Die Erkennung und Verarbeitung emotionaler Gesichtsausdrücke bei Jugendlichen mit Anorexia nervosa

Anorexia nervosa (AN) ist eine erstzunehmende psychische Erkrankung, die besonders häufig Mädchen und Frauen im Jugend- und jungen Erwachsenenalter betrifft. Zusätzlich zu der Kernsymptomatik geht AN häufig auch mit Schwierigkeiten im sozialen und emotionalen Bereich einher, einschließlich Beeinträchtigungen in der Fähigkeit, Emotionen in den Gesichtern anderer Menschen korrekt zu erkennen. Emotionserkennungsdefizite wurden von Studien an erwachsenen Patientinnen mit AN wiederholt berichtet, in jugendlichen Stichproben jedoch bislang nur selten untersucht. Ziel der vorliegenden Dissertation ist es deshalb zu untersuchen, wie Jugendliche mit AN emotionale Gesichtsausdrücke erkennen, wahrnehmen und verarbeiten. Diese Fragestellung wird aus zwei komplementären Blickwinkeln beleuchtet: Studie 1 untersucht die neurophysiologischen Korrelate der Verarbeitung emotionaler Gesichter mit Hilfe von ereigniskorrelierten Potentialen während Studie 2 sich mit Emotionserkennungsfähigkeiten auf der behavioralen Ebene befasst und der Frage nachgeht, inwieweit Defizite in der Emotionserkennung spezifisch für AN sind. In Studie 1 fanden sich Unterschiede in den neurophysiologischen Korrelaten der emotionalen Gesichterverarbeitung zwischen Jugendlichen mit AN und der gesunden Kontrollgruppe. Diese deuten darauf hin, dass für Patientinnen mit AN Gesichter anderer Menschen weniger intrinsisch salient sind, d.h. als weniger „wichtig“ wahrgenommen werden könnten als von gesunden Mädchen. In Studie 2 zeigten weder Patientinnen mit AN noch Patientinnen mit Depression Beeinträchtigungen in der Emotionserkennung. Stattdessen erkannten Patientinnen mit AN bestimmte Emotionen besser als gesunde Mädchen und Mädchen mit Depression. Zusammenfassend lässt sich sagen, dass Jugendliche mit AN Veränderungen in den neurophysiologischen Korrelaten der emotionalen Gesichterverarbeitung aufwiesen, die behavioralen Emotionserkennungsdefizite, die bei erwachsenen Patientinnen mit AN gefunden wurden, bei jugendlichen Patientinnen jedoch nicht vorhanden zu sein schienen.Anorexia nervosa (AN) is a severe mental disorder that affects mostly adolescent and young adult females. It is often accompanied by difficulties in social and emotional functioning including impairments in the correct recognition of emotions in other people’s faces. Studies in adult AN patients have repeatedly reported deficits in emotion recognition but only few studies have investigated emotion recognition in adolescent AN samples. Therefore, the aim of the present dissertation is to investigate how adolescents with AN recognise, perceive, and process emotional facial expressions. This question is addressed from two complementary perspectives: study 1 examines the neurophysiological correlates of emotional face processing using event-related potentials, while study 2 investigates emotion recognition abilities on the behavioural level and addresses the question of disorder specificity. Study 1 found differences in the neurophysiological correlates of emotional face processing between adolescents with AN and the healthy controls. These differences suggest that emotional faces are less intrinsically salient for adolescent patients with AN, i.e. that they might perceive them as less “important” than healthy girls. In study 2, neither patients with AN nor patients with depression showed impairments in emotion recognition. Instead, girls with AN recognised specific emotions better than healthy girls and girls with depression. It can be summarised that adolescents with AN show alterations in the neurophysiological correlates of emotional face processing, but the behavioural deficits that have been found in adult patients with AN do not seem to characterise adolescent patients

Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa

Background Anorexia nervosa (AN) is associated with impairments in socio-emotional functioning, including difficulties in interpersonal relationships as well as alexithymia (difficulties identifying and describing one’s emotions). Although the onset of the disorder is mostly in adolescence, a developmental period in which interpersonal relationships to parents as well as peers undergo major changes, only few studies have investigated the quality of interpersonal relationships in adolescent AN patients. Furthermore, the mechanisms linking poor relationship quality to eating disorder psychopathology are not yet clarified, albeit some research suggests that alexithymia might play a pivotal role. The aims of the present study were investigating the quality of interpersonal relationships to parents and peers in adolescents with AN compared to healthy adolescents as well as exploring the mediating role of alexithymia in the association between relationship quality and eating disorder symptoms. Methods Self-report questionnaires were used to assess relationship quality (Inventory of Parent and Peer Attachment) and alexithymia (Toronto Alexithymia Scale) in 12–18 year old female adolescents with AN (n = 35) in comparison to healthy adolescents (n = 40). Results Adolescents with AN reported lower relationship quality to both of their parents and to peers compared to healthy controls. Relationship quality scores were negatively correlated to alexithymia as well as eating disorder symptoms. Alexithymia fully meditated the association between eating disorder symptoms and relationship quality to parents and partially mediated the association between eating disorder symptoms and relationship quality to peers. Conclusion The results indicate difficulties in interpersonal relationships among adolescents with AN and emphasize the role of peer relationships for adolescents’ eating disorder psychopathology. Alexithymia seems to play an important role in explaining the link between quality of relationships and eating disorder psychopathology. Results suggest that treatment should not only focus on family relationships but also address relationships to peers as well as adolescents’ competence in identifying and dealing with their emotions

Die Erkennung und Verarbeitung emotionaler Gesichtsausdrücke bei Jugendlichen mit Anorexia nervosa

Anorexia nervosa (AN) ist eine erstzunehmende psychische Erkrankung, die besonders häufig Mädchen und Frauen im Jugend- und jungen Erwachsenenalter betrifft. Zusätzlich zu der Kernsymptomatik geht AN häufig auch mit Schwierigkeiten im sozialen und emotionalen Bereich einher, einschließlich Beeinträchtigungen in der Fähigkeit, Emotionen in den Gesichtern anderer Menschen korrekt zu erkennen. Emotionserkennungsdefizite wurden von Studien an erwachsenen Patientinnen mit AN wiederholt berichtet, in jugendlichen Stichproben jedoch bislang nur selten untersucht. Ziel der vorliegenden Dissertation ist es deshalb zu untersuchen, wie Jugendliche mit AN emotionale Gesichtsausdrücke erkennen, wahrnehmen und verarbeiten. Diese Fragestellung wird aus zwei komplementären Blickwinkeln beleuchtet: Studie 1 untersucht die neurophysiologischen Korrelate der Verarbeitung emotionaler Gesichter mit Hilfe von ereigniskorrelierten Potentialen während Studie 2 sich mit Emotionserkennungsfähigkeiten auf der behavioralen Ebene befasst und der Frage nachgeht, inwieweit Defizite in der Emotionserkennung spezifisch für AN sind. In Studie 1 fanden sich Unterschiede in den neurophysiologischen Korrelaten der emotionalen Gesichterverarbeitung zwischen Jugendlichen mit AN und der gesunden Kontrollgruppe. Diese deuten darauf hin, dass für Patientinnen mit AN Gesichter anderer Menschen weniger intrinsisch salient sind, d.h. als weniger „wichtig“ wahrgenommen werden könnten als von gesunden Mädchen. In Studie 2 zeigten weder Patientinnen mit AN noch Patientinnen mit Depression Beeinträchtigungen in der Emotionserkennung. Stattdessen erkannten Patientinnen mit AN bestimmte Emotionen besser als gesunde Mädchen und Mädchen mit Depression. Zusammenfassend lässt sich sagen, dass Jugendliche mit AN Veränderungen in den neurophysiologischen Korrelaten der emotionalen Gesichterverarbeitung aufwiesen, die behavioralen Emotionserkennungsdefizite, die bei erwachsenen Patientinnen mit AN gefunden wurden, bei jugendlichen Patientinnen jedoch nicht vorhanden zu sein schienen.Anorexia nervosa (AN) is a severe mental disorder that affects mostly adolescent and young adult females. It is often accompanied by difficulties in social and emotional functioning including impairments in the correct recognition of emotions in other people’s faces. Studies in adult AN patients have repeatedly reported deficits in emotion recognition but only few studies have investigated emotion recognition in adolescent AN samples. Therefore, the aim of the present dissertation is to investigate how adolescents with AN recognise, perceive, and process emotional facial expressions. This question is addressed from two complementary perspectives: study 1 examines the neurophysiological correlates of emotional face processing using event-related potentials, while study 2 investigates emotion recognition abilities on the behavioural level and addresses the question of disorder specificity. Study 1 found differences in the neurophysiological correlates of emotional face processing between adolescents with AN and the healthy controls. These differences suggest that emotional faces are less intrinsically salient for adolescent patients with AN, i.e. that they might perceive them as less “important” than healthy girls. In study 2, neither patients with AN nor patients with depression showed impairments in emotion recognition. Instead, girls with AN recognised specific emotions better than healthy girls and girls with depression. It can be summarised that adolescents with AN show alterations in the neurophysiological correlates of emotional face processing, but the behavioural deficits that have been found in adult patients with AN do not seem to characterise adolescent patients

