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Fantozzi P, Billeci L, Muratori P, Maestro S, Muratori F, Chakrabarti B, Calderoni S. Autistic traits and perspective taking in youths with anorexia nervosa: an exploratory clinical and eye tracking study. J Eat Disord 2024; 12:116. [PMID: 39143647 PMCID: PMC11325632 DOI: 10.1186/s40337-024-01075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Despite their apparent dissimilarity, Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD) share many features, especially in terms of social and emotional difficulties. In recent years, empathic abilities in AN have been frequently assessed using self-report measures. Otherwise, the director task (DT) has been used to investigate the ability to take the visual perspective of another individual in a communicative context, using eye-tracking technology. The aim of the current study was to test the presence of autism-relevant features in AN, through: (i) comparing self-reported autistic traits and empathic abilities in a group of young inpatients with AN and age/gender matched healthy controls (HC); (ii) comparing performance on the director paradigm. METHODS The participants were females in the age-range between 11 and 18 years: 24 with AN and 23 HC. Autistic traits, empathic abilities, and severity of the eating disorder were respectively measured using: the Autism Quotient (AQ), the Interpersonal Reactivity Index (IRI), and the Eating Disorder Inventory-3 (EDI-3). Both groups performed a computerized task in which a director instructed them to move objects placed on a set of shelves using a mouse, while their eye gaze was tracked. A total of 36 shelf configurations, divided into three categories (with dimensional distractor - with spatial distractor - control), were created. RESULTS Subjects with AN showed higher autistic traits than HC. Eye-tracking data revealed that subjects with AN took longer to decide which object to select and where to move it, both in distractor-trials and in control-trials. In the AN group, we found a significant negative correlation between the total score of the AQ and the number of fixations to the irrelevant object in the dimensional control condition -in which the subjects were asked to focus on dimensional aspects of the object (large-small)-. CONCLUSIONS Autistic traits were over-represented in a group of young inpatients with AN. Through the use of eye-tracking technology, this exploratory study documented some differences between AN inpatients and HC in their online processes during the perspective taking tasks, which could be considered a target of tailored intervention. A larger sample of patients is needed to confirm these preliminary findings.
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Affiliation(s)
- Pamela Fantozzi
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy
| | - Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | - Pietro Muratori
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy
| | - Sandra Maestro
- Residential Eating Disorder Treatment Center "Orti di Ada", Pisa, Italy
| | - Filippo Muratori
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy
| | - Bhismadev Chakrabarti
- Centre for Autism, School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Sara Calderoni
- IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Pisa, I-56018, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Arango-de-Montis I, Reyes-Soto A, Rosales-Lagarde A, Eraña-Díaz ML, Vázquez-Mendoza E, Rodríguez-Delgado A, Muñoz-Delgado J, Vázquez-Mendoza I, Rodriguez-Torres EE. Automatic detection of facial expressions during the Cyberball paradigm in Borderline Personality Disorder: a pilot study. Front Psychiatry 2024; 15:1354762. [PMID: 38895036 PMCID: PMC11184241 DOI: 10.3389/fpsyt.2024.1354762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/04/2024] [Indexed: 06/21/2024] Open
Abstract
Borderline Personality Disorder (BPD) symptoms include inappropriate control of anger and severe emotional dysregulation after rejection in daily life. Nevertheless, when using the Cyberball paradigm, a tossing game to simulate social exclusion, the seven basic emotions (happiness, sadness, anger, surprise, fear, disgust, and contempt) have not been exhaustively tracked out. It was hypothesized that these patients would show anger, contempt, and disgust during the condition of exclusion versus the condition of inclusion. When facial emotions are automatically detected by Artificial Intelligence, "blending", -or a mixture of at least two emotions- and "masking", -or showing happiness while expressing negative emotions- may be most easily traced expecting higher percentages during exclusion rather than inclusion. Therefore, face videos of fourteen patients diagnosed with BPD (26 ± 6 years old), recorded while playing the tossing game, were analyzed by the FaceReader software. The comparison of conditions highlighted an interaction for anger: it increased during inclusion and decreased during exclusion. During exclusion, the masking of surprise; i.e., displaying happiness while feeling surprised, was significantly more expressed. Furthermore, disgust and contempt were inversely correlated with greater difficulties in emotion regulation and symptomatology, respectively. Therefore, the automatic detection of emotional expressions during both conditions could be useful in rendering diagnostic guidelines in clinical scenarios.
