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

Cognitive and emotional empathy in acute and remitted anorexia nervosa: a systematic review

Background

Impairments in empathy are well established in anorexia nervosa (AN). It is unclear, however, whether these deficits only occur in the acute phases of AN due to neurocognitive impacts of starvation (often referred to as context-dependent, or state-like), or if deficits remain once remission has been achieved (trait-like). This debate is commonly referred to as the 'state vs trait' debate.

Objective

This systematic review aims to summarise existing literature regarding empathy in AN, and to investigate whether empathy deficits in AN are state- or trait-based.

Method

A total of 1014 articles were identified, and seven articles remained after the screening process. These seven articles, comparing empathy across three groups (acute AN, remission of AN, and non-clinical controls), were evaluated and summarised in accordance with PRISMA guidelines. Articles were required to have included all three groups and report on either cognitive empathy and/or emotional empathy.

Results

The majority of studies were of satisfactory quality. The results identified were inconsistent, with few articles lending some support to the 'state' hypothesis and others producing nonsignificant results.

Conclusions

There is minimal literature comparing empathy in acute and remission phases of AN. While there were some inconsistencies in included articles, some data indicate that there may be slight improvements to emotional and cognitive empathy following recovery of AN. Further research is needed to better enrich knowledge regarding the role of state vs trait with regard to neurocognitive difficulties experienced by individuals with AN.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335669, identifier CRD42022335669.

Superior facial emotion recognition in adolescents with anorexia nervosa - A replication study

OBJECTIVE

Anorexia nervosa (AN) has been associated with alterations in the processing of socio-emotional information, including impairments in the recognition of emotions in other people's faces. However, adolescents with AN might not show the impairments found in adult patients. The present study investigated facial emotion recognition in adolescents with AN, aiming to replicate our previous results of superior emotion recognition abilities in adolescents with AN compared to adolescents without mental disorders.

METHOD

Adolescent girls (12-18 years) with AN (n = 33) were compared to girls without mental disorders (n = 41). Participants completed one task requiring identification of emotions (happy, sad, afraid, angry, neutral) in faces and one control task.

RESULTS

As expected, adolescents with AN showed superior emotion recognition, with higher accuracy rates specifically for afraid faces.

CONCLUSION

This is the first study replicating previous results on basic emotion recognition in adolescents with AN using (almost) the same methodology. The results suggest that, in contrast to adults, adolescents with AN do not show impairments in facial emotion recognition. The impairments may arise in the longer course of the illness, however, longitudinal studies are necessary to confirm this assumption.

Exploring the intersection of autism spectrum disorder and eating disorders: understanding the unique challenges and treatment considerations for autistic women with eating disorders

PURPOSE OF REVIEW

Autistic women struggle with high levels of both autistic eating behaviours and disordered eating behaviours , which might make them particularly vulnerable to develop eating disorders. Research investigating the presence and characteristics of eating disorders in autistic women is however limited, as is research examining the role of autism in the treatment and recovery of an eating disorder in autistic women.

RECENT FINDINGS

The link between autism and eating disorders has mainly been investigated from the field of eating disorder research, with studies finding an overrepresentation of autism or autistic traits in eating disorders populations. Findings also suggest that autism or autistic traits are associated with a more serious presentation of the eating disorders, including a higher chance of a chronic course of the eating disorders. Most studies however lack comprehensive autism assessments, making it difficult to determine the actual prevalence of autism and its role in women with eating disorders.

SUMMARY

Autistic women with an eating disorder seem to suffer from more complex eating disorders and seem to not benefit from current treatment modalities. This could be partly related to specific autism characteristics such as sensory sensitivities, which are not being considered by current treatment protocols. Future research needs to shed light on what underlies the eating behaviours of autistic women with an eating disorder, in order to help to adapt current treatment modalities to meet the unique needs of these women.

"It's not about wanting to be thin or look small, it's about the way it feels": an IPA analysis of social and sensory differences in autistic and non-autistic individuals with anorexia and their parents

BACKGROUND

Despite increasing evidence to support an overlap between autism and anorexia nervosa (AN), underlying mechanisms remain poorly understood. Social and sensory factors have emerged as promising targets in both autism and AN, however there remains scope to compare these differences across autistic and non-autistic experiences of AN. Drawing on dyadic multi-perspectives, this study explored experiences of social and sensory differences in autistic and non-autistic adults and their parents and/or carers.