The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls

BACKGROUND Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity). METHODS The present study systematically assesses cognitive biases in 12-18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group. DISCUSSION This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder

Look me in the eyes! A preliminary study on eye‐contact in adolescents with anorexia nervosa

Objective Anorexia nervosa (AN) is often associated with impairments in the socio-emotional domain. Avoidance of eye-contact may underlie some of these difficulties and has been found in adults with AN in several studies. This study aimed to clarify whether adolescents with AN also show reduced eye-contact when viewing social stimuli, that is, faces. Methods In this cross-sectional study, girls aged 12–18 years with AN (n = 38) were compared with a clinical (girls with depression and/or anxiety disorders; n = 30) and a healthy (n = 36) control group. Eye-contact was operationalised as maintenance of visual attention to the eye-area of faces showing different emotional expressions (happy, angry, afraid, sad, neutral), recorded via eye-tracking. Results Contrary to our expectations, we did not find adolescents with AN to dwell less on the eye-area than control groups; instead, we found preliminary evidence for increased attention to the eye-area in the AN group compared to the healthy control group. Conclusions The results suggest that reduced eye-contact found in adult AN samples is not (yet) present in adolescents with AN but may develop with the prolonged duration of the disorder. However, replication and longitudinal studies are needed to confirm this assumption

Biased Maintenance of Attention on Sad Faces in Clinically Depressed Youth: An Eye-Tracking Study

The role of negative attention biases (AB), central to cognitive models of adult depression, is yet unclear in youth depression. We investigated negative AB in depressed compared to healthy youth and tested whether AB are more pronounced in depressed than at-risk youth. Negative AB was assessed for sad and angry faces with an eye-tracking paradigm Passive Viewing Task (PVT) and a behavioural task Visual Search Task (VST), comparing three groups of 9-14-year-olds: youth with major depression (MD; n = 32), youth with depressed parents (high-risk; HR; n = 49) and youth with healthy parents (low-risk; LR; n = 42). The PVT revealed MD participants to maintain attention longer on sad faces compared to HR, but not LR participants. This AB correlated positively with depressive symptoms. The VST revealed no group differences. Our results provide preliminary evidence for a negative AB in maintenance of attention on disorder-specific emotional information in depressed compared to at-risk youth

The role of cognitive biases and negative life events in predicting later depressive symptoms in children and adolescents

Aims Cognitive models propose that negative cognitive biases in attention (AB) and interpretation (IB) contribute to the onset of depression. This is the first prospective study to test this hypothesis in a sample of youth with no mental disorder. Methods Participants were 61 youth aged 9–14 years with no mental disorder. At baseline (T1) we measured AB (passive-viewing task), IB (scrambled sentences task) and self-report depressive symptoms. Thirty months later (T2) we measured onset of mental disorder, depressive symptoms and life events (parent- and child-report). The sample included children of parents with (n = 31) and without (n = 30) parental depression. Results Symptoms of depression at T2 were predicted by IB (ß = .35, p = .01) but not AB (ß = .05, p = .72) at T1. This effect was strongest for children who experienced multiple negative life events (F2,48 = 6.0, p = .018, ΔR2 = .08). IB did not predict depressive symptoms at T2 over-and-above the effect of depressive symptoms at T1 (ß = .21, p = .13). Discussion These findings suggest that IB (but not AB) plays an important role in the aetiology of depression. Modifying IB may have a preventive effect on youth depression, particularly for youth who experience negative life events. This prospective study provides important foundations for future experimental studie

