aged between 18 and 43 years-old (M = 21.23, SD = 4.79). Two computerised neuropsychological tasks (i.e., emotional go/no-go and food go/no-go tasks) were used to assess response inhibition in the presence of general versus context-specific stimuli. A set of self-report measures was used to assess variables of interest such as emotion regulation and eating psychopathology.

RESULTS

Results indicated higher response inhibition deficits among participants with higher difficulties in emotion regulation comparing to those with lower difficulties in emotion regulation, particularly in the context of food-related stimuli. In addition, the relationship between difficulties in emotion regulation and eating psychopathology was moderated by inhibitory control deficits in both the context of food and pleasant stimuli.

CONCLUSIONS

The present findings highlight inhibitory control as an important process underlying the relationship between difficulties in emotion regulation and eating psychopathology in non-clinical samples. Findings have important implications for clinical practice and the prevention of eating psychopathology in healthy individuals and individuals with eating disorders.

A systematic review of the relationship between alexithymia and emotional eating in adults

Elucidating psychological characteristics associated with emotional eating may further inform interventions for this behaviour related to eating psychopathology. The present systematic review aimed to examine the relationship between alexithymia and self-reported emotional eating in adults, and provide a narrative synthesis of the existing literature. Using the PRISMA method for systematic reviews, six databases (MEDLINE, PsycInfo, PsycArticles, PubMed, SCOPUS, and Web of Science) were searched for peer-reviewed, quantitative research published between January 1994 and 20^th July 2021, when the searches were conducted. Eligible articles investigated the association between alexithymia, as measured by the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), and emotional eating, as measured by any validated self-report instrument. Nine cross-sectional articles were reviewed, and risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies (Downes, Brennan, Williams, & Dean, 2016). A narrative synthesis of articles suggests positive associations between alexithymia and self-reported emotional eating. Five measures of emotional eating were used across articles, with limited but consistent evidence for the relationship between alexithymia and emotional eating as measured by the Dutch Eating Behaviour Questionnaire (Van strien et al., 1986). Further research is required to add evidence to the nature of the relationship between alexithymia and emotional eating, and to explore mechanisms that might underpin any relationships. Understanding the association between alexithymia and emotional eating may support strategies and interventions for those seeking help for emotional eating and related eating behaviours.

Associations among alexithymia, disordered eating, and depressive symptoms in treatment-seeking adolescent military dependents at risk for adult binge-eating disorder and obesity

PURPOSE

Evidence suggests that difficulties identifying and describing one's feelings, core components of alexithymia, are associated with attitudinal and behavioral symptoms of disordered eating; depressive symptoms also may underlie these associations. Specifically, research indicates that alexithymia is positively related to depressive symptoms, which in turn may promote both disordered-eating attitudes and certain disinhibited-eating behaviors (e.g., emotional eating). Findings also suggest that military-dependent youth with high weight may exhibit elevated depressive symptoms and disordered eating. As such, understanding associations among alexithymia, depressive symptoms, and disordered eating is particularly relevant for this vulnerable population.

METHODS

We examined 149 adolescent military dependents (14.4 ± 1.6y; 55.0% female; 20.0% non-Hispanic Black; BMIz: 1.9 ± 0.4) at high risk for binge-eating disorder and obesity in adulthood. Participants completed questionnaires assessing two components of alexithymia (difficulty identifying feelings [DIF] and difficulty describing feelings [DDF]), depressive symptoms, emotional eating, and trait anxiety; disordered-eating attitudes were assessed via semi-structured interview.

RESULTS

A series of regression-based models examined indirect relationships of DIF and DDF with disordered-eating attitudes and emotional eating through depressive symptoms. Bootstrapped 95% confidence intervals revealed a significant indirect path from each of the alexithymia components to disordered-eating attitudes via depressive symptoms; indirect paths to emotional eating were non-significant.

CONCLUSION

Results support the salience of depressive symptoms in the relationship between alexithymia and disordered-eating attitudes. Future research should utilize prospective designs and explore direct and indirect associations of alexithymia with other disordered-eating behaviors.

LEVEL OF EVIDENCE

Level III, evidence obtained from a well-designed cohort study.