METHODS

Using interpretative phenomenological analysis (IPA), dyadic interviews were conducted with 14 dyads, with seven autistic dyads and seven non-autistic dyads. Data analysis was subjected to a triangulation of interpretations: (1) the participants themselves; (2) a neurotypical researcher; (3) and an Autistic researcher with lived/living experience of AN.

RESULTS

IPA identified three themes in each group, with similarities and differences between autistic and non-autistic dyads. Similar themes were identified regarding the importance of social connectedness and socio-emotional difficulties, as well a common lack of trust in the social and sensory self and body. Autism-specific themes centred on feelings of social 'defectiveness', disparities between sensing and expressing certain cues, and lifelong, multi-sensory processing differences. Non-autistic themes reflected social comparisons and inadequacy, and sensitivities to the learning of ideals and behaviour through early experiences.

CONCLUSIONS

While similarities were observed across both groups, there appeared to be notable differences in the perceived role and influence of social and sensory differences. These findings may have important implications on the delivery and modification of eating disorder interventions. Specifically, they suggest that while treatment targets may look similar, subtle differences in underlying mechanisms and approaches may be required for Autistic individuals with AN across sensory, emotion and communication-based interventions.

Eye movements and ERP biomarkers for face processing problems in avoidant attachment-style individuals

Background

Avoidant attachment poses a serious risk to intimate relationships and offspring. However, there are few studies on the face-processing characteristics and impairments of avoidant individuals based on basic emotion theory. Therefore, this study investigated the issues of emotional processing and deactivation strategies in individuals with avoidant attachment.

Methods

Avoidant and secure individuals were recruited to participate in an eye-tracking experiment and a two-choice oddball task in which they had to distinguish facial expressions of basic emotions (sadness, anger, fear, disgust, and neutral). Eye fixation durations to various parts of the face, including the eyes, nose, and mouth, were measured, and three event-related potentials (ERP) components (P100, N170, and P300) were monitored.

Results

Avoidant individuals could not process facial expressions as easily as secure individuals. Avoidant individuals focused less on the eyes of angry faces when compared to secure individuals. They also exhibited a more positive P100 component and a less negative N170 component when processing faces and a larger amplitude of the P300 component than secure individuals when processing emotional expressions.

Conclusion

Avoidant individuals use deactivating strategies and exhibit specific characteristics at different stages, which are of great significance in social interaction.

ADRA2B and HTR1A: An Updated Study of the Biogenic Amine Receptors Reveals Novel Conserved Motifs Which Play Key Role in Mental Disorders

Mental disorders are strongly connected with several psychiatric conditions including depression, bipolar disorder, schizophrenia, eating disorder, and suicides. There are many biological conditions and pathways that define these complicated illnesses. For example, eating disorders are complex mental health conditions that require the intervention of geneticists, psychiatrists, and medical experts in order to alleviate their symptoms. A patient with suicidal ideation should first be identified and consequently monitored by a similar team of specialists. Both genetics and epigenetics can shed light on eating disorders and suicides as they are found in the main core of such investigations. In the present study, an analysis has been performed on two specific members of the GPCR family toward drawing conclusions regarding their functionality and implementation in mental disorders. Specifically, evolutionary and structural studies on the adrenoceptor alpha 2b (ADRA2B) and the 5-hydroxytryptamine receptor 1A (HTR1A) have been carried out. Both receptors are classified in the biogenic amine receptors sub-cluster of the GPCRs and have been connected in many studies with mental diseases and malnutrition conditions. The major goal of this study is the investigation of conserved motifs among biogenic amine receptors that play an important role in this family signaling pathway, through an updated evolutionary analysis and the correlation of this information with the structural features of the HTR1A and ADRA2B. Furthermore, the structural comparison of ADRA2B, HTR1A, and other members of GPCRs related to mental disorders is performed.

