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

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

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

Your emotion or mine: labeling feelings alters emotional face perception—an ERP study on automatic and intentional affect labeling

Empirical evidence suggests that words are powerful regulators of emotion processing. Although a number of studies have used words as contextual cues for emotion processing, the role of what is being labeled by the words (i.e., one's own emotion as compared to the emotion expressed by the sender) is poorly understood. The present study reports results from two experiments which used ERP methodology to evaluate the impact of emotional faces and self- vs. sender-related emotional pronoun-noun pairs (e.g., my fear vs. his fear) as cues for emotional face processing. The influence of self- and sender-related cues on the processing of fearful, angry and happy faces was investigated in two contexts: an automatic (experiment 1) and intentional affect labeling task (experiment 2), along with control conditions of passive face processing. ERP patterns varied as a function of the label's reference (self vs. sender) and the intentionality of the labeling task (experiment 1 vs. experiment 2). In experiment 1, self-related labels increased the motivational relevance of the emotional faces in the time-window of the EPN component. Processing of sender-related labels improved emotion recognition specifically for fearful faces in the N170 time-window. Spontaneous processing of affective labels modulated later stages of face processing as well. Amplitudes of the late positive potential (LPP) were reduced for fearful, happy, and angry faces relative to the control condition of passive viewing. During intentional regulation (experiment 2) amplitudes of the LPP were enhanced for emotional faces when subjects used the self-related emotion labels to label their own emotion during face processing, and they rated the faces as higher in arousal than the emotional faces that had been presented in the “label sender's emotion” condition or the passive viewing condition. The present results argue in favor of a differentiated view of language-as-context for emotion processing

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 (F 2,48 = 6.0, p = .018, ΔR 2 = .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 studies

Attention Biases for Eating Disorder-Related Stimuli Versus Social Stimuli in Adolescents with Anorexia Nervosa - An Eye-Tracking Study

Anorexia nervosa (AN) is characterized by attention biases for eating disorder-related information as well as altered attentional processing of social information. However, little is known about the interplay between the altered attentional processing of these two types of information. The present study investigates attention biases for eating disorder-related information (pictures of bodies) versus social information (pictures of faces), in adolescents with AN. Attention biases were assessed via eye-tracking during a passive-viewing task in which female bodies and faces were presented simultaneously and thus competed directly for attention. Female adolescents (13-18 years) with AN (n = 28) were compared to a clinical comparison group (adolescents with major depression;n = 20) and a comparison group of adolescents with no mental illness (n = 24). All groups looked longer at bodies than at faces, i.e., showed attention biases for bodies in maintenance of attention. These biases were more pronounced in adolescents with AN than in both comparison groups, particularly for underweight bodies, at the expense of looking less at social stimuli. The results indicate dual attention biases in adolescents with AN (i.e., towards bodies and away from emotional faces) which could have a twofold negative impact on eating disorder psychopathology: increased attention to eating disorder-related information might directly influence eating disorder symptoms while less attention to social information might have an indirect influence through the amplification of interpersonal difficulties