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Affiliation(s)
- Iván Arango-de-Montis
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Adriana Reyes-Soto
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Alejandra Rosales-Lagarde
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
- Dirección Adjunta de Investigación Humanística y Científica, Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT), Mexico City, Mexico
| | - Marta-Lilia Eraña-Díaz
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, Mexico
| | - Enrique Vázquez-Mendoza
- Área Académica de Matemáticas y Física, Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
| | - Andrés Rodríguez-Delgado
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Jairo Muñoz-Delgado
- Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Isaac Vázquez-Mendoza
- Área Académica de Matemáticas y Física, Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
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Tchanturia K, Croft P, Holetic V, Webb J, Dapelo MM. Positive communication workshops: are they useful for treatment programmes for anorexia nervosa? Front Psychol 2023; 14:1234928. [PMID: 37645066 PMCID: PMC10461805 DOI: 10.3389/fpsyg.2023.1234928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Background Social isolation, loneliness and difficulties in relationships are often described as a core feature of eating disorders. Based on the experimental research, we have designed one-off workshops for patients in inpatients and day care services and evaluated its acceptability and effectiveness using feedback questionnaires. Methods This naturalistic project is an evaluation of multiple positive communication workshops. Forty-one participants completed workshop questionnaires, which were provided immediately at the beginning and end of the workshop, including feedback on these one-off groups. The workshops consisted of educational and experiential components. The questionnaire outcomes were evaluated by independent researchers. Results All participants were female adults with a mean age of 33 (12.2) and a diagnosis of Anorexia Nervosa (AN; either restrictive or binge-purge subtype). Post-workshop questionnaires showed large effect sizes in the improvement of understanding the importance and confidence in using positive communication strategies. Discussion Addressing social communication difficulties in eating disorder treatment programmes adds valuable dimensions to these symptom-based treatments in both inpatient settings and day services, and may provide broader benefits in overall social functioning in patients with AN. Conclusion Brief one-off workshops targeting social functioning for patients with eating disorders might be useful complementary input for treatment programmes.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Ilia State University, Tbilisi, Georgia
| | - Philippa Croft
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Victoria Holetic
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jessica Webb
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Marcela Marin Dapelo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Gaggero G, Luminet O, Vermeulen N, De Timary P, Nandrino JL, Goffinet S, Dereau J, Shankland R, Dassonneville C, Grynberg D. A multidimensional examination of affective and cognitive empathy in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37081796 DOI: 10.1002/erv.2980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Socio-emotional features are crucial in the development and maintenance of anorexia nervosa (AN). The present study investigates the patterns of altered and preserved empathic abilities in AN. Empathy is an umbrella term that comprises the ability to recognise another's emotional state, take another's perspective, and fantasise (cognitive empathy), as well as the ability to experience vicarious emotions and signal them (affective empathy). These empathic abilities were measured in 43 AN patients and 33 healthy women through a multi-method approach comprising self-report measures, behavioural tasks and bodily correlates. Further, we assessed self-reported approach-avoidance attitudes towards suffering others. Results showed that, within the domain of cognitive empathy, AN patients reported impairment in recognising emotional expressions of anger and fantasising. Concerning affective empathy, they manifested lower sharing of others' positive emotions, higher self-reported distress, and higher facial expressiveness during a video depicting a suffering person. Finally, AN patients reported lower motivation to approach suffering others. Our results draw a complex picture of preserved and altered empathic abilities in AN and capture which are the deficits mediated by the higher levels of anxiety and depression reported by the AN population and those that seem to persist independently from these co-morbid conditions.
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Affiliation(s)
- G Gaggero
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - O Luminet
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Fund for Scientific Research (FRS-FNRS), Brussels, Belgium
| | - N Vermeulen
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Fund for Scientific Research (FRS-FNRS), Brussels, Belgium
| | - P De Timary
- Department of Adult Psychiatry, UCLouvain, Institute of Neuroscience and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - J L Nandrino
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - S Goffinet
- Service de Psychiatrie Infanto-Juvénile, Hospital Erasme, HUB, Université Libre de Bruxelles, Brussels, Belgium
| | - J Dereau
- Clinique La Ramée, Bruxelles, Belgique
| | - R Shankland
- Laboratory DIPHE (Development, Individual, Personality, Handicap, Education), Department of Psychology of Development, Education and Vulnerabilities, University Lumière Lyon, Bron, France
- Laboratory LIP/PC2S, Department of Psychology, University Grenoble Alpes/Savoie-Mont-Blanc, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - C Dassonneville
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - D Grynberg
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
- Institut Universitaire de France, Paris, France
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Monteleone AM, Cascino G, Ruzzi V, Marafioti N, Marone L, Croce Nanni R, Troisi A. Non-verbal social communication in individuals with eating disorders: an ethological analysis in experimental setting. Eat Weight Disord 2022; 27:3125-3133. [PMID: 35829898 PMCID: PMC9803750 DOI: 10.1007/s40519-022-01442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/29/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Evidence that social difficulties promote the development and the maintenance of eating disorders (EDs) derive from self-reported data and only partially from experimental tasks. This study objectively assessed non-verbal behaviors of individuals with EDs in a psycho-social stress scenario. METHODS Thirty-one women suffering from EDs (13 with anorexia nervosa and 18 with bulimia nervosa) and 15 healthy women underwent the Trier Social Stress Test (TSST), the paradigm of psycho-social stress, and were videotaped. Throughout the procedure, anxiety feelings were measured by the State-Trait Anxiety Inventory state subscale and saliva samples were collected to evaluate cortisol levels. Non-verbal behaviors were analyzed through the Ethological Coding System for Interviews and were compared between study samples through multivariate analysis of variance. Multivariate regression analyses were performed to assess the association between anxiety, cortisol and behavioral responses to TSST. RESULTS Women with EDs showed reduced submissiveness, flight (cutoff from social stimuli) and gesture compared to healthy peers during TSST. Submissiveness and flight behaviors were negatively associated with stress-induced anxiety, while TSST-induced anxiety and cortisol increases were positively associated with looking at the other's face behavior in participants with EDs. In this population, cortisol reactivity was also positively associated with submissiveness and negatively with gesture. CONCLUSION Women with EDs showed a hostile and freezing response to acute psycho-social stress: reduced submissiveness and flight may represent strategies to manage social anxiety. These findings confirm that the non-verbal behavior assessment provides complementary information to those derived from traditional measurements and suggests research and clinical implications. LEVEL OF EVIDENCE I Evidence obtained from experimental study.
