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

No association between alexithymia and emotion recognition or theory of mind in a sample of adolescents enhanced for autistic traits

LAY ABSTRACT

Alexithymia is a sub-clinical condition characterised by difficulties identifying and describing one's own emotions, which is found in many, but not all autistic people. The alexithymia hypothesis suggests that certain aspects of socio-cognitive functioning typically attributed to autism, namely difficulties in emotion recognition, might be better explained by often co-occurring alexithymia. It is important to understand what is specific to autism and what is due to other co-occurring characteristics to develop appropriate support for autistic people. However, most research on this topic has been conducted in adults, which limits our knowledge about the relevance of this theory to younger autistic populations. This study tested whether difficulties in emotion recognition and theory of mind traditionally associated with autism might be better explained by alexithymia in a sample of adolescents with and without a diagnosis of autism. Results found that difficulties in emotion recognition and theory of mind were both associated with autistic traits, and this was not accounted for by individual differences in levels of alexithymia. This research suggests that more work is needed to understand the applicability of the alexithymia hypothesis in younger populations, but that at least in adolescents and when using parent-report measures, alexithymia may not account for emotion recognition or theory of mind difficulties associated with autistic traits.

Alexithymia modulates emotion concept activation during facial expression processing

Alexithymia is characterized by difficulties in emotional information processing. However, the underlying reasons for emotional processing deficits in alexithymia are not fully understood. The present study aimed to investigate the mechanism underlying emotional deficits in alexithymia. Using the Toronto Alexithymia Scale-20, we recruited college students with high alexithymia (n = 24) or low alexithymia (n = 24) in this study. Participants judged the emotional consistency of facial expressions and contextual sentences while recording their event-related potentials. Behaviorally, the high alexithymia group showed longer response times versus the low alexithymia group in processing facial expressions. The event-related potential results showed that the high alexithymia group had more negative-going N400 amplitudes compared with the low alexithymia group in the incongruent condition. More negative N400 amplitudes are also associated with slower responses to facial expressions. Furthermore, machine learning analyses based on N400 amplitudes could distinguish the high alexithymia group from the low alexithymia group in the incongruent condition. Overall, these findings suggest worse facial emotion perception for the high alexithymia group, potentially due to difficulty in spontaneously activating emotion concepts. Our findings have important implications for the affective science and clinical intervention of alexithymia-related affective disorders.

Recognition of others' interoceptive states in those with and without eating disorders

BACKGROUND

The ability to recognize one's own emotions is associated with one's ability to recognize others' emotions. Beyond the domain of emotion, however, the relationship between recognition of one's own internal states (interoception) and others' interoceptive states has not been investigated, either in the typical population or clinical groups with interoceptive difficulties (e.g. eating disorders; EDs).

METHOD

This study investigated recognition of one's own and others' internal states in adults with and without eating disorders, using a high frequency visual noise paradigm. Participants completed self-report measures of interoception, alexithymia (difficulties recognising one's own emotional internal states) and ED symptomatology, and the Heartbeat Counting Task measure of cardiac interoceptive accuracy.

RESULTS

Alexithymia was significantly negatively correlated with recognition of others' interoceptive states. EDs were not associated with difficulties recognising others' interoceptive states.

CONCLUSIONS

The ability to recognise one's own emotional internal states is associated with the recognition of others' interoceptive states, which may contribute to social skills and the ability to care for others.

Bidirectional relationship between insular grey matter volume and alexithymia: Evidence from a longitudinal study

BACKGROUND

The insula is considered to be involved in emotional cognitive processes, and may be structurally altered in people with alexithymia. However, it remains unclear how the relationship between the insula and alexithymia changes over time. This study aimed to investigate whether alexithymia has longitudinal relationship with the insular structure.

METHODS

Having processed structural MRI data via FreeSurfer, the insula was divided into five sub-regions, and the Toronto Alexithymia Scale was administered to assess alexithymia in the general population. Subsequently, we established the latent change score models between insular sub-regions and the alexithymia (N = 252).

RESULTS

The TAS-20 mean value of the sample at Time 1 was not significantly different by sex (t = -0.993, df = 250, p = 0.321), while the TAS-20 mean value at Time 2 was slightly different by sex (t = 2.025, df = 250, p = 0.044). Most insular grey matter volumes at Time 1 and Time 2 were significantly associated with TAS-20 at Time 2. The baseline alexithymia and insular grey matter volume positively predicted the other's rate of change between Time 1 and Time 2 in a bidirectional way.

LIMITATIONS

This study had a limited number of measurement time points, potential bias due to smaller sample sizes and gender imbalance, as well as the potential for inaccuracy in the self-report measure of alexithymia.

CONCLUSIONS

Time-lagged alexithymia changes and insular grey matter volume changes occur in coupled manner over time, which might improve our understanding of the neurological underpinnings of alexithymia, and shed light on clinical and psychological treatment for alexithymia.

Contrasting Metacognitive, Emotion Recognition and Alexithymia Profiles in Bulimia, Anorexia, and Schizophrenia

ABSTRACT

Alexithymia, or deficits in emotion recognition, and metacognitive capacity have been noted both in psychosis and eating disorders and potentially linked to psychopathology. This study sought to compare levels of impairments in these phenomena and their associations with psychopathology in groups with eating disorders and psychosis. Participants with diagnoses of a schizophrenia spectrum disorder (SSD; n = 53), anorexia (n = 40), or bulimia (n = 40) were recruited from outpatient clinics. Alexithymia was measured with the Toronto Alexithymia Scale; emotion recognition, with the Ekman Faces Test; and metacognition, with the Metacognitive Assessment Scale-Abbreviated. Psychopathology was measured with the Eating Attitudes Test, Body Image Questionnaire, and Positive and Negative Syndrome Scale. Results indicated that the SSD group had significantly poorer metacognitive function than either eating disorder group. Metacognition was related to body image in the anorexia group and a range of different forms of general psychopathology in the bulimia group. Alexithymia was related to eating disorder behaviors in the bulimia group.

Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition

OBJECTIVES

Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions.

METHODS

In this cross-sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self-perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2-Adult Faces including 24 faces representing anger, fear, sadness, and happiness.

RESULTS

Facemasks impaired the self-perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation.

CONCLUSION

Facemasks reduced clinicians' self-confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.

Videoconferencing analytic psychodrama in treating young adults' psychological suffering: preliminary results

The study aims to explore the effects that videoconferencing Analytic Psychodrama (AP) has on the psychological wellbeing and emotional competence of young adults who are suffering from mental health problems. Twenty-two undergraduate students, asking for help at the Psychological Counselling Service of the University of Bologna for anxiety-depressive problems, took part in the three online groups that met weekly from October 2020 to July 2021. The Clinical Outcomes in Routine Evaluation Outcome Measure, the Trait Emotional Intelligence Questionnaire Short Form, the Toronto Alexithymia Scale, the Interpersonal Reactivity Index, and the Group Climate Questionnaire were used as test-retest questionnaires for clinical outcomes, emotional competence, and group climate evaluations. There was a statistically significant difference between the pre-test and 10-month scores for patients in clinical outcomes. Alexithymia significantly decreased and emotional intelligence and group engagement increased post-intervention. Videoconferencing AP sounds promising for alleviating psychological problems and to improve young adults' emotional competence.

Affective cognition in eating disorders: a systematic review and meta-analysis of the performance on the "Reading the Mind in the Eyes" Test

BACKGROUND

The Reading the Mind in the Eyes Test (RMET) is listed in the National Institute of Mental Health's Research Domain Criteria as a tool apt to measure the understanding of others' mental states. People diagnosed with anorexia nervosa (AN) showed poorer performances on the RMET than healthy controls. Less data are available concerning other eating disorders.

METHODS

Systematic review of four major databases from inception to July 15, 2021 following the PRISMA guidelines. Meta-analysis of cross-sectional observational studies comparing the scores of the RMET between patients with eating disorders and age- and-gender matched control groups.

RESULTS

Out of 21 studies, we retrieved 29 independent samples of patients diagnosed with an eating disorder. Patients with active AN (n = 580) showed worse performances on the RMET than controls (n = 1019). Year of publication accounted for 61% of the (substantial: I² = 81%) heterogeneity in the meta-analysis. Earlier studies were more likely to find worse performances on the RMET of patients with active AN than later studies. Patients with bulimia nervosa (n = 185) performed poorly as compared to controls (n = 249), but the results were not statistically significant on the random-effect model. Obese patients with binge-eating disorder (n = 54) did not differ on the RMET from obese controls (n = 52). Patients with eating disorder not otherwise specified (n = 57) showed minimal differences compared to controls (n = 96). Study quality was good in six studies only.

CONCLUSIONS

Patients with eating disorders do not suffer from an impaired understanding of others' mental states, except for a still-to-be-identified subgroup of patients with active AN.

LEVEL OF EVIDENCE

I, systematic review and meta-analysis.

Revisiting alexithymia as an important construct in the treatment of anorexia nervosa: a proposal for future research

Consistent research supports altered emotional processing in adult patients with anorexia nervosa (AN), including elevations in alexithymia, or deficits in identifying and describing emotions and other internal experiences. Despite increasing interest in emotion-focused therapies for AN, alexithymia is often not directly addressed within many existing treatments, and little empirical work has moved beyond descriptive, cross-sectional research. In this paper, we propose that refining the field's understanding of alexithymia may provide insights into poor outcomes in existing psychological treatments for AN. First, we provide a brief overview of existing work exploring alexithymia in AN, and then describe several next steps in treatment-relevant research, including differentiating alexithymia from related constructs, considering neurobiological correlates of alexithymia, testing the link between alexithymia and outcome across treatment modalities, and piloting adjunctive treatment techniques focused on emotional identification and description. Altogether, exploring adjunctive treatment approaches targeting alexithymia may offer one promising possibility for improving long-term outcomes.

Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults

OBJECTIVE

This study aims to explore whether orthorexia nervosa, like other eating disorders, is associated with difficulties identifying, describing, and regulating one's own emotions among a sample of Lebanese adults.

METHODS

A cross-sectional study was conducted during October 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. All participants above 18 years of age were allowed to participate in this study. A total of 787 Lebanese adults out of 920 (85.54%) completed an online survey including Arabic versions of the ORTO-R measure of orthorexia, the Toronto Alexithymia Scale, the Difficulty in Emotion Regulation Scale, and the Eating Attitudes Test.

RESULTS

After making sure that all norms are verified, hierarchical linear regressions were conducted to evaluate the association between disordered eating attitudes (EAT scores) and ON (model 1), and after controlling for difficulties in emotion regulation (DERS score) (model 2). Model 1 accounted for 15.1% of the variance of ON (adj. R2 = 0.151, F(1, 786) = 140.06, p < 0.001) and showed that higher levels of disordered eating (higher EAT scores) (β = 0.15) were significantly associated with more ON tendencies and behaviors. When adding the DERS total score to the model, Model 2 was a much better fit with 17.7% of the variance of ON (adj. R2 = 0.177, F(2, 786) = 84.44, p < 0.001), with higher levels of emotion dysregulation (higher DERS scores) (β = 0.06) and more disordered eating attitudes (higher EAT scores) (β = 0.13) were associated with higher levels of ON (Table 5).

CONCLUSION

The present research suggests that people with high ON tendencies experience troubles recognizing, regulating, and describing their emotions, similarly to other disordered eating.