Emotion recognition, alexithymia, empathy, and emotion regulation in women with anorexia nervosa

PURPOSE

Anorexia nervosa (AN) is associated with challenges in recognizing, understanding, and interpreting one's own and other's emotional states, feelings, and thoughts. It is unknown whether difficulties in emotion processing occur independently of common comorbid symptoms of AN and predict acute eating disorder characteristics. We aimed to examine emotion recognition, alexithymia, emotion regulation, and empathy in individuals with AN and to assess whether these predict eating disorder symptoms independently from comorbid symptoms.

METHODS

Participants included 42 women with AN and 40 healthy control (HC) women between 18-30 years. Basic and complex emotion recognition was assessed with face photos and video clips. Alexithymia, empathy, emotion regulation, and comorbid symptoms (anxiety, depressive, and obsessive-compulsive symptoms and ASD traits) were assessed with self-assessment questionnaires.

RESULTS

Participants with AN exhibited difficulties in basic and complex emotion recognition, as well as increased alexithymia, decreased empathy, and challenges in emotion regulation when compared to HCs. After controlling for comorbid symptoms, differences remained only in complex emotion recognition. Challenges in emotion recognition were associated with lower body mass index, and increased alexithymia was associated with increased eating disorder symptoms. Increased challenges in emotion regulation were associated with a shorter duration of illness, higher body mass index, and increased eating disorder symptoms.

CONCLUSIONS

Participants with AN displayed widespread deficit in emotion processing, but only challenges in complex emotion recognition occurred independently from comorbid symptoms. Deficits in emotion processing may contribute to the illness severity and thus could be an important treatment target.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Judging the emotional states of customer service staff in the workplace: A multimodal dataset analysis

Background

Emotions play a decisive and central role in the workplace, especially in the service-oriented enterprises. Due to the highly participatory and interactive nature of the service process, employees' emotions are usually highly volatile during the service delivery process, which can have a negative impact on business performance. Therefore, it is important to effectively judge the emotional states of customer service staff.

Methods

We collected data on real-life work situations of call center employees in a large company. Three consecutive studies were conducted: first, the emotional states of 29 customer service staff were videotaped by wide-angle cameras. In Study 1, we constructed scoring criteria and auxiliary tools of picture-type scales through a free association test. In Study 2, two groups of experts were invited to evaluate the emotional states of customer service staff. In Study 3, based on the results in Study 2 and a multimodal emotional recognition method, a multimodal dataset was constructed to explore how each modality conveys the emotions of customer service staff in workplace.

Results

Through the scoring by 2 groups of experts and 1 group of volunteers, we first developed a set of scoring criteria and picture-type scales with the combination of SAM scale for judging the emotional state of customer service staff. Then we constructed 99 (out of 297) sets of stable multimodal emotion datasets. Based on the comparison among the datasets, we found that voice conveys emotional valence in the workplace more significantly, and that facial expressions have more prominant connection with emotional arousal.

Conclusion

Theoretically, this study enriches the way in which emotion data is collected and can provide a basis for the subsequent development of multimodal emotional datasets. Practically, it can provide guidance for the effective judgment of employee emotions in the workplace.

Problematic eating behaviours of autistic women-A scoping review

Aim

Eating and feeding behaviours of autistic individuals and related consequences have been mainly investigated in autistic children or in autistic adults with intellectual disabilities. Behaviours such as food selectivity or food neophobia have been shown to persist into adolescence and adulthood and are associated with aversive consequences. However, much less is known about the eating behaviours of autistic adults without intellectual disabilities, especially those of women. By means of a scoping review, we aim to assess the extent of the scientific literature on what is known about the eating behaviours of these women and the possible consequences of such eating behaviour.

Method

Medline, Cochrane, PubMed and PsycInfo databases were searched according to Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines.

Results

Five studies met the eligibility criteria and were included in this review. Autistic women not only reported high levels of eating behaviour frequently seen in autism spectrum disorders (ASD), but also high levels of disordered eating behaviour, similar to that of women with eating disorders.