Social-emotional functioning in young people with symptoms of eating disorders: A gender inclusive analogue study

INTRODUCTION

Contemporary models of eating disorders (EDs) suggest that EDs are maintained by social-emotional difficulties. However, supporting evidence is derived largely from female, clinic-based samples. This study, which refrained from gender specific inclusion criteria, aimed to improve understanding of social-emotional functioning in a large community-based analogue sample of young adults aged 16-26.

METHODS

Five hundred and forty-four participants (85.1% female; mean age 21, SD = 4.3) completed the Eating Attitudes Test, Clinical Outcomes in Routine Evaluation, Difficulties in Emotion Regulation Scale, Social Phobia Inventory, Revised Social Anhedonia Scale, Toronto Alexithymia Scale, and the Reading the Mind in the Eyes Task.

RESULTS

One hundred and sixty-four participants scored over the EAT-26 clinical cutoff, and a two-way multivariate analysis of covariance found a medium-sized, statistically significant main effect of group on social-emotional functioning (F(5, 530) = 6.204, p ≤ .001, Wilks' Λ = 0.945, d = 0.48.), suggesting that individuals with significant ED symptoms found it more challenging to notice, label, and regulate emotions in themselves and recognize emotions in others. Gender did not significantly impact social-emotional functioning (F(10, 1,060) = 0.556, p = .850, Wilks' Λ = 0.990), and there was no significant group by gender interaction (F(10, 1,060) = 0.688, p = .737, Wilks' Λ = 0.987).

CONCLUSION

These data suggest that the social-emotional difficulties, particularly with emotion recognition and regulation, present in clinical samples are also evident in young people of all genders with significant disordered eating. Future work could aim to recruit an even more gender-diverse community sample to further elucidate social-emotional functioning in individuals in the community with significant disordered eating.

Drunkorexia: An Examination of the Role of Theory of Mind and Emotional Awareness among Adolescents

This study aimed to investigate Theory of Mind (ToM) and emotional awareness in drunkorexia, an emerging behavior characterized by calorie restriction when drinking alcohol is planned. A sample of 246 adolescents (148 females, 98 males; range 17-20) completed self-reported measures assessing drunkorexia, ToM and lack of emotional awareness. Drunkorexia was negatively correlated with ToM abilities, with reading neutral emotions, and positively with lack of emotional awareness. ToM and lack of emotional awareness were also found to predict drunkorexia. Findings highlighted that adolescents who engage in drunkorexia may have difficulties in reading others' mental states and being aware of their emotions.

Giving words to emotions: the use of linguistic analysis to explore the role of alexithymia in an expressive writing intervention

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.

The influence of alexithymia on memory for emotional faces and realistic social interactions

High levels of alexithymia are typically associated with impaired memory for emotional, but not neutral words. We conducted two experimental studies to establish if this effect generalises to non-verbal socially relevant stimuli. Thirty-nine female undergraduates (Study 1) viewed faces with different expressions (neutral, angry, happy or sad) and 38 female students (Study 2) viewed videos of realistic social interactions (featuring anger, happiness, sadness or neutral affect). Participants were asked to identify the emotion portrayed and were subsequently given an intentional recognition memory test for the stimuli. They also completed self-report measures of alexithymia and mood (depression & anxiety). In Study 1, memory for emotional (especially angry), but not neutral faces was negatively related to the "difficulty describing feelings" facet of alexithymia. In Study 2, memory for emotional (particularly those featuring anger), but not neutral videos was negatively related to the "difficulty identifying feelings" and "externally oriented thinking" facets of alexithymia. In both studies, these memory deficits were independent of the effects of age and mood. Furthermore, the deficits appear to be most evident in the conscious recollection of the emotional stimuli. Our findings confirm that the memory deficit for emotional words in alexithymia generalises to important non-verbal socially relevant stimuli.

The association between alexithymia and eating behavior in children and adolescents

OBJECTIVE

Alexithymia, or the difficulty identifying or describing one's own emotions, may be a risk factor for dysregulated eating and excess weight gain. However, the relationships between alexithymia and eating behaviors in community samples of non-clinical youth have not been well-characterized. We hypothesized that alexithymia would be positively associated with disordered and disinhibited eating in a community-based sample of boys and girls without an eating disorder.

