Advertisement

Attentional Bias, Emotion Recognition, and Emotion Regulation in Anorexia: State or Trait?

      Background

      Anorexia nervosa (AN) is associated with difficulties in emotion recognition and regulation and with attentional biases to social affective stimuli. This study aimed to examine these factors in a group of women following long-term recovery from AN.

      Methods

      The Reading the Mind in the Eyes task, Difficulties in Emotion Regulation Scale, and a computerized pictorial Stroop task (angry and neutral faces) were administered to 175 women: 50 with acute AN, 35 recovered from AN, and 90 healthy control subjects (HCs).

      Results

      The recovered group had a significantly higher social and angry-threat attentional bias than HCs, with medium effect sizes, and significantly lower scores on the emotion recognition measure than HCs, with a medium effect size. On the other hand, the recovered group did not significantly differ from the HC group in terms of emotion regulation.

      Conclusions

      Attentional biases to social affective pictorial stimuli and difficulties with emotion recognition appear to be traits associated with a lifetime history of AN, whereas emotion regulation difficulties appear to remit when the individual successfully recovers from the illness.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zucker N.L.
        • Losh M.
        • Bulik C.M.
        • LaBar K.S.
        • Piven J.
        • Pelphrey K.A.
        Anorexia nervosa and autism spectrum disorders: Guided investigation of social cognitive endophenotypes.
        Psychol Bull. 2007; 133: 976-1006
        • Russell T.
        • Schmidt U.
        • Tchanturia K.
        Aspects of social cognition in anorexia nervosa: Affective and cognitive theory of mind.
        Psychiatry Res. 2009; 168: 181-185
        • Fox J.
        • Harrison A.
        The relation of anger to disgust: The potential role of coupled emotions within eating pathology.
        Clin Psychol Psychother. 2008; 15: 86-95
        • Tchanturia K.
        • Godley J.
        • Treasure J.
        • Bara-Carril N.
        • Schmidt U.
        Theory of mind in anorexia nervosa.
        Eur Eat Disord Rev. 2004; 12: 361-366
        • Harrison A.
        • Sullivan S.
        • Tchanturia K.
        • Treasure J.
        Emotion recognition and regulation in women with anorexia nervosa.
        Clin Psychol Psychother. 2009; 16: 348-356
        • Schmidt U.
        • Treasure J.
        Anorexia nervosa: Valued and visible.
        Br J Clin Psychol. 2006; 45: 343-366
        • Dobson K.S.
        • Dozois D.J.A.
        Attentional biases in eating disorders: A meta-analytic review of Stroop performance.
        Clin Psychol Rev. 2004; 23: 1001-1022
        • Johansson L.
        • Ghaderi A.
        • Andersson G.
        Stroop interference for food- and body-related words: A meta-analysis.
        Eat Behav. 2005; 6: 271-281
        • Harrison A.
        • Sullivan S.
        • Tchanturia K.
        • Treasure J.
        Emotional functioning in eating disorders: Attentional bias, emotion recognition and emotion regulation.
        Psychol Med. 2010; ([published online ahead of print January 27])
        • Kaye W.H.
        • Bulik C.M.
        • Thornton L.
        • Barbarich N.
        • Masters K.
        Comorbidity of anxiety disorders with anorexia and bulimia nervosa.
        Am J Psychiatry. 2004; 161: 2215-2221
        • Gillberg C.
        • Rastam M.
        Do some cases of anorexia nervosa reflect underlying autistic-like conditions?.
        Behav Neurol. 1992; 19: 27-32
        • Godart N.T.
        • Flament M.F.
        • Curt F.
        • Perdereau F.
        • Jeammet P.
        Comorbidity between eating disorders and anxiety disorders.
        Int J Eat Disord. 2003; 23: 253-270
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        4th ed. American Psychiatric Press, Washington, DC1994
        • Fairburn C.G.
        • Cooper Z.
        • O'Connor M.E.
        Cognitive Behaviour Therapy and Eating Disorders.
        Guilford Publications, Guildford, UK2008
        • First M.B.
        • Spitzer R.L.
        • Gibbon M.
        • Williams J.B.W.
        Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV).
        American Psychiatric Press, Washington, DC1996
        • Fairburn C.G.
        • Beglin S.J.
        Assessment of eating disorders: Interview or self-report questionnaire?.
        Int J Eat Disord. 1994; 16: 363-370
        • Ashwin C.
        • Wheelwright S.
        • Baron-Cohen S.
        Attention bias to faces in Asperger Syndrome: A pictorial emotion Stroop study.
        Psychol Med. 2006; 36: 835-843
        • Forster K.I.
        • Forster J.C.
        DMDX: A Windows display program with millisecond accuracy.
        Behav Res Methods Instrum Comput. 2003; 35: 116-124
        • Lundqvist D.
        • Flykt A.
        • Ohman A.
        The Karolinska Directed Emotional Faces.
        Karolinska Institute, Stockholm1998
        • Baron-Cohen S.
        • Wheelwright S.
        • Hill J.
        • Raste Y.
        • Plumb I.
        The Reading the Mind in the Eyes Task Revised Version: A study with normal adults and adults with Asperger Syndrome or high functioning autism.
        J Child Psychol Psychiatry. 2001; 42: 241-251