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Affiliation(s)
- Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy.
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy
| | - Niccolò Marafioti
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy
| | - Luigi Marone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy
| | | | - Alfonso Troisi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Leppanen J, Patsalos O, Surguladze S, Kerr-Gaffney J, Williams S, Tchanturia K. Evaluation of film stimuli for the assessment of social-emotional processing: a pilot study. PeerJ 2022; 10:e14160. [PMID: 36444380 PMCID: PMC9700451 DOI: 10.7717/peerj.14160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Difficulties in top-down and bottom-up emotion generation have been proposed to play a key role in the progression of psychiatric disorders. The aim of the current study was to develop more ecologically valid measures of top-down interpretation biases and bottom-up evoked emotional responses. Methods A total of 124 healthy female participants aged 18-25 took part in the study. We evaluated two sets of 18 brief film clips. The first set of film clips presented ambiguous social situations designed to examine interpretation biases. Participants provided written interpretations of each ambiguous film clip which were subjected to sentiment analysis. We compared the films in terms of the valence of participants interpretations. The second set of film clips presented neutral and emotionally provoking social scenarios designed to elicit subjective and facial emotional responses. While viewing these film clips participants mood ratings and facial affect were recorded and analysed using exploratory factor analyses. Results Most of the 18 ambiguous film clips were interpreted in the expected manner while still retaining some ambiguity. However, participants were more attuned to the negative cues in the ambiguous film clips and three film clips were identified as unambiguous. These films clips were deemed unsuitable for assessing interpretation bias. The exploratory factor analyses of participants' mood ratings and evoked facial affect showed that the positive and negative emotionally provoking film clips formed their own factors as expected. However, there was substantial cross-loading of the neutral film clips when participants' facial expression data was analysed. Discussion A subset of the film clips from the two tasks could be used to assess top-down interpretation biases and bottom-up evoked emotional responses. Ambiguous negatively valenced film clips should have more subtle negative cues to avoid ceiling effects and to ensure there is enough room for interpretation.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, King’s College London, University of London, London, United Kingdom
| | - Olivia Patsalos
- Department of Psychological Medicine, King’s College London, University of London, London, United Kingdom
| | - Sophie Surguladze
- Department of Psychological Medicine, King’s College London, University of London, London, United Kingdom
| | - Jess Kerr-Gaffney
- Department of Psychological Medicine, King’s College London, University of London, London, United Kingdom
| | - Steven Williams
- Department of Neuroimaging, King’s College London, University of London, London, United Kingdom
| | - Ketevan Tchanturia
- Department of Psychological Medicine, King’s College London, University of London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, United Kingdom
- Psychology Department, Illia State University, Tbilisi, Georgia
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Test–Retest Reliability in Automated Emotional Facial Expression Analysis: Exploring FaceReader 8.0 on Data from Typically Developing Children and Children with Autism. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Automated emotional facial expression analysis (AEFEA) is used widely in applied research, including the development of screening/diagnostic systems for atypical human neurodevelopmental conditions. The validity of AEFEA systems has been systematically studied, but their test–retest reliability has not been researched thus far. We explored the test–retest reliability of a specific AEFEA software, Noldus FaceReader 8.0 (FR8; by Noldus Information Technology). We collected intensity estimates for 8 repeated emotions through FR8 from facial video recordings of 60 children: 31 typically developing children and 29 children with autism spectrum disorder. Test–retest reliability was imperfect in 20% of cases, affecting a substantial proportion of data points; however, the test–retest differences were small. This shows that the test–retest reliability of FR8 is high but not perfect. A proportion of cases which initially failed to show perfect test–retest reliability reached it in a subsequent analysis by FR8. This suggests that repeated analyses by FR8 can, in some cases, lead to the “stabilization” of emotion intensity datasets. Under ANOVA, the test–retest differences did not influence the pattern of cross-emotion and cross-group effects and interactions. Our study does not question the validity of previous results gained by AEFEA technology, but it shows that further exploration of the test–retest reliability of AEFEA systems is desirable.