LEVEL OF EVIDENCE

5.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Development and validation of the Interoceptive States Static Images (ISSI) database

Internal bodily signals provide an essential function for human survival. Accurate recognition of such signals in the self, known as interoception, supports the maintenance of homeostasis, and is closely related to emotional processing, learning and decision-making, and mental health. While numerous studies have investigated interoception in the self, the recognition of these states in others has not been examined despite its crucial importance for successful social relationships. This paper presents the development and validation of the Interoceptive States Static Images (ISSI), introducing a validated database of 423 visual stimuli for the study of non-affective internal state recognition in others, freely available to other researchers. Actors were photographed expressing various exemplars of both interoceptive states and control actions. The images went through a two-stage validation procedure, the first involving free-labelling and the second using multiple choice labelling and quality rating scales. Five scores were calculated for each stimulus, providing information about the quality and specificity of the depiction, as well as the extent to which labels matched the intended state/action. Results demonstrated that control action stimuli were more recognisable than internal state stimuli. Inter-category variability was found for the internal states, with some states being more recognisable than others. Recommendations for the utilisation of ISSI stimuli are discussed. The stimulus set is freely available to researchers, alongside data concerning recognisability.

Facial Emotion Recognition Predicts Alexithymia Using Machine Learning

Objective

Alexithymia, as a fundamental notion in the diagnosis of psychiatric disorders, is characterized by deficits in emotional processing and, consequently, difficulties in emotion recognition. Traditional tools for assessing alexithymia, which include interviews and self-report measures, have led to inconsistent results due to some limitations as insufficient insight. Therefore, the purpose of the present study was to propose a new screening tool that utilizes machine learning models based on the scores of facial emotion recognition task.

Method

In a cross-sectional study, 55 students of the University of Tabriz were selected based on the inclusion and exclusion criteria and their scores in the Toronto Alexithymia Scale (TAS-20). Then, they completed the somatization subscale of Symptom Checklist-90 Revised (SCL-90-R), Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II), and the facial emotion recognition (FER) task. Afterwards, support vector machine (SVM) and feedforward neural network (FNN) classifiers were implemented using K-fold cross validation to predict alexithymia, and the model performance was assessed with the area under the curve (AUC), accuracy, sensitivity, specificity, and F1-measure.

Results

The models yielded an accuracy range of 72.7–81.8% after feature selection and optimization. Our results suggested that ML models were able to accurately distinguish alexithymia and determine the most informative items for predicting alexithymia.

Conclusion

Our results show that machine learning models using FER task, SCL-90-R, BDI-II, and BAI could successfully diagnose alexithymia and also represent the most influential factors of predicting it and can be used as a clinical instrument to help clinicians in diagnosis process and earlier detection of the disorder.

The relationship between alexithymia and theory of mind: A systematic review

Theory of Mind (ToM), the ability to represent the mental states of oneself and others, is an essential social skill disrupted across many psychiatric conditions. The transdiagnostic nature of ToM impairment means it is plausible that ToM impairment is related to alexithymia (difficulties identifying and describing one's own emotions), as alexithymia is seen across psychiatric conditions. Whilst many studies have examined links between alexithymia and ToM, results are mixed. Therefore, the purpose of this systematic review is to provide a taxonomy of ToM tests and assess their relationship with alexithymia. Tests are grouped according to whether they assess propensity to engage spontaneously in ToM or accuracy of ToM inferences, with tests further subdivided into those that do, and do not, require emotion recognition. A review of 63 suitable studies suggests that alexithymia is often associated with reduced ToM, and inaccurate ToM when tasks require emotion recognition. This latter finding appears due to impaired emotion recognition, rather than ToM impairment per se. Further directions and considerations for future research are discussed.

Alexithymia explains atypical spatiotemporal dynamics of eye gaze in autism

Recognition of emotional facial expressions is considered to be atypical in autism. This difficulty is thought to be due to the way that facial expressions are visually explored. Evidence for atypical visual exploration of emotional faces in autism is, however, equivocal. We propose that, where observed, atypical visual exploration of emotional facial expressions is due to alexithymia, a distinct but frequently co-occurring condition. In this eye-tracking study we tested the alexithymia hypothesis using a number of recent methodological advances to study eye gaze during several emotion processing tasks (emotion recognition, intensity judgements, free gaze), in 25 adults with, and 45 without, autism. A multilevel polynomial modelling strategy was used to describe the spatiotemporal dynamics of eye gaze to emotional facial expressions. Converging evidence from traditional and novel analysis methods revealed that atypical gaze to the eyes is best predicted by alexithymia in both autistic and non-autistic individuals. Information theoretic analyses also revealed differential effects of task on gaze patterns as a function of alexithymia, but not autism. These findings highlight factors underlying atypical emotion processing in autistic individuals, with wide-ranging implications for emotion research.

Believing emotions are uncontrollable is linked to eating disorder psychopathology via suppression and reappraisal

OBJECTIVE

Research suggests that beliefs about emotional controllability influence the use of emotion regulation strategies, which in turn impact psychological health and illness. However, no research has yet investigated whether emotional controllability is linked to eating psychopathology. The current study investigates whether these concepts are related, as individuals with eating disorders have problems with emotion regulation.

METHOD

We collected self-report data from 718 participants from a community sample using validated questionnaires, and ran mediational analyses to assess the relationship between emotional controllability and eating psychopathology, via reappraisal and suppression, two emotion regulation strategies.

RESULTS

Our mediational analyses suggest that believing emotions to be uncontrollable relates to high levels of suppression (β = -.08), low levels of reappraisal (β = .19) and poorer eating disorder psychopathology (β = -.11). Reappraisal and suppression were found to partially mediate the relationship between emotional controllability and eating psychopathology.