METHOD

Two hundred children (8-17 years old) across the weight spectrum completed an interview to assess loss of control (LOC) eating and eating-related psychopathology, a laboratory test meal designed to induce disinhibited eating, and questionnaires to assess alexithymia, eating in the absence of hunger, and emotional eating. Linear and logistic regressions were conducted to examine the relationship between alexithymia and eating variables, with age, sex, race, and fat mass as covariates. Test meal analyses also adjusted for lean mass. Given the overlap between alexithymia and depression, all models were repeated with depressive symptoms as an additional covariate.

RESULTS

Alexithymia was associated with an increased likelihood of reporting LOC eating (p < .05). Moreover, alexithymia was positively associated with disordered eating attitudes, emotional eating, and eating in the absence of hunger (ps < .05). Greater alexithymia was associated with more carbohydrate and less fat intake at the test meal (ps < .05). After adjusting for depressive symptoms, alexithymia remained associated with eating in the absence of hunger and carbohydrate and fat intake (ps < .05).

DISCUSSION

In healthy children, alexithymia is associated with some facets of eating behavior and food intake. If supported prospectively, these preliminary findings suggest alexithymia may be a modifiable risk factor to reduce disordered eating and excess weight gain in youth.

The influence of non-clinical eating-related psychopathology on the recognition of emotion from static faces and realistic social interactions

Emotion recognition deficits have consistently been reported in clinical and sub-clinical disordered eating. However, most studies have used static faces, despite the dynamic nature of everyday social interactions. The current aims were to confirm previous findings of emotion recognition deficits in non-clinical disordered eating and to determine if these deficits would be more evident in response to static as compared to dynamic emotional stimuli. We also aimed to establish if these emotion recognition deficits could be explained by comorbid psychopathology (depression, anxiety or alexithymia). Eighty-nine females were assigned to groups based on scores on the Eating Disorders Inventory (EDI); high (n = 45) and low (n = 44). Participants were presented with emotional faces and video clips portraying fear, anger, disgust, sadness, happiness, surprise and neutral affect. As predicted, the high EDI group correctly recognised fewer emotional displays than did the low EDI group. However, this deficit was not more evident for negative as opposed to positive emotions. Furthermore, the deficit was not larger for static stimuli in comparison to dynamic. Overall emotion recognition accuracy was negatively associated with Drive for Thinness, but not Bulimia or Body Dissatisfaction. Importantly, the emotion recognition deficits observed in the high EDI group and that were associated with eating disorder symptoms were independent of depression, anxiety and alexithymia. Findings confirm that even minor elevations in disordered eating are associated with poorer emotion recognition. This is important, as problems in recognition of the emotional displays of others are thought to be a risk factor for clinical eating disorders.

Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale

OBJECTIVE

The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups.

METHOD

Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs.

RESULTS

Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions.

CONCLUSION

Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.

Visual Attention to Ambiguous Emotional Faces in Eating Disorders: Role of Alexithymia

Eating disorders (EDs) are often accompanied by social-emotional problems. Recently, alexithymia has been suggested to explain objective emotion processing deficits in EDs. We tested if elevated levels of alexithymia may explain emotional face-processing problems in a mixed ED group (N = 24, 19 with anorexia and five with bulimia), comparing them with high-alexithymic (N = 25) and low-alexithymic healthy controls (N = 25). Participants judged the mixture ratio of clear and ambiguous facial emotion blends while eye movements were recorded. The ED group was less accurate judging ambiguous blends containing anger or disgust and attended less to the faces compared with low-alexithymic controls. Reduced attention to faces, in particular the eye region, was linked to confusion with ambiguous anger and disgust in the ED group only. Although significant group differences only emerged compared with low-alexithymic controls, the visual attention patterns underlying the ED group's problems with subtle anger and disgust expressions were not driven by alexithymia. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Autonomic Reactivity to Arousing Stimuli with Social and Non-social Relevance in Alexithymia