        • Hallerbäck M.U.
        • Lugnegård T.
        • Hjärthag F.
        • Gillberg C.
        The Reading the Mind in the Eyes Test: Test-retest reliability of a Swedish version.
        Cognit Neuropsychiatry. 2009; 14: 127-143
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Gratz K.L.
        • Roemer L.
        Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale.
        J Psychchopathol Behav Assess. 2004; 26: 41-54
        • Lovibond S.H.
        • Lovibond P.F.
        Manual for the Depression Anxiety Stress Scales.
        2nd ed. Psychology Foundation, Sydney, Australia1995
        • Foa E.B.
        • Huppert J.D.
        • Leiberg S.
        • Langner R.
        • Kichic R.
        • Hajcak G.
        • Salkovskis P.
        The Obsessive-Compulsive Inventory: Development and validation of a short version.
        Psychol Assess. 2002; 14: 485-495
        • Nelson H.E.
        National Adult Reading Test.
        2nd ed. NFER-Nelson, Windsor, UK1991
        • Rosenthal R.
        Meta-Analytic Procedures for Social Research (Revised).
        Sage, Newbury Park, CA1991
        • Cohen J.
        Statistical Power Analysis for the Behavioural Sciences.
        2nd ed. Academic Press, New York1988
        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Miller R.G.
        Simultaneous Statistical Inference.
        McGraw-Hill, New York1966
        • Leppänen J.M.
        Emotional information processing in mood disorders: A review of behavioral and neuroimaging findings.
        Curr Opin Psychiatry. 2006; 19: 34-39
        • Troop N.A.
        • Allan S.
        • Treasure J.
        • Katzman M.
        Social comparison and submissive behaviour in eating disorder patients.
        Psychol Psychother. 2003; 76: 237-249
        • Troop N.A.
        • Connan F.
        Shame, social rank and eating disorders.
        in: Ruggieri G.M. Eating Disorders in the Mediterranean Area: An Exploration in Transcultural Psychology. Nova Science Publishers, New York2003
        • Connan F.
        • Troop N.
        • Landau S.
        • Campbell I.C.
        • Treasure J.
        Poor social comparison and the tendency to submissive behavior in anorexia nervosa.
        Int J Eat Disord. 2007; 40: 733-739
        • Hartmann A.
        • Zeeck A.
        • Barrett M.S.
        Interpersonal problems in eating disorders.
        Int J Eat Disord. 2009; ([published online ahead of print August 28])
        • Craig J.S.
        • Hatton C.
        • Craig F.B.
        • Bentall R.P.
        Persecutory beliefs, attributions and theory of mind: Comparison of patients with paranoid delusions, Asperger's syndrome and healthy controls.
        Schizophr Res. 2004; 69: 29-33
        • Kettle J.W.L.
        • O'Brien-Simpson L.
        • Allen N.B.
        Impaired theory of mind in first episode schizophrenia: Comparison with community, university and depressed controls.
        Schizophr Res. 2008; 99: 96-102
        • Havet-Thomassin V.
        • Allain P.
        • Etcharry-Bouyx F.
        • Le Gall D.
        What about theory of mind after severe brain injury?.
        Brain Inj. 2006; 20: 83-91
        • Losh M.
        • Piven J.
        Social-cognition and the broad autism phenotype: Identifying genetically meaningful phenotypes.
        J Child Psychol Psychiatry. 2006; 48: 105-112
        • Pollak S.D.
        • Kistler D.J.
        Early experience is associated with the development of categorical representations for facial expressions of emotion.
        Proc Natl Acad Sci U S A. 2002; 99: 9072-9076
        • Pollak S.D.
        • Sinha P.
        Effects of early experience on children's recognition of facial displays of emotion.
        Dev Psychol. 2002; 38: 784-791
        • Bradley S.J.
        • Taylor M.J.
        • Rovet J.F.
        • Goldberg E.
        • Hood J.
        • Wachsmuth R.
        • et al.
        Assessment of brain function in adolescent anorexia nervosa before and after weight gain.
        J Clin Exp Neuropsychol. 1997; 19: 20-33
        • Lane R.D.
        • Quinlan D.M.
        • Schwartz G.E.
        • Walker P.A.
        • Zeitlin S.B.
        The Levels of Emotional Awareness Scale: A cognitive-developmental measure of emotion.
        J Pers Assess. 1990; 55: 124-134
        • Oldershaw A.
        • Hambrook D.
        • Tchanturia K.
        • Treasure J.
        • Schimidt U.
        Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients.
        Psychosom Med. 2010; 72: 73-79
        • Lau J.Y.
        • Pine D.S.
        Elucidating risk mechanisms of gene-environment interactions on paediatric anxiety: Integrating findings from neuroscience.
        Eur Arch Psychiatry Clin Neurosci. 2008; 258: 97-106
        • Southgate L.
        • Tchantuuria K.
        • Treasure J.
        Building a model of the aetiology of eating disorders by translating experimental neuroscience into clinical practice.
        J Ment Health. 2005; 14: 553-566
        • Connan F.
        • Campbell I.C.
        • Katzman M.
        • Lightman S.L.
        • Treasure J.
        A neurodevelopmental model for anorexia nervosa.
        Physiol Behav. 2003; 79: 13-24
        • Strober M.
        Pathologic fear conditioning and anorexia nervosa: On the search for novel paradigms.
        Int J Eat Disord. 2004; 35: 504-508