DISCUSSION

The current study has demonstrated relationships that support investigations relating emotional controllability, emotion regulation and psychological health. This research has potential implications for developing interventions to target beliefs about emotions in order to help improve emotion regulation skills and eating psychopathology.

Skin Conductance as an Index of Alexithymic Traits in the General Population

Alexithymia concerns a difficulty identifying and communicating one’s own emotions, and a tendency towards externally-oriented thinking. Recent work argues that such alexithymic traits are due to altered arousal response and poor subjective awareness of “objective” arousal responses. Although there are individual differences within the general population in identifying and describing emotions, extant research has focused on highly alexithymic individuals. Here we investigated whether mean arousal and concordance between subjective and objective arousal underpin individual differences in alexithymic traits in a general population sample. Participants rated subjective arousal responses to 60 images from the International Affective Picture System whilst their skin conductance was recorded. The Autism Quotient was employed to control for autistic traits in the general population. Analysis using linear models demonstrated that mean arousal significantly predicted Toronto Alexithymia Scale scores above and beyond autistic traits, but concordance scores did not. This indicates that, whilst objective arousal is a useful predictor in populations that are both above and below the cut-off values for alexithymia, concordance scores between objective and subjective arousal do not predict variation in alexithymic traits in the general population.

Recognizing Emotions through Facial Expressions: A Largescale Experimental Study

Experimental research examining emotional processes is typically based on the observation of images with affective content, including facial expressions. Future studies will benefit from databases with emotion-inducing stimuli in which characteristics of the stimuli potentially influencing results can be controlled. This study presents Portuguese normative data for the identification of seven facial expressions of emotions (plus a neutral face), on the Radboud Faces Database (RaFD). The effect of participants’ gender and models’ sex on emotion recognition was also examined. Participants (N = 1249) were exposed to 312 pictures of white adults displaying emotional and neutral faces with a frontal gaze. Recognition agreement between the displayed and participants’ chosen expressions ranged from 69% (for anger) to 97% (for happiness). Recognition levels were significantly higher among women than among men only for anger and contempt. The emotion recognition was higher either in female models or in male models depending on the emotion. Overall, the results show high recognition levels of the facial expressions presented, indicating that the RaFD provides adequate stimuli for studies examining the recognition of facial expressions of emotion among college students. Participants’ gender had a limited influence on emotion recognition, but the sex of the model requires additional consideration.

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

BACKGROUND

Autistic people are disproportionately vulnerable to anorexia nervosa and other eating disorders (ED), and within the general population, autistic traits correlate with ED psychopathology. A putative mechanism which may underpin this heightened risk is alexithymia, a difficulty identifying and describing emotional states which is observed in both autism and ED. In two experiments with independent non-clinical samples, we explored whether alexithymia might mediate the heightened risk of eating psychopathology in individuals high in autistic traits.

METHODS

Our first experiment used the PROCESS macro for SPSS to examine relationships between alexithymia (measured by the Toronto Alexithymia Scale (TAS-20)), autistic traits (autism quotient (AQ)), and eating psychopathology (Eating Attitudes Test (EAT-26)) in 121 participants. Our second experiment (n = 300) replicated and furthered this analysis by examining moderating effects of sex and controlling for anxiety and depression as covariates. We also included an additional performance-based measure of alexithymia, the Levels of Emotional Awareness Scale (LEAS).

RESULTS

Study 1 suggested that TAS-20 scores mediated the relationship between heightened autistic traits and eating psychopathology. Replication and further scrutiny of this finding, in study 2, revealed that this mediation effect was partial and specific to the female participants in this sample. The mediation effect appeared to be carried by the difficulty identifying feelings subscale of the TAS-20, even when depression and anxiety were controlled for. LEAS scores, however, were not significantly related to autistic traits or eating psychopathology.

LIMITATIONS

Cross-sectional data prevents any conclusions around the direction and causality of relationships between alexithymia, autistic traits, and eating psychopathology (alongside depression and anxiety), necessitating longitudinal research. Our non-clinical sample was predominantly Caucasian undergraduate students, so it remains to be seen if these results would extrapolate to clinical and/or autistic samples. Divergence between the TAS-20 and LEAS raises crucial questions regarding the construct validity of these measures.

CONCLUSIONS

Our findings with respect to autistic traits suggest that alexithymia could partially explain the prevalence of ED in autistic people and may as such be an important consideration in the pathogenesis and treatment of ED in autistic and non-autistic people alike. Further research with clinical samples is critical to explore these ideas. Differences between men and women, furthermore, emphasize the importance of looking for sex-specific as well as generic risk factors in autistic and non-autistic men and women.

The role of alexithymia in social cognition: Evidence from a non-clinical population

BACKGROUND

Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment.

METHODS

We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills.

RESULTS

Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states.

LIMITATIONS

The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships.

CONCLUSIONS

These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.

Consistent evidence of a link between Alexithymia and general intelligence

Alexithymia is a personality construct characterised most notably by a difficulty in identifying and expressing feelings. Although the emotional difficulties in alexithymia are well established, to date little work has examined its relationship to broader cognitive abilities, such as general intelligence. Across three independent, healthy adult samples (Ns = 389, 318, & 273), we examined whether alexithymia was associated with general intelligence. In all three samples, we observed a significant negative association between alexithymia and general intelligence. In two of the samples, general intelligence was a significant predictor of alexithymia even when accounting for performance on tests of facial emotion recognition ability and supramodal emotion recognition ability (measured with faces, bodies, and voices). From a theoretical perspective, these results suggest that models of alexithymia need to incorporate a role for more generalised cognitive functioning. From a practical perspective, studies examining links between alexithymia and clinical disorders, many of which have known links to general intelligence, should consider including a measure of general intelligence in order to adjust for this potentially confounding factor.

