Anorexia nervosa and its relation to depression, anxiety, alexithymia and emotional processing deficits

  • Dorothée Lulé
  • Ulrike M. E. SchulzeEmail author
  • Kathrin Bauer
  • Friederike Schöll
  • Sabine Müller
  • Anne-Katharina Fladung
  • Ingo Uttner
Original Article



Psychopathological changes and dysfunction in emotion processing have been described for anorexia nervosa (AN). Yet, findings are applicable to adult patients only. Furthermore, potential for discriminative power in clinical practice in relation to clinical parameters has to be discussed. The aim of this study was to investigate psychopathology and emotional face processing in adolescent female patients with AN.


In a sample of 15 adolescent female patients with AN (16.2 years, SD ± 1.26) and 15 age and sex matched controls we assessed alexithymia, depression, anxiety and empathy in addition to emotion labelling and social information processing.


AN patients had significantly higher alexithymia, higher levels of depression, and state and trait anxiety compared to controls. There was a trend for a lower ability to recognize disgust. Happiness as a positive emotion was recognized better. All facial expressions were recognized significantly faster by AN patients. Associations of pathological eating behaviour and trait anxiety were seen.


In accordance with the stress reduction hypothesis, typical psychopathology of alexithymia, anxiety and depression is prevalent in female adolescent AN patients. It is present detached from physical stability. Pathogenesis of AN is multifactorial and already fully present in adolescence. An additional reinforcement process can be discussed. For clinical practice, those parameters might have a better potential for early prognostic factors related to AN than physical parameters and possible implication for intervention is given.


Anorexia nervosa Emotion recognition Anxiety Depression Alexithymia 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Dorothée Lulé
    • 2
  • Ulrike M. E. Schulze
    • 1
    Email author
  • Kathrin Bauer
    • 1
  • Friederike Schöll
    • 2
  • Sabine Müller
    • 1
  • Anne-Katharina Fladung
    • 3
  • Ingo Uttner
    • 2
  1. 1.Department of Child and Adolescent Psychiatry/PsychotherapyUniversity of UlmUlmGermany
  2. 2.Department of NeurologyUniversity of UlmUlmGermany
  3. 3.Department of Psychiatry and Psychotherapy IIIUniversity of UlmUlmGermany

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