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Lavallee A, Pham TH, Gandolphe MC, Saloppé X, Ott L, Nandrino JL. Monitoring the emotional facial reactions of individuals with antisocial personality disorder during the retrieval of self-defining memories. PLoS One 2022; 17:e0268818. [PMID: 35675301 PMCID: PMC9176833 DOI: 10.1371/journal.pone.0268818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
While a deficit in the recognition of facial expression has been demonstrated in persons with antisocial personality disorder (ASPD), few studies have investigated how individuals with ASPD produce their own emotional facial expressions. This study examines the production of facial emotional expressions of male inpatients with ASPD in a forensic hospital compared with a control group as they retrieve autobiographical memories. This design constitutes a specific ecological experimental approach fostering the evocation of personal feelings. Two indicators characterizing the activation of facial expression were used: activation of emotional action units and emotional dominance. The results showed that individuals with ASPD 1) activated angrier facial expressions than control participants for both indicators, 2) displayed a higher dominance of angry facial expressions during the retrieval of positive self-defining memories than control participants and 3) recalled significant memories that were less associated with neutral facial states than the control sample, regardless of the valence of their memories. These findings highlight the core role of anger in ASPD and the possible development of pathological anger, which would distinguish trajectories toward anxious or mood disorders and trajectories characterized by external disorders.
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Affiliation(s)
- Audrey Lavallee
- SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq Cedex, France
- Department of Legal Psychology, University of Mons, Mons, Belgium
- Groupement des Hôpitaux de l’Institut Catholique de Lille, Lille, France
| | - Thierry. H. Pham
- Department of Legal Psychology, University of Mons, Mons, Belgium
- Research Center in Social Defense, Tournai, Belgium
| | | | - Xavier Saloppé
- SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq Cedex, France
- Research Center in Social Defense, Tournai, Belgium
- Psychiatric Hospital, Saint-Amand-les-Eaux, France
| | - Laurent Ott
- SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq Cedex, France
| | - Jean-Louis Nandrino
- SCALab, UMR CNRS 9193, University of Lille, Villeneuve d’Ascq Cedex, France
- * E-mail:
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Determining the Intensity of Basic Emotions among People Suffering from Anorexia Nervosa Based on Free Statements about Their Body. ELECTRONICS 2022. [DOI: 10.3390/electronics11010138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Objective: This study sought to address one of the challenges of psychiatry-computer aided diagnosis and therapy of anorexia nervosa. The goal of the paper is to present a method of determining the intensity of five emotions (happiness, sadness, anxiety, anger and disgust) in medical notes, which was then used to analyze the feelings of people suffering from anorexia nervosa. In total, 96 notes were researched (46 from people suffering from anorexia and 52 from healthy people). Method: The developed solution allows a comprehensive assessment of the intensity of five feelings (happiness, sadness, anxiety, anger and disgust) occurring in text notes. This method implements Nencki Affective Word List dictionary extension, in which the original version has a limited vocabulary. The method was tested on a group of patients suffering from anorexia nervosa and a control group (healthy people without an eating disorder). Of the analyzed medical, only 8% of the words are in the original dictionary. Results: As a result of the study, two emotional profiles were obtained: one pattern for a healthy person and one for a person suffering from anorexia nervosa. Comparing the average emotional intensity in profiles of a healthy person and person with a disorder, a higher value of happiness intensity is noticeable in the profile of a healthy person than in the profile of a person with an illness. The opposite situation occurs with other emotions (sadness, anxiety, disgust, anger); they reach higher values in the case of the profile of a person suffering from anorexia nervosa. Discussion: The presented method can be used when observing the patient’s progress during applied therapy. It allows us to state whether the chosen method has a positive effect on the mental state of the patient, and if his emotional profile is similar to the emotional profile of a healthy person. The method can also be used during first diagnosis visit.
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Mason TB, Lesser EL, Dolgon-Krutolow AR, Wonderlich SA, Smith KE. An updated transdiagnostic review of social cognition and eating disorder psychopathology. J Psychiatr Res 2021; 143:602-627. [PMID: 33190838 DOI: 10.1016/j.jpsychires.2020.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023]
Abstract
Existing data suggest that deficits in social cognitive functioning are transdiagnostic phenomena that are observed across various forms of psychopathology. The goal of the present review was to provide an updated systematic review of the literature on social cognitive functioning across eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Studies that assessed six areas of social cognition were included: theory of mind, social perception, social knowledge, attributional bias, emotion perception, and emotion processing. A systematic search identified 71 studies, the majority of which examined adult women with AN. Research typically focused on alexithymia, theory of mind, empathy, social processing, emotion recognition, or emotion processing. Results suggested some deficits in social cognition in EDs. AN had the most studies with some evidence for deficiencies in social cognition but a fair amount of variability. Research on BN and BED was limited and inconsistent, though there appear to be some deficits in social cognition. Together, the limited coverage across EDs and heterogeneous methodology preclude firm conclusions regarding general or ED-specific deficits, as well as understanding the role of social cognition in ED etiology and maintenance. Therefore, several key questions and future directions are outlined for research moving forward.