Facial Emotion Recognition Abilities in Women Experiencing Eating Disorders

OBJECTIVE

Impairments in facial emotion recognition are an underlying factor of deficits in emotion regulation and interpersonal difficulties in mental disorders and are evident in eating disorders (EDs).

METHODS

We used a computerized psychophysical paradigm to manipulate parametrically the quantity of signal in facial expressions of emotion (QUEST threshold seeking algorithm). This was used to measure emotion recognition in 308 adult women (anorexia nervosa [n = 61], bulimia nervosa [n = 58], healthy controls [n = 130], and mixed mental disorders [mixed, n = 59]). The M (SD) age was 22.84 (3.90) years. The aims were to establish recognition thresholds defining how much information a person needs to recognize a facial emotion expression and to identify deficits in EDs compared with healthy and clinical controls. The stimuli included six basic emotion expressions (fear, anger, disgust, happiness, sadness, surprise), plus a neutral expression.

RESULTS

Happiness was discriminated at the lowest, fear at the highest threshold by all groups. There were no differences regarding thresholds between groups, except for the mixed and the bulimia nervosa group with respect to the expression of disgust (F(3,302) = 5.97, p = .001, η = .056). Emotional clarity, ED pathology, and depressive symptoms did not predict performance (RChange ≤ .010, F(1,305) ≤ 5.74, p ≥ .079). The confusion matrix did not reveal specific biases in either group.

CONCLUSIONS

Overall, within-subject effects were as expected, whereas between-subject effects were marginal and psychopathology did not influence emotion recognition. Facial emotion recognition abilities in women experiencing EDs compared with women experiencing mixed mental disorders and healthy controls were similar. Although basic facial emotion recognition processes seems to be intact, dysfunctional aspects such as misinterpretation might be important in emotion regulation problems.

CLINICAL TRIAL REGISTRATION NUMBER

DRKS-ID: DRKS00005709.

Emotion Recognition Abilities in Adults with Anorexia Nervosa are Associated with Autistic Traits

Difficulties in socio-emotional functioning are proposed to contribute to the development and maintenance of anorexia nervosa (AN). This study aimed to examine emotion recognition abilities in individuals in the acute and recovered stages of AN compared to healthy controls (HCs). A second aim was to examine whether attention to faces and comorbid psychopathology predicted emotion recognition abilities. The films expressions task was administered to 148 participants (46 AN, 51 recovered AN, 51 HC) to assess emotion recognition, during which attention to faces was recorded using eye-tracking. Comorbid psychopathology was assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule-2nd edition (ADOS-2). No significant differences in emotion recognition abilities or attention to faces were found between groups. However, individuals with a lifetime history of AN who scored above the clinical cut-off on the ADOS-2 displayed poorer emotion recognition performance than those scoring below cut-off and HCs. ADOS-2 scores significantly predicted emotion recognition abilities while controlling for group membership and intelligence. Difficulties in emotion recognition appear to be associated with high autism spectrum disorder (ASD) traits, rather than a feature of AN. Whether individuals with AN and high ASD traits may require different treatment strategies or adaptations is a question for future research.

Autism spectrum disorder traits are associated with empathic abilities in adults with anorexia nervosa

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.

Neural Mechanisms in Eating Behaviors: A Pilot fMRI Study of Emotional Processing

OBJECTIVE

Emotional processing dysfunction evident in eating disorders (ED) such as anorexia nervosa (AN) and bulimia nervosa (BN), is considered relevant to the development and maintenance of these disorders. The purpose of the current functional magnetic resonance imaging (fMRI) study was to pilot a comparison of the activity of the fronto-limbic and fronto-striatal brain areas during an emotion processing task in persons with ED.

METHODS

24 women patients with ED were scanned, while showing emotionally stimulating (pleasant, unpleasant) and neutral images from the International Affective Picture System (IAPS).

RESULTS

During the pleasant condition, significant differences in Dorsolateral Prefrontal Cortex (DLPFC) activations were found with AN participants presenting greater activation compared to BN and ED comorbid groups (EDc) and healthy controls also showing greater activation of this brain area compared to BN and EDc. Left putamen was less activated in EDc compared to both controls (C) and AN. During the unpleasant condition, AN participants showed hyperactivation of the Orbito-frontal Cortex (OFC) when compared to EDc.

CONCLUSION

This study highlights the potential functional relevance of brain areas that have been associated with self-control. These findings should help advance understanding the neural substrate of ED, though they should be considered as preliminary and be cautiously interpreted.

Psychometric properties of the Toronto Alexithymia Scale (TAS-20) in Brazil

Internationally, the most widely used self-report instrument to assess alexithymia (a clinical condition characterized by serious deficits in the cognitive processing of emotions) is the Toronto Alexithymia Scale (TAS-20). Because this measure has been poorly investigated in Brazil and emerging research suggests that TAS-20 scores might vary from one culture to another, we sought to: (1) investigate the psychometric properties of a Brazilian TAS-20; and (2) examine the degree to which Brazilian non-clinical TAS-20 scores differ from the scores of non-clinical samples from other cultures. A sample of 850 non-clinical Brazilian adults were administered a number of questionnaires and performance-based measures via online data collection. Data analyses inspected internal consistency and factor structure of the TAS-20, and tested the association of TAS-20 scores to emotional functioning and psychopathology. In line with previous international research, the Brazilian TAS-20 showed acceptable to adequate psychometric properties. Furthermore, TAS-20 scores associated negatively with empathy and emotional perception, and positively with emotion dysregulation and personality traits like dependency, abrupt changes in mood, and avoidance of criticism. Also noteworthy, our non-clinical Brazilian TAS-20 scores were very similar to those observed in other previously published non-clinical TAS-20 scores from seven non-Brazilian cultures.