Emotional difficulties in alexithymia and their social consequences have been linked to alterations in autonomic nervous system. However, most of previous studies did not take into account the distinction between the affective and the cognitive dimensions of the alexithymia, leading to inconsistent results. Aim: In this study, we compared the effects of both dimensions of alexithymia on the autonomic arousal to emotional and social visual stimulations. Methods: Skin conductance responses (SCRs) to items of the International Affective Pictures System characterized by emotional (unpleasant, neutral, and pleasant), social (with humans) or non-social (without humans) content were recorded in non-alexithymic (NA), affective (AA) and cognitive alexithymic (CA) participants, selected on the basis of the Toronto Alexithymia Scale and the Bermond-Vorst Alexithymia Questionnaire. All participants responded to questionnaires of empathy, social phobia, depression, and anxiety before the experiment and evaluated the arousal of the pictures after it. Results: Cognitive alexithymic group showed lower amplitudes of SCRs to pictures with social than without social relevance whereas the opposite pattern was observed for the NA group. Arousal emotional effects of the pictures on SCRs did not differ among groups. In addition, CA participants showed lower scores than NA in the Personal Taking sub-scale of the empathy questionnaire, while AA showed lower scores than NA in the fantasy sub-scale. The CA group showed higher social phobia, depression and anxiety scores, than the other two groups. Conclusion: This work has two original outcomes: first, affective alexithymics expressed lower empathic affective scores than other groups; second, alexithymia modulated the impact of the social relevance of the stimuli on the autonomic reactivity, this impact vanishing in affective alexithymics and reversing in cognitive alexithymics. Thus, though the groups could not be distinguished on the basis of emotional effect on SCRs, they clearly differed when the empathic characteristics and the autonomic impact of social relevance were considered. Finally, the described autonomic signature to social relevant information could contribute to elucidate the difficulty of alexithymics to deal with emotions during social transactions.

The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample: An eye-tracking study

This study aimed to: (i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; (ii) examine if the bias occurs during initial orientation or later strategic processing; and (iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional deployment was continuously monitored using an eye-tracker. They subsequently identified the emotion portrayed in a separate series of faces. The highest (n=18) and lowest scorers (n=17) on the Eating Disorders Inventory (EDI) were compared on the attention and facial emotion recognition tasks. Those with relatively high scores exhibited impaired facial emotion recognition, confirming previous findings in similar non-clinical samples. They also displayed biased attention away from emotional faces during later strategic processing, which is consistent with previously observed impairments in clinical samples. These differences were related to drive-for-thinness. Although we found no evidence of a bias towards angry faces, it is plausible that the observed impairments in emotion recognition and avoidance of emotional faces could disrupt social functioning and act as a risk factor for the development of eating disorders.

Acceptance and Body Dissatisfaction: Examining the Efficacy of a Brief Acceptance Based Intervention for Body Dissatisfaction in College Women

Background: Body dissatisfaction among college women is concerning given its high prevalence and associated negative consequences. While cognitive-behavioral approaches to reducing body dissatisfaction have considerable support, it may be beneficial to target the problematic relationship that some individuals have with their internal experiences. Aims: To examine the relative efficacy of an acceptance-based compared to a cognitive restructuring approach to targeting body dissatisfaction. Method: College women were randomly assigned to an acceptance (n = 21), cognitive restructuring (n = 21) or a neutral comparison condition (n = 24). Participants completed a body dissatisfaction challenge postintervention and their dissatisfaction, distress about body-related thoughts and emotions, and the extent they felt defined by their outward appearance were measured. Results: Both approaches provided a protective effect against decreases in body satisfaction and related feelings. Conclusion: Acceptance and CBT approaches to treating body dissatisfaction are worthy of future investigation.