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Affiliation(s)
- Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Anna R Dolgon-Krutolow
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen A Wonderlich
- Sanford Center for Bio-behavioral Research, Sanford Health, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.
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11
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Internal states and interoception along a spectrum of eating disorder symptomology. Physiol Behav 2021; 230:113307. [PMID: 33373691 DOI: 10.1016/j.physbeh.2020.113307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Recent studies on atypical interoceptive capabilities have focused on clinical populations, including anorexia nervosa[1,2]. The present exploratory study aims to characterize the influence of disordered eating symptomology on interoceptive capabilities in college students, a population for which dangerous dieting behaviors may emerge. METHOD Ninety-nine participants were randomized to consume a blinded high calorie or low calorie midday shake. Participants reported frequency of eating disorder cognitions and behaviors; indicated changes in satiety, happiness, and energy pre- and post-consumption; and guessed the calories in their shake. Outcomes (perceived satiety, changes in mood, and caloric guess) were regressed on eating disorder symptoms scores, the high/low calorie shake condition, and the interaction between these predictors. RESULTS Those randomized to receive the high calorie shake reported feeling fuller, but only when endorsing lower levels of eating concern. Those randomized to the high calorie shake reported greater post-meal happiness, but only at greater levels of eating concerns. Lastly, those with lower levels of eating restraint reported an expected positive association between level of fullness and calorie guess, but those with higher levels of eating restraint did not exhibit any relationship between perceived fullness and calorie guess. DISCUSSION Results of this exploratory suggest that irregular eating habits (e.g., not eating a sufficient amount for lunch) may have direct consequences on interoceptive capabilities. Further, these capacities may be impacted by individual differences in eating concern and restraint. Preliminary findings suggest that impairment in deciphering visceral signals may be associated with the degree of eating disorder symptomology; such impairment may occur at lower levels of symptomatology than normative data would indicate.
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Harrison A. Experimental Investigation of Non-Verbal Communication in Eating Disorders. Psychiatry Res 2021; 297:113732. [PMID: 33535088 DOI: 10.1016/j.psychres.2021.113732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
This study aimed to be the first to measure non-verbal communication in 25 eating disorder (ED) and 25 non-ED control participants during a naturalistic social interaction incorporating positive, negative and neutrally-valenced topics. The first hypothesis, that ED participants would show significantly reduced facial emotional expression than controls, was not supported. Supporting the second hypothesis of between-group differences in non-verbal behaviour, ED participants were less likely to lean in towards their interlocutor (d=.81) discussing negatively-valanced topics and were more likely to be positioned upright when discussing positively-valenced topics (d=.1.09) than controls. Irrespective of emotional valence, ED participants positioned their gaze on their interlocutor significantly less (d=.29) and spent more time looking down (d=.54), or away than controls (d=.63). ED participants moved their hands along with speech significantly less (d=.63) and gestured fewer real/hypothetical/imagined images/actions/objects) than controls (d=.57), irrespective of emotional valence. Instead, ED participants indicated discomfort in the social interaction, touching their nose (d=.89) or playing with their nails (d=.95) more often than controls. ED participants, regardless of emotional valence, showed significantly lowered electro-dermal activity (d=.60) than controls, supporting the exploratory hypothesis. People with EDs appear to make less efficient use of non-verbal communication than controls.
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Affiliation(s)
- A Harrison
- Associate Professor in Psychology, University College London, Institute of Education, Department of Psychology and Human Development.
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13
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Nanayama Tanaka C, Higa H, Ogawa N, Ishido M, Nakamura T, Nishiwaki M. Negative Mood States Are Related to the Characteristics of Facial Expression Drawing: A Cross-Sectional Study. Front Psychol 2021; 11:576683. [PMID: 33391093 PMCID: PMC7773925 DOI: 10.3389/fpsyg.2020.576683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/12/2020] [Indexed: 11/13/2022] Open
Abstract
An assessment of mood or emotion is important in developing mental health measures, and facial expressions are strongly related to mood or emotion. This study thus aimed to examine the relationship between levels of negative mood and characteristics of mouth parts when moods are drawn as facial expressions on a common platform. A cross-sectional study of Japanese college freshmen was conducted, and 1,068 valid responses were analyzed. The questionnaire survey consisted of participants’ characteristics, the Profile of Mood States (POMS), and a sheet of facial expression drawing (FACED), and the sheet was digitized and analyzed using an image-analysis software. Based on the total POMS score as an index of negative mood, the participants were divided into four groups: low (L), normal (N), high (H), and very high (VH). Lengths of drawn lines and between both mouth corners were significantly longer, and circularity and roundness were significantly higher in the L group. With increasing levels of negative mood, significant decreasing trends were observed in these lengths. Convex downward and enclosed figures were significantly predominant in the L group, while convex upward figures were significantly predominant and a tendency toward predominance of no drawn mouths or line figures was found in the H and VH groups. Our results suggest that mood states can be significantly related to the size and figure characteristics of drawn mouths of FACED on a non-verbal common platform. That is, these findings mean that subjects with low negative mood may draw a greater and rounder mouth and figures that may be enclosed and downward convex, while subjects with a high negative mood may not draw the line, or if any, may draw the line shorter and upward convex.