Interaction between polymorphisms of the oxytocinergic system genes and emotion perception in inpatients with anorexia nervosa

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.

No effect of age on emotion recognition after accounting for cognitive factors and depression

A decline in emotion recognition ability across the lifespan has been well documented. However, whether age predicts emotion recognition difficulties after accounting for potentially confounding factors which covary with age remains unclear. Although previous research suggested that age-related decline in emotion recognition ability may be partly a consequence of cognitive (fluid intelligence, processing speed) and affective (e.g., depression) factors, recent theories highlight a potential role for alexithymia (difficulty identifying and describing one’s emotions) and interoception (perception of the body’s internal state). This study therefore aimed to examine the recognition of anger and disgust across the adult lifespan in a group of 140 20–90-year-olds to see whether an effect of age would remain after controlling for a number of cognitive and affective factors potentially impacted by age. In addition, using an identity recognition control task, the study aimed to determine whether the factors accounting for the effects of age on emotion discrimination also contribute towards generalised face processing difficulties. Results revealed that discrimination of disgust and anger across the lifespan was predicted by processing speed and fluid intelligence, and negatively by depression. No effect of age was found after these factors were accounted for. Importantly, these effects were specific to emotion discrimination; only crystallised intelligence accounted for unique variance in identity discrimination. Contrary to expectations, although interoception and alexithymia were correlated with emotion discrimination abilities, these factors did not explain unique variance after accounting for other variables.

Facial mimicry, facial emotion recognition and alexithymia in post-traumatic stress disorder

Individuals with post-traumatic stress disorder (PTSD) show abnormalities in higher-order emotional processes, including emotion regulation and recognition. However, automatic facial responses to observed facial emotion (facial mimicry) has not yet been investigated in PTSD. Furthermore, whereas deficits in facial emotion recognition have been reported, little is known about contributing factors. We thus investigated facial mimicry and potential effects of alexithymia and expressive suppression on facial emotion recognition in PTSD. Thirty-eight PTSD participants, 43 traumatized and 33 non-traumatized healthy controls completed questionnaires assessing alexithymia and expressive suppression. Facial electromyography was measured from the muscles zygomaticus major and corrugator supercilii during a facial emotion recognition task. Corrugator activity was increased in response to negative emotional expressions compared to zygomaticus activity and vice versa for positive emotions, but no significant group differences emerged. Individuals with PTSD reported greater expressive suppression and alexithymia than controls, but only levels of alexithymia predicted lower recognition of negative facial expressions. While automatic facial responses to observed facial emotion seem to be intact in PTSD, alexithymia, but not expressive suppression, plays an important role in facial emotion recognition of negative emotions. If replicated, future research should evaluate whether successful interventions for alexithymia improve facial emotion recognition abilities.

The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia

Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.

Alexithymia explains increased empathic personal distress in individuals with and without eating disorders

It is often assumed that empathy impairments are common in individuals with eating disorders (EDs), but empirical work has been limited and produced mixed results, making the clinical features and treatment needs of this population difficult to determine. Alexithymia, characterised by difficulties identifying and describing one’s own emotions, frequently co-occurs with EDs and is associated with atypical recognition of, and empathy for, others’ emotions. This study used an existing empathy for pain paradigm to determine whether atypical empathy in EDs stems from co-occurring alexithymia, rather than EDs per se. Empathy (specifically personal distress in response to others’ pain) was assessed in individuals with EDs ( N = 21) and an alexithymia-matched control group ( N = 22). Participants were simultaneously members of a high alexithymia ( N = 16) or low alexithymia ( N = 27) group, allowing the independent contributions of alexithymia and EDs to be determined. Participants judged the laterality of hands and feet in painful and non-painful situations, and the degree of empathic interference on response times was measured. Results indicated that observation of painful stimuli affected task performance in those with high levels of alexithymia more than those with low levels, but no effect of ED diagnosis was observed. These findings suggest that co-occurring alexithymia explains increased empathic personal distress in ED populations. Atypical empathy may therefore not be a core feature of EDs, and interventions aimed at improving empathy-related social functioning may only be necessary for patients who also have alexithymia. These findings emphasise the importance of determining the influence of co-occurring alexithymia when assessing empathy in clinical populations.

Genome-wide meta-analysis of cognitive empathy: heritability, and correlates with sex, neuropsychiatric conditions and cognition

We conducted a genome-wide meta-analysis of cognitive empathy using the 'Reading the Mind in the Eyes' Test (Eyes Test) in 88,056 research volunteers of European Ancestry (44,574 females and 43,482 males) from 23andMe Inc., and an additional 1497 research volunteers of European Ancestry (891 females and 606 males) from the Brisbane Longitudinal Twin Study. We confirmed a female advantage on the Eyes Test (Cohen's d=0.21, P<2.2 × 10^-16), and identified a locus in 3p26.1 that is associated with scores on the Eyes Test in females (rs7641347, P_meta=1.58 × 10^-8). Common single nucleotide polymorphisms explained 5.8% (95% CI: 4.5%-7.2%; P=1.00 × 10^-17) of the total trait variance in both sexes, and we identified a twin heritability of 28% (95% CI: 13%-42%). Finally, we identified significant genetic correlation between the Eyes Test and anorexia nervosa, openness (NEO-Five Factor Inventory), and different measures of educational attainment and cognitive aptitude.

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.

