Abstract
Experimental research, supported by systematic reviews, establishes that people with eating disorders have emotional difficulties in terms of recognising, regulating and expressing their emotions. These emotional difficulties contribute to poor social functioning and problems with relationships. The existing literature includes a broad range of studies, many of which have utilised self-report measures, but experimental studies of emotions in eating disorders are still limited. The primary aim of this paper is to highlight gaps in the clinical research on emotions in eating disorders, focusing on experimental investigations from our lab and highlighting potentially useful future directions for further basic research and its translation into new developments in treatment and prevention. Recent findings using experimental paradigms to study the expression of emotions along with neuroimaging research exploring differences in facial emotion processing are discussed, and clinical implications are presented.
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Tchanturia K et al. Work and social adjustment in patients with anorexia nervosa. Compr Psychiat. 2013;54(1):41–5.
Tchanturia K et al. Altered social hedonic processing in eating disorders. Int J Eat Disorder. 2012;45(8):962–9.
Harrison A, Mountford VA, Tchanturia K. Social anhedonia and work and social functioning in the acute and recovered phases of eating disorders. Psychiat Res. 2014;218(1–2):187–94.
Doris E et al. A qualitative study of friendship in patients with anorexia nervosa and possible autism spectrum disorder. Psychology. 2014;5:1338–49. This study showed that patients with anorexia nervosa report difficulties in friendships before the onset of the eating disorder.
Tchanturia K et al. Exploring autistic traits in anorexia: a clinical study. Mol Autism. 2013;4(1):44. This study reports that 36 % of patients with anorexia nervosa in an inpatient programme exhibit above-threshold levels of autistic traits in the brief screening AQ-10.
Baron-Cohen S et al. Do girls with anorexia nervosa have elevated autistic traits? Mol Autism. 2013;4(1):24.
Oldershaw A et al. The socio-emotional processing stream in anorexia nervosa. Neurosci Biobehav R. 2011;35(3):970–88.
Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord. 2013;1:13.
Duckworth AL, Steen TA, Seligman ME. Positive psychology in clinical practice. Annu Rev Clin Psychol. 2005;1:629–51.
Fredrickson BL. Positivity: groundbreaking research to release your inner optimistic and thrive. Oxford: Oneworld; 2009.
Seligman ME, Csikszentmihalyi M. Positive psychology. An Introduction Am Psychol. 2000;55(1):5–14.
Santos V et al. The role of positive emotion and contributions of positive psychology in depression treatment: systematic review. Clin Pract Epidemol Ment Health. 2013;9:221–37.
Fredrickson BL. What good are positive emotions? Rev Gen Psychol. 1998;2(3):300–19.
Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol. 2001;56(3):218–26.
Cohn MA et al. Happiness unpacked: positive emotions increase life satisfaction by building resilience. Emotion. 2009;9(3):361–8.
Lang K et al. Central coherence in eating disorders: an updated systematic review and meta-analysis. World J Biol Psychiatry. 2014;1:1–13.
Lopez C, Stahl D, Tchanturia K. Estimated intelligence quotient in anorexia nervosa: a systematic review and meta-analysis of the literature. Ann Gen Psychiatry. 2010;9:40.
Lyubomirsky S, Layous K. How do simple positive activities increase well-being? Curr Dir Psychol Sci. 2013;22(1):57–62.
Gillham JE et al. Preventing depression among early adolescents in the primary care setting: a randomized controlled study of the Penn Resiliency Program. J Abnorm Child Psychol. 2006;34(2):203–19.
Brunwasser SM, Gillham JE, Kim ES. A meta-analytic review of the Penn Resiliency Program’s effect on depressive symptoms. J Consult Clin Psychol. 2009;77(6):1042–54.
Gongora VC. Satisfaction with life, well-being, and meaning in life as protective factors of eating disorder symptoms and body dissatisfaction in adolescents. Eat Disord. 2014;1:1–15.
Stice E, Ng J, Shaw H. Risk factors and prodromal eating pathology. J Child Psychol Psychiatry. 2010;51(4):518–25.
Keel PK, Forney KJ. Psychosocial risk factors for eating disorders. Int J Eat Disord. 2013;46(5):433–9.
Stice E, Becker CB, Yokum S. Eating disorder prevention: current evidence-base and future directions. Int J Eat Disord. 2013;46(5):478–85.
Hay P. A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. Int J Eat Disord. 2013;46(5):462–9.