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Affiliation(s)
| | - Hayato Higa
- Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Noriko Ogawa
- Graduate School of Engineering, Osaka Institute of Technology, Osaka, Japan.,Faculty of Nursing, Setsunan University, Osaka, Japan
| | - Minenori Ishido
- Faculty of Engineering, Osaka Institute of Technology, Osaka, Japan
| | | | - Masato Nishiwaki
- Faculty of Engineering, Osaka Institute of Technology, Osaka, Japan
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Villanueva-Valle J, Díaz JL, Jiménez S, Rodríguez-Delgado A, Arango de Montis I, León-Bernal A, Miranda-Terres E, Muñoz-Delgado J. Facial and Vocal Expressions During Clinical Interviews Suggest an Emotional Modulation Paradox in Borderline Personality Disorder: An Explorative Study. Front Psychiatry 2021; 12:628397. [PMID: 33841202 PMCID: PMC8024539 DOI: 10.3389/fpsyt.2021.628397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Videotape recordings obtained during an initial and conventional psychiatric interview were used to assess possible emotional differences in facial expressions and acoustic parameters of the voice between Borderline Personality Disorder (BPD) female patients and matched controls. The incidence of seven basic emotion expressions, emotional valence, heart rate, and vocal frequency (f0), and intensity (dB) of the discourse adjectives and interjections were determined through the application of computational software to the visual (FaceReader) and sound (PRAAT) tracks of the videotape recordings. The extensive data obtained were analyzed by three statistical strategies: linear multilevel modeling, correlation matrices, and exploratory network analysis. In comparison with healthy controls, BPD patients express a third less sadness and show a higher number of positive correlations (14 vs. 8) and a cluster of related nodes among the prosodic parameters and the facial expressions of anger, disgust, and contempt. In contrast, control subjects showed negative or null correlations between such facial expressions and prosodic parameters. It seems feasible that BPD patients restrain the facial expression of specific emotions in an attempt to achieve social acceptance. Moreover, the confluence of prosodic and facial expressions of negative emotions reflects a sympathetic activation which is opposed to the social engagement system. Such BPD imbalance reflects an emotional alteration and a dysfunctional behavioral strategy that may constitute a useful biobehavioral indicator of the severity and clinical course of the disorder. This face/voice/heart rate emotional expression assessment (EMEX) may be used in the search for reliable biobehavioral correlates of other psychopathological conditions.
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Affiliation(s)
- Javier Villanueva-Valle
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - José-Luis Díaz
- Facultad de Medicina Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Said Jiménez
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Andrés Rodríguez-Delgado
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Iván Arango de Montis
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Areli León-Bernal
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Edgar Miranda-Terres
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Jairo Muñoz-Delgado
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
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15
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Gkouskou K, Vlastos I, Karkalousos P, Chaniotis D, Sanoudou D, Eliopoulos AG. The "Virtual Digital Twins" Concept in Precision Nutrition. Adv Nutr 2020; 11:1405-1413. [PMID: 32770212 PMCID: PMC7666894 DOI: 10.1093/advances/nmaa089] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
Nutritional and lifestyle changes remain at the core of healthy aging and disease prevention. Accumulating evidence underscores the impact of genetic, metabolic, and host gut microbial factors on individual responses to nutrients, paving the way for the stratification of nutritional guidelines. However, technological advances that incorporate biological, nutritional, lifestyle, and health data at an unprecedented scale and depth conceptualize a future where preventative dietary interventions will exceed stratification and will be highly individualized. We herein discuss how genetic information combined with longitudinal metabolomic, immune, behavioral, and gut microbial parameters, and bioclinical variables could define a digital replica of oneself, a "virtual digital twin," which could serve to guide nutrition in a personalized manner. Such a model may revolutionize the management of obesity and its comorbidities, and provide a pillar for healthy aging.