Alexithymia, a compounding factor for eating and social avoidance symptoms in anorexia nervosa

Socio-affective difficulties, in particular difficulties in representing, communicating and feeling emotions, may play a critical role in anorexia nervosa (AN). The aim of this longitudinal study was to explore the links between alexithymia and two types of difficulties in AN: eating symptoms and social avoidance. Sixty adolescent girls with AN were recruited following hospitalisation in a specialised department. They completed self-administered questionnaires of alexithymia (TAS-20), of central symptoms of the eating disorders (EDI), and of anxious and depressive affects (SCL-90). Anxiety and social avoidance were assessed in the course of a standardised interview (LSAS). These measures were performed at inclusion, and at 6-, 12- and 18-months' follow-up. The relationship between TAS-20 and EDI or LSAS total scale scores across the four time points was assessed using mixed-effects models, including anxiety, depression, BMI, anorexia subtype, and age as co-factors. Partial least square regression was used to refine this multivariate analysis at subscale level, at inclusion and 18 months. Robust associations between TAS-20 and EDI scores were found, independently from anxious and depressive scores, nutritional state and AN subtype. These effects appeared more particularly linked to the implication of the dimensions difficulties identifying and describing feelings, interpersonal mistrust, feelings of inadequacy and interoceptive awareness deficit. There was also a durable association between alexithymia and social anxiety and avoidance, after adjusting for the confounding effects of depression, and anxiety, and the state of starvation. Difficulties in describing feelings appeared particularly involved here. Thus alexithymia does appear as a factor in the persistence of disorders in AN, and difficulties identifying and describing feelings could compound the social difficulties and major the relational isolation of these patients.

Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia

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.

People with chronic facial pain perform worse than controls at a facial emotion recognition task, but it is not all about the emotion

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.

Capacities for theory of mind, metacognition, and neurocognitive function are independently related to emotional recognition in schizophrenia

While many with schizophrenia spectrum disorders experience difficulties understanding the feelings of others, little is known about the psychological antecedents of these deficits. To explore these issues we examined whether deficits in mental state decoding, mental state reasoning and metacognitive capacity predict performance on an emotion recognition task. Participants were 115 adults with a schizophrenia spectrum disorder and 58 adults with substance use disorders but no history of a diagnosis of psychosis who completed the Eyes and Hinting Test. Metacognitive capacity was assessed using the Metacognitive Assessment Scale Abbreviated and emotion recognition was assessed using the Bell Lysaker Emotion Recognition Test. Results revealed that the schizophrenia patients performed more poorly than controls on tests of emotion recognition, mental state decoding, mental state reasoning and metacognition. Lesser capacities for mental state decoding, mental state reasoning and metacognition were all uniquely related emotion recognition within the schizophrenia group even after controlling for neurocognition and symptoms in a stepwise multiple regression. Results suggest that deficits in emotion recognition in schizophrenia may partly result from a combination of impairments in the ability to judge the cognitive and affective states of others and difficulties forming complex representations of self and others.

Joint effect of alexithymia and mood on the categorization of nonverbal emotional vocalizations

The role of stable factors, such as alexithymia (i.e., difficulties identifying and expressing feelings, externally oriented cognitive style), or temporary factors, such as affective states (mood), on emotion perception has been widely investigated in the literature. However, little is known about the separate or joint effect of the alexithymia level and affective states (positive affectivity, negative affectivity) on the recognition of nonverbal emotional vocalizations (NEV) (e.g., laughs, cries, or sighs). In this study, participants had to categorize NEV communicating 10 emotions by selecting the correct verbal emotional label. Results show that the level of alexithymia is negatively correlated to the capacity to accurately categorize negative vocalizations, and more particularly sad NEV. On the other hand, negative affectivity appeared negatively correlated with the ability to accurately categorize NEV in general, and negative vocalizations in particular. After splitting the results by the alexithymia level (high vs. low scorers), significant associations between mood and accuracy rates were found in the group of high alexithymia scorers only. These findings support the idea that alexithymic features act across sensory modalities and suggest a mood-interference effect that would be stronger in those individuals.

Unique associations between young adult men's emotional functioning and their body dissatisfaction and disordered eating

Research on emotional functioning, body dissatisfaction, and disordered eating in males is predominated by studies of negative affect and emotion regulation. Other aspects of emotional functioning, namely emotion recognition and attentional biases toward emotional stimuli, have received little empirical attention. The present study investigated the unique associations between different aspects of men's emotional functioning and their disordered eating attitudes, muscularity dissatisfaction, and body fat dissatisfaction. Results from 132 male undergraduates showed that muscularity dissatisfaction was uniquely associated with both emotion regulation difficulties and an attentional bias toward rejecting faces. Body fat dissatisfaction was not uniquely associated with any aspect of emotional functioning. Disordered eating was uniquely associated with emotion regulation difficulties. Collectively, the results indicate differences in the patterns of associations between men's emotional functioning and their body dissatisfaction and disordered eating.

Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism

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.

Alexithymia and eating disorders: a critical review of the literature

Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.

Alexithymia and the processing of emotional facial expressions (EFEs): systematic review, unanswered questions and further perspectives

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.

Dissociation and social cognition in schizophrenia spectrum disorder

While there is emerging evidence that dissociation is linked with trauma history and possibly symptoms in schizophrenia, it remains unclear whether dissociation represents a symptom dimensions in its own right in schizophrenia and as such is uniquely related to other features of illness. To explore this issue the current study sought to find out whether dissociation was uniquely related to an index of social cognition closely linked to social functioning, namely affect recognition. We hypothesized that dissociation would be linked with affect recognition because symptoms of dissociation may uniquely disrupt processes which are expected to be needed for correctly recognizing emotions. The sample contained 49 participants diagnosed with a schizophrenia spectrum disorder who were in a non-acute phase of disorder. Participants were concurrently administered the Bell-Lysaker Emotion Recognition Task, the Dissociative Experiences Scale, the Post Traumatic Stress Disorder Checklist and the Positive and Negative Symptoms Scale. Stepwise linear regression analyses were performed in which dissociative symptoms were forced to enter after the other symptoms in order to predict deficits in affect recognition. These analyses revealed that greater levels of dissociative symptoms predicted poorer recognition of negative emotions over and above that of positive, negative, cognitive and PTSD symptoms. Results are consistent with the possibility that dissociation represents a unique dimension o f psychopathology in schizophrenia which may be linked to function.

The influence of emotional intensity on facial emotion recognition in disordered eating

Significant facial emotion recognition (FER) deficits have been observed in participants exhibiting high levels of eating psychopathology. The current study aimed to determine if the pattern of FER deficits is influenced by intensity of facial emotion and to establish if eating psychopathology is associated with a specific pattern of emotion recognition errors that is independent of other psychopathological or personality factors. Eighty females, 40 high and 40 low scorers on the Eating Disorders Inventory (EDI) were presented with a series of faces, each featuring one of five emotional expressions at one of four intensities, and were asked to identify the emotion portrayed. Results revealed that, in comparison to Low EDI scorers, high scorers correctly recognised significantly fewer expressions, particularly of fear and anger. There was also a trend for this deficit to be more evident for subtle displays of emotion (50% intensity). Deficits in anger recognition were related specifically to scores on the body dissatisfaction subscale of the EDI. Error analyses revealed that, in comparison to Low EDI scorers, high scorers made significantly more and fear-as-anger errors. Also, a tendency to label anger expressions as sadness was related to body dissatisfaction. Current findings confirm FER deficits in subclinical eating psychopathology and extend these findings to subtle expressions of emotion. Furthermore, this is the first study to establish that these deficits are related to a specific pattern of recognition errors. Impaired FER could disrupt normal social functioning and might represent a risk factor for the development of more severe psychopathology.

Perception of emotion and bilateral advantage in women with eating disorders, their healthy sisters, and nonrelated healthy controls

BACKGROUND

Eating disorders (EDs) are characterized not only by disordered eating, but also by other psychopathology. In this exploratory study, we examined the ability of women with different diagnoses of EDs, their unaffected sisters, and healthy unrelated controls to recognize their own and other's emotions. We also looked at interhemispheric integration of emotion recognition and its relationship with depression.

METHOD

Five groups of women participated: 1. anorexia nervosa restricting (AN-R) and 2. (AN-B/B) binge/purge, 3. bulimia nervosa binge/purge, (BN-B/P), 4. healthy sisters of women with ED, and 5. unrelated healthy controls. We used two questionnaires measuring alexithymia and depression, and two lateralized experimental tasks requiring recognition of facial emotion. Unilateral versus bilateral presentation allow the indexing of interhemispheric integration.