Galsworthy-Francis L, Allan S. Cognitive Behavioural Therapy for anorexia nervosa: a systematic review. Clin Psychol Rev. 2014;34(1):54–72.
Watson HJ, Bulik CM. Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions. Psychol Med. 2013;43(12):2477–500.
Gale C et al. An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clin Psychol Psychother. 2014;21(1):1–12.
Berman MI, Boutelle KN, Crow SJ. A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. Eur Eat Disord Rev. 2009;17(6):426–34.
Wildes JE, Marcus MD. Development of emotion acceptance behavior therapy for anorexia nervosa: a case series. Int J Eat Disord. 2011;44(5):421–7.
Tchanturia K, Doris E, Fleming C. Effectiveness of cognitive remediation and emotion skills training [CREST] for anorexia nervosa in group format: a naturalistic pilot study. Eur Eat Disord Rev. 2014;22(3):200–5.
Money C et al. A brief emotion focused intervention for inpatients with anorexia nervosa: a qualitative study. J Health Psychol. 2011;16(6):947–58.
Schmidt U et al. Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. Br J Psychiatry. 2012;201(5):392–9.
Hambrook D, Brown G, Tchanturia K. Emotional intelligence in anorexia nervosa: is anxiety a missing piece of the puzzle? Psychiatry Res. 2012;200(1):12–9. This is the first study exploring emotional intelligence in people with anorexia nervosa using a well-validated measure, showing poorer performance in patients, when compared to healthy controls.
Mayer JD. Mayer-Salovey-Caruso emotional intelligence test (MSCEIT), version 2.0. Toronto: Multi-Health Systems; 2002.
Zonnevijlle-Bender MJ et al. Do adolescent anorexia nervosa patients have deficits in emotional functioning? Eur Child Adolesc Psychiatry. 2002;11(1):38–42.
Zonnevylle-Bender MJ et al. Emotional functioning in anorexia nervosa patients: adolescents compared to adults. Depress Anxiety. 2004;19(1):35–42.
Jansch C, Harmer C, Cooper MJ. Emotional processing in women with anorexia nervosa and in healthy volunteers. Eat Behav. 2009;10(3):184–91.
Kucharska-Pietura K et al. The recognition of emotion in the faces and voice of anorexia nervosa. Int J Eat Disord. 2004;35(1):42–7.
Mendlewicz L et al. Decoding emotional facial expressions in depressed and anorexic patients. J Affect Disord. 2005;89(1–3):195–9.
Kessler H et al. Alexithymia and facial emotion recognition in patients with eating disorders. Int J Eat Disord. 2006;39(3):245–51.
Pollatos O et al. Impaired central processing of emotional faces in anorexia nervosa. Psychosom Med. 2008;70(6):701–8.
Castro L et al. Facial affect recognition in anorexia nervosa: is obsessionality a missing piece of the puzzle? Aust N Z J Psychiatry. 2010;44(12):1118–25.
Kuhnpast N, Gramann K, Pollatos O. Electrophysiologic evidence for multilevel deficits in emotional face processing in patients with bulimia nervosa. Psychosom Med. 2012;74(7):736–44.
Baron-Cohen S et al. The Autism-Spectrum Quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001;31(1):5–17.
Russell TA et al. Aspects of social cognition in anorexia nervosa: affective and cognitive theory of mind. Psychiatry Res. 2009;168(3):181–5.
Harrison A et al. Emotion recognition and regulation in anorexia nervosa. Clin Psychol Psychother. 2009;16(4):348–56.
Harrison A et al. Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation. Psychol Med. 2010;40(11):1887–97.
Harrison A, Tchanturia K, Treasure J. Attentional bias, emotion recognition, and emotion regulation in anorexia: state or trait? Biol Psychiatry. 2010;68(8):755–61.
Adenzato M, Todisco P, Ardito RB. Social cognition in anorexia nervosa: evidence of preserved theory of mind and impaired emotional functioning. PLoS ONE. 2012;7(8):e44414.
Goddard E, Treasure J. Anxiety and social-emotional processing in eating disorders: examination of family trios. Cog Ther Res. 2013;37:890–904.
Tapajoz PSF et al. Theory of mind and central coherence in eating disorders: two sides of the same coin? Psychiatry Res. 2013;210(3):1116–22.
Kanakam N et al. Social and emotional processing as a behavioural endophenotype in eating disorders: a pilot investigation in twins. Eur Eat Disord Rev. 2013;21(4):294–307.