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Affiliation(s)
| | - Ioannis Vlastos
- Department of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Karkalousos
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Dimitrios Chaniotis
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Despina Sanoudou
- Clinical Genomics and Pharmacogenomics Unit, 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece,Center for New Biotechnologies and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece,Center of Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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16
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Vuillier L, Carter Z, Teixeira AR, Moseley RL. Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology. Mol Autism 2020; 11:63. [PMID: 32758290 PMCID: PMC7406391 DOI: 10.1186/s13229-020-00364-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/15/2020] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- L. Vuillier
- Department of Psychology, Bournemouth University, Poole, UK
| | - Z. Carter
- Department of Psychology, Bournemouth University, Poole, UK
| | - A. R. Teixeira
- Department of Psychology, Bournemouth University, Poole, UK
| | - R. L. Moseley
- Department of Psychology, Bournemouth University, Poole, UK
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17
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Bentz M, Westwood H, Jepsen JRM, Plessen KJ, Tchanturia K. The autism diagnostic observation schedule: Patterns in individuals with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:571-579. [PMID: 32729156 DOI: 10.1002/erv.2757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/04/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Studies have used the Autism Diagnostic Observation Schedule (the ADOS-2) in individuals with anorexia nervosa (AN), but the patterns of scores have not been assessed. We examined which subset of the ADOS-2 items best discriminate individuals with AN from healthy controls (HC), and assessed the potential clustering of AN participants based on different profiles of the ADOS-2 item scores. METHOD We combined datasets from two previous studies, and (a) compared mean ranks between young AN participants (N = 118) and HC (N = 42), (ii) replicated the item selection procedure of the existing ADOS-2 algorithm to assess sensitivity of items in the AN group, and (c) applied a two-step clustering analysis in the AN group (N = 149). RESULTS AN participants displayed significantly higher mean ranks than HC participants in five of 32 items. All five items are part of the existing ADOS-2 algorithm. We found two clusters of AN participants; one representing normal social behaviour, comprising 68% of the individuals with AN, and one representing less efficient social behaviour, comprising 32% of individuals with AN. CONCLUSIONS The items comprising the social affective cluster of the existing ADOS-2 algorithm are well suited to assess difficulties with social functioning in individuals with AN.
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Affiliation(s)
- Mette Bentz
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Heather Westwood
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Kate Tchanturia
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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18
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Keep your interoceptive streams under control: An active inference perspective on anorexia nervosa. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:427-440. [DOI: 10.3758/s13415-020-00777-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Meneguzzo P, Collantoni E, Bonello E, Busetto P, Tenconi E, Favaro A. The predictive value of the early maladaptive schemas in social situations in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:318-331. [PMID: 31999048 DOI: 10.1002/erv.2724] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) show an impairment in the recognition and expression of emotions, as well as an increased sensitivity to being socially excluded, and rigid maladaptive schemas. The Cyberball paradigm is a virtual ball-toss game that can simulate social exclusion and inclusion. Our aim is to evaluate how cognitive schemas can influence the perception and the evaluation of the experiences of social inclusion/exclusion. METHODS Thirty-two AN patients and 34 healthy controls completed a psychological evaluation and were randomly assigned to exclusion or overinclusion paradigm of the Cyberball task. RESULTS Patients with AN showed a significantly higher level of maladaptive schemas as well as higher sensitivity to being ostracized by peers in comparison with healthy controls. Regression analyses identified specific significant relation between being ostracized and dependence/incompetence, negativity/pessimism, and self-sacrifice. DISCUSSION Our findings provide evidence that patients with AN may be ineffective in expressing their mood in exclusive and overinclusive social situations. Specific cognitive/temperamental schemas might play a role in the way people communicate their feelings, and they could be considered targets for psychotherapy interventions to improve social interpretation and emotional recognition/communication.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Elisa Bonello
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Paolo Busetto
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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20
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Abstract
PURPOSE OF REVIEW This review delineates issues in the conceptualization and operationalization of eating disorder recovery, highlights recent findings about recovery (since 2016), and proposes future directions. RECENT FINDINGS A longstanding problem in the field is that there are almost as many different definitions of recovery in eating disorders as there are studies on the topic. Yet, there has been a general shift to accepting that psychological/cognitive symptoms are important to recovery in addition to physical and behavioral indices. Further, several operationalizations of recovery have been proposed over the past two decades, and some efforts to validate operationalizations exist. However, this work has had limited impact and uptake, such that the field is suffering from "broken record syndrome," where calls are made for universal definitions time and time again. It is critical that proposed operationalizations be compared empirically to help arrive at a consensus definition and that institutional/organizational support help facilitate this. Themes in recent recovery research include identifying predictors, examining biological/neuropsychological factors, and considering severe and enduring anorexia nervosa. From qualitative research, those who have experienced eating disorders highlight recovery as a journey, as well as factors such as hope, self-acceptance, and benefiting from support from others as integral to the process of recovery. The field urgently needs to implement a universal definition of recovery that is backed by evidence, that can parsimoniously be implemented in clinical practice, and that will lead to greater harmonization of scientific findings.