"I Am a Total...Loser" - The Role of Interpretation Biases in Youth Depression

Negative interpretation biases have been found to characterize adults with depression and to be involved in the development and maintenance of the disorder. However, less is known about their role in youth depression. The present study investigated i) whether negative interpretation biases characterize children and adolescents with depression and ii) to what extent these biases are more pronounced in currently depressed youth compared to youth at risk for depression (as some negative interpretation biases have been found already in high-risk youth before disorder onset). After a negative mood induction interpretation biases were assessed with two experimental tasks: Ambiguous Scenarios Task (AST) and Scrambled Sentences Task (SST) in three groups of 9-14-year-olds: children and adolescents with a diagnosis of major depression (n = 32), children and adolescents with a high risk for depression (children of depressed parents; n = 48), as well as low-risk children and adolescents (n = 42). Depressed youth exhibited substantially more negative interpretation biases than both high-risk and low-risk groups (as assessed with both tasks), while the high-risk group showed more negative interpretation biases than the low-risk group only as assessed via the SST. The results indicate that the negative interpretation biases that are to some extent already present in high-risk populations before disorder onset are strongly amplified in currently depressed youth. The different findings for the two tasks suggest that more implicit interpretation biases (assessed with the SST) might represent cognitive vulnerabilities for depression whereas more explicit interpretation biases (assessed with the AST) may arise as a consequence of depressive symptomatology

Biased Maintenance of Attention on Sad Faces in Clinically Depressed Youth: An Eye-Tracking Study

The role of negative attention biases (AB), central to cognitive models of adult depression, is yet unclear in youth depression. We investigated negative AB in depressed compared to healthy youth and tested whether AB are more pronounced in depressed than at-risk youth. Negative AB was assessed for sad and angry faces with an eye-tracking paradigm [Passive Viewing Task (PVT)] and a behavioural task [Visual Search Task (VST)], comparing three groups of 9–14-year-olds: youth with major depression (MD; n = 32), youth with depressed parents (high-risk; HR; n = 49) and youth with healthy parents (low-risk; LR; n = 42). The PVT revealed MD participants to maintain attention longer on sad faces compared to HR, but not LR participants. This AB correlated positively with depressive symptoms. The VST revealed no group differences. Our results provide preliminary evidence for a negative AB in maintenance of attention on disorder-specific emotional information in depressed compared to at-risk youth

An Eye-Tracking Study of Attention Biases in Children at High Familial Risk for Depression and Their Parents with Depression

Attention biases (AB) are a core component of cognitive models of depression yet it is unclear what role they play in the transgenerational transmission of depression. 44 children (9-14 years) with a high familial risk of depression (HR) were compared on multiple measures of AB with 36 children with a low familial risk of depression (LR). Their parents: 44 adults with a history of depression (HD) and 36 adults with no history of psychiatric disorder (ND) were also compared. There was no evidence of group differences in AB; neither between the HR and LR children, nor between HD and ND parents. There was no evidence of a correlation between parent and child AB. The internal consistency of the tasks varied greatly. The Dot-Probe Task showed unacceptable reliability whereas the behavioral index of the Visual-Search Task and an eye-tracking index of the Passive-Viewing Task showed better reliability. There was little correlation between the AB tasks and the tasks showed minimal convergence with symptoms of depression or anxiety. The null-findings of the current study contradict our expectations and much of the previous literature. They may be due to the poor psychometric properties associated with some of the AB indices, the unreliability of AB in general, or the relatively modest sample size. The poor reliability of the tasks in our sample suggest caution should be taken when interpreting the positive findings of previous studies which have used similar methods and populations