Goddard E et al. Cognitive flexibility, central coherence and social emotional processing in males with an eating disorder. World J Biol Psychiatry. 2014;15(4):317–26.
Oldershaw A et al. Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosom Med. 2010;72(1):73–9.
Tapajoz PSF et al. Theory of mind in eating disorders and their relationship to clinical profile. Eur Eat Disord Rev. 2013;21(6):479–87.
Medina-Pradas C et al. Emotional theory of mind in eating disorders. Int J Clin Hlth Psyc. 2012;12(2):189–202.
Kenyon M et al. Theory of mind in bulimia nervosa. Int J Eat Disord. 2012;45(3):377–84.
Ekman P et al. Universals and cultural differences in the judgments of facial expressions of emotion. J Pers Soc Psychol. 1987;53(4):712–7.
Thayer JF, Johnsen BH. Sex differences in judgement of facial affect: a multivariate analysis of recognition errors. Scand J Psychol. 2000;41(3):243–6.
Hall JA, Matsumoto D. Gender differences in judgments of multiple emotions from facial expressions. Emotion. 2004;4(2):201–6.
Friederich HC et al. Differential motivational responses to food and pleasurable cues in anorexia and bulimia nervosa: a startle reflex paradigm. Psychol Med. 2006;36(9):1327–35.
Lang PJ, Bradley MM, Cuthbert BN. International affective picture system (IAPS): affective ratings of pictures and instruction manual. Gainesville: University of Florida; 2005.
Fonville L et al. Increased BOLD signal in the fusiform gyrus during implicit emotion processing in anorexia nervosa. Neuroimage Clin. 2014;4:266–73. This is the first study exploring neurocorrelates in a well-established implicit emotion processing task, showing differences between patients and non-eating disorder controls when they see positive faces.
Surguladze S et al. A differential pattern of neural response toward sad versus happy facial expressions in major depressive disorder. Biol Psychiatry. 2005;57(3):201–9.
Davies H et al. Evoked facial emotional expression and emotional experience in people with anorexia nervosa. Int J Eat Disord. 2011;44(6):531–9. This is the first experimental study of positive and negative facial expression in people with and without anorexia nervosa, showing flat facial expression in patients.
Davies H, Schmidt U, Tchanturia K. Emotional facial expression in women recovered from anorexia nervosa. BMC Psychiatry. 2013;13:291.
Davies H et al. Cognitive remediation and emotion skills training for anorexia nervosa: an observational study using neuropsychological outcomes. Eur Eat Disord Rev. 2012;20(3):211–7.
Hambrook D et al. Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome. Br J Clin Psychol. 2011;50(3):310–25.
Rhind C et al. An exploratory study of evoked facial affect in adolescent females with anorexia nervosa. Psychiatry Res. 2014.
Tarrega S et al. Explicit and implicit emotional expression in bulimia nervosa in the acute state and after recovery. PLoS ONE. 2014;9(7):e101639.
Floyd K, Burgoon J. Reacting to nonverbal expressions of liking: a test of interaction adaptation theory. Commun Monogr. 1999;66:219–39.
Sullivan D, Masters R. Facial displays and political leadership: some experimental findings. In: Schubert G, Masters R, editors. Primate politics. Carbondale: Southern Illinois University Press; 1991. p. 188–206.
Deborde AS et al. Relations between alexithymia and anhedonia: a study in eating disordered and control subjects. L’Encéphale. 2006;32(1 Pt 1):83–91.
Stice E. Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull. 2002;128(5):825–48.
Sharpe H et al. Is fat talking a causal risk factor for body dissatisfaction? A systematic review and meta-analysis. Int J Eat Disord. 2013;46(7):643–52.
Acknowledgments
KT would like to thank Swiss Anorexia Foundation, Maudsley Charity, Psychiatry Research Trust, and M. Marin Dapelo would like to thank the CONICYT-Becas Chile Ph.D. Scholarship abroad programme.
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Kate Tchanturia, Marcela A. Marin Dapelo, Amy Harrison, and David Hambrook declare that they have no conflict of interest.
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Tchanturia, K., Dapelo, M.A.M., Harrison, A. et al. Why Study Positive Emotions in the Context of Eating Disorders?. Curr Psychiatry Rep 17, 537 (2015). https://doi.org/10.1007/s11920-014-0537-x
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DOI: https://doi.org/10.1007/s11920-014-0537-x