Conclusions

Autistic women seem to exhibit high levels of eating behaviour frequently seen in ASD as well as disordered eating behaviour. Future research needs to shed light on what underlies these problematic eating behaviours, in order to help to adapt current treatment modalities to meet the unique needs of these women.

This scoping review indicates that autistic women exhibit both eating behaviours frequently seen in autism spectrum disorders (ASD) and disordered eating behaviours, similar to those of women with eating disorders.

The review also indicates that studies investigating these eating behaviours of autistic women are still very scarce, and those that are available often lack a comprehensive assessment of the ASD diagnosis.

Future studies are needed to confirm the findings and to further explore how and why autistic women eat the way they eat, in order to help to adapt current treatment modalities to meet the unique needs of these women.

Altered Processing of Social Emotions in Individuals With Autistic Traits

Social impairment is a defining phenotypic feature of autism. The present study investigated whether individuals with autistic traits exhibit altered perceptions of social emotions. Two groups of participants (High-AQ and Low-AQ) were recruited based on their scores on the autism-spectrum quotient (AQ). Their behavioral responses and event-related potentials (ERPs) elicited by social and non-social stimuli with positive, negative, and neutral emotional valence were compared in two experiments. In Experiment 1, participants were instructed to view social-emotional and non-social emotional pictures. In Experiment 2, participants were instructed to listen to social-emotional and non-social emotional audio recordings. More negative emotional reactions and smaller amplitudes of late ERP components (the late positive potential in Experiment 1 and the late negative component in Experiment 2) were found in the High-AQ group than in the Low-AQ group in response to the social-negative stimuli. In addition, amplitudes of these late ERP components in both experiments elicited in response to social-negative stimuli were correlated with the AQ scores of the High-AQ group. These results suggest that individuals with autistic traits have altered emotional processing of social-negative emotions.

Anorexia Nervosa and Autism Spectrum Disorder: A Systematic Review

BACKGROUND

Recent research has shown a growing interest in exploring the relationship between anorexia nervosa (AN) and autism spectrum disorder (ASD). Both conditions seem to share areas of cognitive, social and behavioural impairment, leading to relevant implications on treatment, especially when they are in comorbidity. This literature review aims to synthesise the latest studies on this topic to investigate the co-occurrence of AN and ASD, suggest future research directions and consider implications for treatment.

METHOD

Records were systematically (PRISMA guidelines) identified through PubMed, EBSCOhost, Scopus and Web of Science searching.

RESULTS

Thirteen studies met the eligibility criteria and were therefore included in the review. Results seem to confirm an overrepresentation of ASD symptoms in AN. Only few studies investigated the AN-ASD comorbidity in young people and report slightly lower rates than those conducted with adults.

CONCLUSIONS

Analysed studies suggest that while the comorbidity seems to exacerbate the severity of the condition, autistic traits appear to be rather stable over time and not related to body weight. Thus, future longitudinal studies and gender- specific assessment tools can help clarify the relationship between the two disorders, examine the onset of ASD symptoms and develop structured guidelines for treatment.

Anorexia nervosa and comorbid autism spectrum disorders

PURPOSE OF REVIEW

Traits of autism spectrum disorder (ASD) are overrepresented among individuals with anorexia nervosa (AN) and may also moderate the behavioral manifestation of AN. This review aims to provide an overview of AN and comorbid ASD.

RECENT FINDINGS

Elevated ASD traits do not seem to precede AN among some individuals but are rather related to the illness stage. However, studies have suggested that there are ASD-specific mechanisms for developing AN in a subgroup of individuals with AN. Pronounced traits of ASD and diagnosed ASD are associated with illness prolongation and poorer outcomes in AN, and individuals with AN and elevated ASD traits may benefit less from many of the current treatments. Studies do not support a specific genetic relationship between ASD and AN.

SUMMARY

Recent research encourages the improved recognition of elevated ASD traits in individuals with AN and provides grounds for developing tailored treatments for those with this comorbidity.

Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa

Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants’ eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.

Advances in Eating Disorders

Eating disorders (EDs) are a group of mental disorders characterized by an altered food intake and the presence of inappropriate behaviors for the control of body weight, framed as an excessive concern regarding one’s weight and figure [...]