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Facial Emotion Recognition Abilities in Women Experiencing Eating Disorders

Wyssen, Andrea, PhD; Lao, Junpeng, PhD; Rodger, Helen, MSc; Humbel, Nadine, MSc; Lennertz, Julia, MSc; Schuck, Kathrin, PhD; Isenschmid, Bettina, MD; Milos, Gabriella, MD; Trier, Stephan, MD; Whinyates, Katherina, MSc; Assion, Hans-Jörg, MD; Ueberberg, Bianca, MD; Müller, Judith, MSc; Klauke, Benedikt, PhD; Teismann, Tobias, PhD; Margraf, Jürgen, PhD; Juckel, Georg, MD; Kossmann, Christian, MD; Schneider, Silvia, PhD; Caldara, Roberto, PhD; Munsch, Simone, PhD

doi: 10.1097/PSY.0000000000000664

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

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

Results Happiness was discriminated at the lowest, fear at the highest threshold by all groups. There were no differences regarding thresholds between groups, except for the mixed and the bulimia nervosa group with respect to the expression of disgust (F(3,302) = 5.97, p = .001, η2 = .056). Emotional clarity, ED pathology, and depressive symptoms did not predict performance (R 2 Change ≤ .010, F(1,305) ≤ 5.74, p ≥ .079). The confusion matrix did not reveal specific biases in either group.

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

Clinical Trial Registration Number: DRKS-ID: DRKS00005709.

From the Departments of Clinical Psychology and Psychotherapy (Wyssen, Humbel, Munsch) and Visual and Social Neuroscience (Lao, Rodger, Caldara), University of Fribourg, Fribourg, Switzerland; Faculty of Psychology, Mental Health Research and Treatment Center (Lennertz, Schuck, Teismann, Margraf, Schneider), Ruhr University Bochum, Bochum, Germany; Kompetenzzentrum für Essverhalten (Isenschmid), Adipositas und Psyche Spital Zofingen; Departement of Consulation-Liaison Psychiatry and Psychosomatic Medicine (Milos), University Clinic Zürich, Zürich, Switzerland; Privatklinik Aadorf (Trier), Aadorf; Klinik Schützen (Whinyates), Rheinfelden, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine (Assion, Ueberberg), LWL-Klinik Dortmund; Department of Psychiatry, Psychotherapy, Psychosomatic and Preventive Medicine (Juckel, Kossmann), LWL-Klinik Bochum, Ruhr University Bochum, Bochum, Germany; and Christoph-Dornier-Clinic for Psychotherapy (Müller, Klauke), Münster, Germany.

Address correspondence to Simone Munsch, PhD, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Fribourg, Rue de Faucigny 2, 1700 Fribourg, Switzerland. E-mail:

Supplemental Content

Caldara and Munsch shared last authorship.

Received for publication January 17, 2018; revision received October 31, 2018.

Copyright © 2019 by American Psychosomatic Society
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