Genome-wide analyses of self-reported empathy: correlations with autism, schizophrenia, and anorexia nervosa

Empathy is the ability to recognize and respond to the emotional states of other individuals. It is an important psychological process that facilitates navigating social interactions and maintaining relationships, which are important for well-being. Several psychological studies have identified difficulties in both self-report and performance-based measures of empathy in a range of psychiatric conditions. To date, no study has systematically investigated the genetic architecture of empathy using genome-wide association studies (GWAS). Here we report the results of the largest GWAS of empathy to date using a well-validated self-report measure of empathy, the Empathy Quotient (EQ), in 46,861 research participants from 23andMe, Inc. We identify 11 suggestive loci (P < 1 × 10^-6), though none were significant at P < 2.5 × 10^-8 after correcting for multiple testing. The most significant SNP was identified in the non-stratified analysis (rs4882760; P = 4.29 × 10^-8), and is an intronic SNP in TMEM132C. The EQ had a modest but significant narrow-sense heritability (0.11 ± 0.014; P = 1.7 × 10^-14). As predicted, based on earlier work, we confirmed a significant female advantage on the EQ (P < 2 × 10^-16, Cohen's d = 0.65). We identified similar SNP heritability and high genetic correlation between the sexes. Also, as predicted, we identified a significant negative genetic correlation between autism and the EQ (r_g = -0.27 ± 0.07, P = 1.63 × 10^-4). We also identified a significant positive genetic correlation between the EQ and risk for schizophrenia (r_g = 0.19 ± 0.04; P = 1.36 × 10^-5), risk for anorexia nervosa (r_g = 0.32 ± 0.09; P = 6 × 10^-4), and extraversion (r_g = 0.45 ± 0.08; 5.7 × 10^-8). This is the first GWAS of self-reported empathy. The results suggest that the genetic variations associated with empathy also play a role in psychiatric conditions and psychological traits.

Exploring emotion regulation and emotion recognition in people with presymptomatic Huntington's disease: The role of emotional awareness

Interest in the role of both emotion regulation and recognition in our understanding of mental health has been steadily increasing, especially in people with chronic illness who also have psychological difficulties. One illness which belongs to this category is Huntington's disease. Huntington's disease (HD) is a chronic neurodegenerative disorder that can cause a number of cognitive and psychological difficulties, including emotion recognition deficits, even before the onset of the symptoms required to make a formal diagnosis. Despite the lack of definite evidence, recent studies have suggested that deficits of emotion regulation and recognition may be expected to play a pivotal role in the early cognitive manifestations of HD. In this study, we hypothesised that the ability to regulate emotions can be impaired in people with presymptomatic HD, and that such impairment may be associated with a deficit of emotion recognition. To test this, an online survey was carried out with 117 English and Italian-speaking people with presymptomatic HD, compared to 217 controls matched for age and education. The results suggest that, in presymptomatic participants, emotion regulation and emotion recognition are generally not significantly impaired, and no significant relationships between performances on the two constructs were observed. However, a specific impairment in emotional awareness (a subscale on the Difficulties in Emotion Regulation Scale, DERS) was observed, which appears to be enhanced by the co-occurrence of depressive symptoms, even at a subclinical level. Consequently, it is suggested that difficulties in emotional awareness may represent a precursor of more general emotion recognition impairments, which only become apparent as the disease reaches a more symptomatic level. Clinical implications of the findings are discussed and directions for future research are proposed.

A Theoretical and Empirical Linkage between Road Accidents and Binge Eating Behaviors in Adolescence

This study aimed at identifying specific clusters of maladaptive emotional–behavioral symptoms in adolescent victims of motorbike collisions considering their scores on alexithymia and impulsivity in addition to examining the prevalence of clinical binge eating behaviors (respectively through the Youth Self-Report (YSR), Toronto Alexithymia Scale-20 (TAS-20), Barratt Impulsiveness Scale-11 (BIS-11), and Binge Eating Scale (BES)). Emotional–behavioral profiles, difficulties in identifying and describing feelings, impulsivity, and binge eating behaviors have been assessed in 159 adolescents addressing emergency departments following motorbike collisions. Our results showed a cluster of adolescents with clinical binge eating behaviors, high rates of motorbike accidents, and high levels of internalizing and externalizing problems, alexithymia, and impulsivity (23.3% of the sample); a second cluster of adolescents with clinical binge eating behaviors, a moderate number of collisions, and moderate levels of emotional and behavioral problems on the above four dimensions (25.8% of the sample); and a third cluster of youth without clinical binge eating behaviors, with a moderate number of accidents, and with low scores on the four dimensions (50.9% of the sample). Adolescents of Cluster 1 showed a higher likelihood to be involved in motorbike collisions than the youth in Clusters 2 and 3 (p < 0.0001). We suggest that adolescents’ motor collisions could be associated with their difficulties in emotion regulation and with their impaired psychological profiles, which could also underpin their disordered eating. The identification of specific clusters of psychopathological symptoms among this population could be useful for the construction of prevention and intervention programs aimed at reducing motor collision recidivism and alleviating co-occurring psychopathologies.

Multidimensional assessment of empathic abilities in patients with insular glioma

Recent studies have provided evidence that there are two possible systems for empathy: affective empathy (AE) and cognitive empathy (CE). Neuroimaging paradigms have proven that the insular cortex is involved in empathy processing, particularly in AE. However, these observations do not provide causal evidence for the role of the insula in empathy. Although impairments in empathy have been described following insular damage in a few case studies, it is not clear whether insular cortex is involved in CE and whether these two systems are impaired independently or laterally in patients with insular gliomas. In this study, we assessed 17 patients with an insular glioma, 17 patients with a noninsular glioma, and 30 healthy controls using a method that combined a self-report empathy questionnaire with the emotion recognition task, assessment of empathy for others' pain, and the emotional perspective-taking paradigm. We found that patients with an insular glioma had lower scores for empathic concern and perspective taking than did either healthy controls or lesion controls. The patients' abilities to recognize facial emotions, perceive others' pain, and understand the emotional perspectives of others were also significantly impaired. Furthermore, we did not observe a laterality effect on either AE or CE among those with insular lesions. These findings revealed that both AE and CE are impaired in patients with an insular glioma and that the insular cortex may be a central neuroanatomical structure in both the AE and CE systems.