RESULTS

Alexithymia: All the ED groups were found to be more alexithymic and depressed on the self report scales compared to the two healthy groups. Depression completely mediated alexithymia in the AN-R group but not in the AN-B/P and BN-B/P patients. Sisters of ED women were more alexithymic than unrelated controls. Lateralized facial emotion recognition: ED women showed no deficits in recognizing basic emotions. However, the clinical groups did not show a bilateral advantage whereas the two healthy groups did so.

CONCLUSIONS

We present three conclusions: we show, for the first time, evidence for a deficit in hemispheric integration in EDs. This implies that EDs may be a disconnection syndrome; alexithymia characterizes women with EDs and members of their family; depression is manifested differently in AN-R, than in women who binge/purge.

Reduced capacity in automatic processing of facial expression in restrictive anorexia nervosa and obesity

There is growing evidence that disordered eating is associated with facial expression recognition and emotion processing problems. In this study, we investigated the question of whether anorexia and obesity occur on a continuum of attention bias towards negative facial expressions in comparison with healthy individuals of normal weight. Thirty-three patients with restrictive anorexia nervosa (AN-R), 30 patients with obesity (OB) and 63 healthy age and social-economic status matched controls were recruited. Our results indicated that AN-R patients were more attentive to angry faces and had difficulties in being attentive to positive expressions, whilst OB patients had problems in looking for or being attentive to negative expressions independently of self-reported depression and anxiety. Our findings did not support the idea that AN-R and OB occur on a continuum. We found that AN-R was associated with a reduced capacity in positive facial expression processing, whereas OB was associated with a reduced capacity in negative facial expressions processing. The social relevance of our findings and a possible explanation based upon neuroscience are discussed.

An investigation into the relationship between eating disorder psychopathology and autistic symptomatology in a non-clinical sample

OBJECTIVE. Female adults with a diagnosis of anorexia nervosa (AN) have been found to score higher than healthy controls on a questionnaire that measures characteristics associated with Autism Spectrum Disorders (ASD). This research investigated the relationship between eating disorder (ED) and ASD symptomatology in a non-clinical sample, with an additional focus on prenatal testosterone (pT) levels. DESIGN. A cross-sectional research design was used. The selected age group of both males and females allowed for a focus on early onset of ED symptomatology in both sexes. METHODS. Self-reported questionnaire data from the Eating Attitudes Test (EAT-26) and the Autism Spectrum Quotient (AQ) were collected from 132 schoolchildren (61 boys, 71 girls) aged 11 to 14, with no recorded psychiatric diagnoses. Digit ratio (2D:4D) measures to index levels of pT exposure were also obtained. RESULTS. A significant relationship between levels of ED symptomatology and ASD symptomatology was identified. Particularly strong relationships were identified between the EAT-26 and the attention to detail and communication subscales of the AQ. Few relationships were found for digit ratios. CONCLUSION. The results extend previous research from a sample with a diagnosis of AN to a non-clinical population. Those registering higher levels of ED symptomatology also reported higher levels of attention to detail and communication difficulties associated with ASD.

Alexithymia and emotional regulation: A cluster analytical approach

BACKGROUND

Alexithymia has been a familiar conception of psychosomatic phenomenon. The aim of this study was to investigate whether there were subtypes of alexithymia associating with different traits of emotional expression and regulation among a group of healthy college students.

METHODS

1788 healthy college students were administered with the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20) and another set of questionnaires assessing emotion status and regulation. A hierarchical cluster analysis was conducted on the three factor scores of the TAS-20. The cluster solution was cross-validated by the corresponding emotional regulation.

RESULTS

The results indicated there were four subtypes of alexithymia, namely extrovert-high alexithymia (EHA), general-high alexithymia (GHA), introvert-high alexithymia (IHA) and non-alexithymia (NA). The GHA was characterized by general high scores on all three factors, the IHA was characterized by high scores on difficulty identifying feelings and difficulty describing feelings but low score on externally oriented cognitive style of thinking, the EHA was characterized by high score on externally oriented cognitive style of thinking but normal score on the others, and the NA got low score on all factors. The GHA and IHA were dominant by suppressive character of emotional regulation and expression with worse emotion status as compared to the EHA and NA.

CONCLUSIONS

The current findings suggest there were four subtypes of alexithymia characterized by different emotional regulation manifestations.