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Processing of emotionally ambiguous stimuli in eating disorders: an fMRI pilot study



People with eating disorders (EDs) have difficulties understanding their own emotions and recognizing the emotions of others, especially in ambiguous settings. We examined the neuronal mechanisms underlying the emotion processing of ambiguous interpersonal stimuli in EDs and healthy controls (HCs).


The fMRI data were acquired by a blocked experimental design with 28 women (14 EDs) during the visual presentation of a modified Thematic Apperception Test.


EDs showed very strong associations between experienced and inferred emotions evoked by the stimuli; no such relationship was found in HCs. HCs displayed elevated left anterior insula activity during the mentalizing condition; EDs showed increased activity in the right supramarginal gyrus and medial prefrontal cortex.


The two groups seem to apply different strategies for judging emotionally ambiguous stimuli, albeit resulting in equivalent judgments. We assume that activity in the supramarginal gyrus and insula in EDs is linked with suppressing their own perspective while considering emotional states, probably due to alexithymia and the lack of awareness of their own mental states. We hypothesize that the strong correlation between experienced and inferred emotions in EDs could reflect their tendency to use others as a reference point for perceiving themselves and gaining information about their affective state.

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No level of evidence, this is a basic science study.

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Code availability

Code for data pre-processing and analysis may be provided by a co-author of this study Martin Gajdoš.


  1. Mason TB, Lesser EL, Dolgon-Krutolow AR et al (2020) An updated transdiagnostic review of social cognition and eating disorder psychopathology. J Psychiatr Res.

    Article  PubMed  Google Scholar 

  2. MacLeod C, Mathews A (2012) Cognitive bias modification approaches to anxiety. Annu Rev Clin Psychol 8:189–217.

    Article  PubMed  Google Scholar 

  3. Silani G, Lamm C, Ruff CC, Singer T (2013) Right supramarginal gyrus is crucial to overcome emotional egocentricity bias in social judgments. J Neurosci Off J Soc Neurosci 33:15466–15476.

    CAS  Article  Google Scholar 

  4. Nomura M, Iidaka T, Kakehi K et al (2003) Frontal lobe networks for effective processing of ambiguously expressed emotions in humans. Neurosci Lett 348:113–116

    CAS  Article  Google Scholar 

  5. Steward T, Menchon JM, Jiménez-Murcia S et al (2018) Neural network alterations across eating disorders: a narrative review of fMRI studies. Curr Neuropharmacol 16:1150–1163.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. Murray H (1943) The thematic apperception test: plate and manual. Harvard University Press, Cambridge (MA)

    Google Scholar 

  7. Webster DM, Kruglanski AW (1994) Individual differences in need for cognitive closure. J Pers Soc Psychol 67:1049–1062

    CAS  Article  Google Scholar 

  8. Adolphs R (2009) The social brain: neural basis of social knowledge. Annu Rev Psychol 60:693–716.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Terasawa Y, Fukushima H, Umeda S (2013) How does interoceptive awareness interact with the subjective experience of emotion? An fMRI study. Hum Brain Mapp 34:598–612.

    Article  PubMed  Google Scholar 

  10. Lamm C, Singer T (2010) The role of anterior insular cortex in social emotions. Brain Struct Funct 214:579–591.

    Article  PubMed  Google Scholar 

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This work was funded by a research grant from the Ministry of Health of the Czech Republic—conceptual development of research organization (FNBr, 65269705), Career Restart Grant from Grant Agency of Masaryk University (MUNI/R/1162/2020) and Czech Science Foundation (GA15-20970S). We acknowledge the core facility MAFIL of CEITEC Masaryk University supported by the Ministry of Education, Youth and Sports of the Czech Republic (LM2018129Czech-BioImaging).

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Correspondence to Petra Holštajn Zemánková.

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The data that support the findings of this study are confidential, however may be obtained from the corresponding author upon reasonable request.

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The study was approved by the Institutional Review Board of the University Hospital Brno.

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All the participants gave their informed consent prior to taking part in the study.

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Holštajn Zemánková, P., Gajdoš, M., Světlák, M. et al. Processing of emotionally ambiguous stimuli in eating disorders: an fMRI pilot study. Eat Weight Disord 26, 2757–2761 (2021).

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  • Eating disorders
  • Mentalization
  • fMRI
  • Thematic apperception test
  • Ambiguity
  • Right supramarginal gyrus