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.

Interoception and psychopathology: A developmental neuroscience perspective

Interoception refers to the perception of the physiological condition of the body, including hunger, temperature, and heart rate. There is a growing appreciation that interoception is integral to higher-order cognition. Indeed, existing research indicates an association between low interoceptive sensitivity and alexithymia (a difficulty identifying one's own emotion), underscoring the link between bodily and emotional awareness. Despite this appreciation, the developmental trajectory of interoception across the lifespan remains under-researched, with clear gaps in our understanding. This qualitative review and opinion paper provides a brief overview of interoception, discussing its relevance for developmental psychopathology, and highlighting measurement issues, before surveying the available work on interoception across four stages of development: infancy, childhood, adolescence and late adulthood. Where gaps in the literature addressing the development of interoception exist, we draw upon the association between alexithymia and interoception, using alexithymia as a possible marker of atypical interoception. Evidence indicates that interoceptive ability varies across development, and that this variance correlates with established age-related changes in cognition and with risk periods for the development of psychopathology. We suggest a theory within which atypical interoception underlies the onset of psychopathology and risky behaviour in adolescence, and the decreased socio-emotional competence observed in late adulthood.

Do parental traumatic experiences have a role in the psychological functioning of early adolescents with binge eating disorder?

PURPOSE

Few studies have addressed the psychological characteristics of adolescents with binge eating disorder (BED). No research has focused on the psychological functioning of these adolescents' parents or on the prevalence of traumatic experiences among them.

METHODS

In this study, 202 adolescents aged 11-13 and their parents were recruited from mental health clinics to complete the youth self-report (YSR), the response evaluation measure for youth (REM-71), the Toronto Alexithymia Scale (TAS-20), the Symptom Check-List (SCL-90-R), and the traumatic experience checklist (TEC).

RESULTS

Female adolescents scored higher than males on withdrawal, internalizing problems, dissociation, and somatization subscales. Boys scored higher than girls on externalizing problems and acting out subscales. Maternal depression predicted withdrawal and dissociation in female adolescents. Maternal sexual abuse predicted social problems in males and self-destructive behaviors in females. Paternal physical abuse predicted delinquent behavior and acting out in males.

CONCLUSIONS

Our data suggest that parental traumatic experiences play a role in their offspring's mental health; the data also showed different psychopathological configurations in male and female adolescents with BED and their parents, suggesting the development of prevention and treatment polices specific to gender.

Emotional decision-making in autism spectrum disorder: the roles of interoception and alexithymia

The way choices are framed influences decision-making. These “framing effects” emerge through the integration of emotional responses into decision-making under uncertainty. It was previously reported that susceptibility to the framing effect was reduced in individuals with autism spectrum disorder (ASD) due to a reduced tendency to incorporate emotional information into the decision-making process. However, recent research indicates that, where observed, emotional processing impairments in ASD may be due to co-occurring alexithymia. Alexithymia is thought to arise due to impaired interoception (the ability to perceive the internal state of one’s body), raising the possibility that emotional signals are not perceived and thus not integrated into decision-making in those with alexithymia and that therefore reduced framing effects in ASD are a product of co-occurring alexithymia rather than ASD per se. Accordingly, the present study compared framing effects in autistic individuals with neurotypical controls matched for alexithymia. Results showed a marked deviation between groups. The framing effect was, in line with previous data, significantly smaller in autistic individuals, and there was no relationship between alexithymia or interoception and decision-making in the ASD group. In the neurotypical group, however, the size of the framing effect was associated with alexithymia and interoception, even after controlling for autistic traits. These results demonstrate that although framing effects are associated with interoception and alexithymia in the neurotypical population, emotional and interoceptive signals have less impact upon the decision-making process in ASD.

Alexithymia: a general deficit of interoception

Alexithymia is a sub-clinical construct, traditionally characterized by difficulties identifying and describing one's own emotions. Despite the clear need for interoception (interpreting physical signals from the body) when identifying one's own emotions, little research has focused on the selectivity of this impairment. While it was originally assumed that the interoceptive deficit in alexithymia is specific to emotion, recent evidence suggests that alexithymia may also be associated with difficulties perceiving some non-affective interoceptive signals, such as one's heart rate. It is therefore possible that the impairment experienced by those with alexithymia is common to all aspects of interoception, such as interpreting signals of hunger, arousal, proprioception, tiredness and temperature. In order to determine whether alexithymia is associated with selectively impaired affective interoception, or general interoceptive impairment, we investigated the association between alexithymia and self-reported non-affective interoceptive ability, and the extent to which individuals perceive similarity between affective and non-affective states (both measured using questionnaires developed for the purpose of the current study), in both typical individuals (n = 105 (89 female), mean age = 27.5 years) and individuals reporting a diagnosis of a psychiatric condition (n = 103 (83 female), mean age = 31.3 years). Findings indicated that alexithymia was associated with poor non-affective interoception and increased perceived similarity between affective and non-affective states, in both the typical and clinical populations. We therefore suggest that rather than being specifically associated with affective impairment, alexithymia is better characterized by a general failure of interoception.

Understanding self and others: from origins to disorders

In order to interpret and engage with the social world, individuals must understand how they relate to others. Self-other understanding forms the backbone of social cognition and is a central concept explored by research into basic processes such as action perception and empathy, as well as research on more sophisticated social behaviours such as cooperation and intergroup interaction. This theme issue integrates the latest research into self-other understanding from evolutionary biology, anthropology, psychology, neuroscience and psychiatry. By gathering perspectives from a diverse range of disciplines, the contributions showcase ways in which research in these areas both informs and is informed by approaches spanning the biological and social sciences, thus deepening our understanding of how we relate to others in a social world.