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21
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Hildebrandt T, Schulz K, Fleysher L, Griffen T, Heywood A, Sysko R. Development of a methodology to combine fMRI and EMG to measure emotional responses in patients with anorexia nervosa. Int J Eat Disord 2018; 51:722-729. [PMID: 30120839 PMCID: PMC8720298 DOI: 10.1002/eat.22893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Individuals with eating disorders are theorized to have basic impairments in affective appraisal and social-emotional processing that contribute to pathogenesis of the disease. We aimed to determine if facial electromyography could be used to discriminate between happy and disgust emotions during simultaneous acquisition of an fMRI BOLD sequence in efforts to establish a novel tool for investigating emotion-driven hypotheses about eating pathology. In line with standards for rigor and reproducibility, we provide detailed protocols and code to support each step of this project. METHOD Sixteen adolescents with low-weight eating disorders viewed emotional faces (Happy or Disgust) and were asked to mimic their facial expression during simultaneous BOLD and EMG (Corrugator supercilli, Lavator lavii, Zygomaticus major) acquisition. Trials were repeated with the scanner off and again with scanner on (i.e., fatigue). RESULTS The Levator and Zygomaticus activation patterns discriminated disgust and happy faces successfully. The pattern held between scanner on and off conditions, but muscle activation attenuated in the Fatigue condition, especially for the Zygomaticus. DISCUSSION Simultaneous fMRI-EMG is a new tool capable of discriminating specific emotions based on muscle activation patterns and can be leveraged to answer emotion-driven hypotheses about clinical populations characterized by difficulty labeling or processing emotions.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kurt Schulz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Trevor Griffen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley Heywood
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robyn Sysko
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Leppanen J, Sedgewick F, Treasure J, Tchanturia K. Differences in the Theory of Mind profiles of patients with anorexia nervosa and individuals on the autism spectrum: A meta-analytic review. Neurosci Biobehav Rev 2018; 90:146-163. [DOI: 10.1016/j.neubiorev.2018.04.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 03/01/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
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23
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Cardi V, Tchanturia K, Treasure J. Premorbid and Illness-related Social Difficulties in Eating Disorders: An Overview of the Literature and Treatment Developments. Curr Neuropharmacol 2018; 16:1122-1130. [PMID: 29345581 PMCID: PMC6187758 DOI: 10.2174/1570159x16666180118100028] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/06/2017] [Accepted: 01/11/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Social difficulties in eating disorders can manifest as predisposing traits and premorbid difficulties, and/or as consequences of the illness. OBJECTIVE The aim of this paper is to briefly review the evidence of social problems in people with eating disorders and to consider the literature on treatments that target these features. METHOD A narrative review of the literature was conducted. RESULTS People with eating disorders often manifest traits, such as shyness, increased tendency to submissiveness and social comparison, and problems with peer relationships before illness onset. Further social difficulties occur as the illness develops, including impaired social cognition and increased threat sensitivity. All relationships with family, peers and therapists are compromised by these effects. Thus, social difficulties are both risk and maintaining factors of eating disorders and are suitable targets for interventions. Several forms of generic treatments (e.g. interpersonal psychotherapy, cognitive analytic therapy, focal psychodynamic therapy) have an interpersonal focus and show some efficacy. Guided self-management based on the cognitive interpersonal model of the illness directed to both individuals and support persons has been found to improve outcomes for all parties. Adjunctive treatments that focus on specific social difficulties, such as cognitive remediation and emotion skills training and cognitive bias modification have been shown to have a promising role. CONCLUSION More work is needed to establish whether these approaches can improve on the rather disappointing outcomes that are attained by currently used treatments for eating disorders.
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Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychological Medicine, 103 Denmark Hill, LondonSE5 8AF, UK
| | - Kate Tchanturia
- Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychological Medicine, 103 Denmark Hill, LondonSE5 8AF, UK
| | - Janet Treasure
- Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychological Medicine, 103 Denmark Hill, LondonSE5 8AF, UK
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24
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Mallorquí-Bagué N, Vintró-Alcaraz C, Sánchez I, Riesco N, Agüera Z, Granero R, Jiménez-Múrcia S, Menchón JM, Treasure J, Fernández-Aranda F. Emotion Regulation as a Transdiagnostic Feature Among Eating Disorders: Cross-sectional and Longitudinal Approach. EUROPEAN EATING DISORDERS REVIEW 2017; 26:53-61. [PMID: 29168283 DOI: 10.1002/erv.2570] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 11/11/2022]
Abstract
Emotion regulation (ER) difficulties are observed in eating disorders (EDs). However, few studies have explored ER before and after treatment. The aims are as follows: to explore ER difficulties across ED types and a healthy control (HC) group (Study 1) and to assess pretreatment and post-treatment changes among ED types (Study 2). In Study 1, adult women with EDs (n = 438) and HC (n = 126) completed an assessment including Eating Disorders Inventory-2, Difficulties in Emotion Regulation Scale and Symptom Checklist-90-Revised. Patients in Study 2 (n = 69) were also reassessed after treatment. All ED types reported worse ER compared with HC (p < .001); also, ER differences were found between ED types. Prospective analyses show ER improvements after treatment (p < .001; |d| = 0.51), especially in patients with bulimia nervosa (p < .001; |d| = 1.03; Reliable Change Index = 9.79) with greater improvement in those with a better treatment outcome (p = .034). In conclusion, emotion dysregulation is a part of all forms of EDs. Furthermore, emotional dysregulation can be modified. ED treatments for anorexia nervosa and binge eating disorder might be enhanced by targeting ER skills. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Núria Mallorquí-Bagué
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain
| | | | - Isabel Sánchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain
| | - Nadine Riesco
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain
| | - Zaida Agüera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychobiology and Methodology, Autonomous University of Barcelona, Spain
| | - Susana Jiménez-Múrcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Spain
| | - José M Menchón
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Spain
| | - Janet Treasure
- The Institute of Psychiatry, Psychology, and Neuroscience, Department of Psychological Medicine, King's College London, UK
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Spain
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