Positive communication workshops: are they useful for treatment programmes for anorexia nervosa?

Background: Social isolation, loneliness and difficulties in relationships are often described as a core feature of eating disorders. Based on the experimental research, we have designed one-off workshops for patients in inpatients and day care services and evaluated its acceptability and effectiveness using feedback questionnaires. Methods: This naturalistic project is an evaluation of multiple positive communication workshops. Forty-one participants completed workshop questionnaires, which were provided immediately at the beginning and end of the workshop, including feedback on these one-off groups. The workshops consisted of educational and experiential components. The questionnaire outcomes were evaluated by independent researchers. Results: All participants were female adults with a mean age of 33 (12.2) and a diagnosis of Anorexia Nervosa (AN; either restrictive or binge-purge subtype). Post-workshop questionnaires showed large effect sizes in the improvement of understanding the importance and confidence in using positive communication strategies. Discussion: Addressing social communication difficulties in eating disorder treatment programmes adds valuable dimensions to these symptom-based treatments in both inpatient settings and day services, and may provide broader benefits in overall social functioning in patients with AN. Conclusion: Brief one-off workshops targeting social functioning for patients with eating disorders might be useful complementary input for treatment programmes.

Emotion Recognition in Face and Body Motion in Bulimia Nervosa.

Social cognition has been studied extensively in anorexia nervosa (AN), but there are few studies in bulimia nervosa (BN). This study investigated the ability of people with BN to recognise emotions in ambiguous facial expressions and in body movement. Participants were 26 women with BN, who were compared with 35 with AN, and 42 healthy controls. Participants completed an emotion recognition task by using faces portraying blended emotions, along with a body emotion recognition task by using videos of point-light walkers. The results indicated that BN participants exhibited difficulties recognising disgust in less-ambiguous facial expressions, and a tendency to interpret non-angry faces as anger, compared with healthy controls. These difficulties were similar to those found in AN. There were no significant differences amongst the groups in body motion emotion recognition. The findings suggest that difficulties with disgust and anger recognition in facial expressions may be shared transdiagnostically in people with eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Computerised analysis of facial emotion expression in eating disorders.

BACKGROUND: Problems with social-emotional processing are known to be an important contributor to the development and maintenance of eating disorders (EDs). Diminished facial communication of emotion has been frequently reported in individuals with anorexia nervosa (AN). Less is known about facial expressivity in bulimia nervosa (BN) and in people who have recovered from AN (RecAN). This study aimed to pilot the use of computerised facial expression analysis software to investigate emotion expression across the ED spectrum and recovery in a large sample of participants. METHOD: 297 participants with AN, BN, RecAN, and healthy controls were recruited. Participants watched film clips designed to elicit happy or sad emotions, and facial expressions were then analysed using FaceReader. RESULTS: The finding mirrored those from previous work showing that healthy control and RecAN participants expressed significantly more positive emotions during the positive clip compared to the AN group. There were no differences in emotion expression during the sad film clip. DISCUSSION: These findings support the use of computerised methods to analyse emotion expression in EDs. The findings also demonstrate that reduced positive emotion expression is likely to be associated with the acute stage of AN illness, with individuals with BN showing an intermediate profile.

Expression of positive emotions differs in illness and recovery in anorexia nervosa.

People with Anorexia Nervosa (AN) display reduced facial expression of emotions. This study investigated the expression of positive affect in response to a film, examining Duchenne and non-Duchenne smiles in 20 women who have recovered from AN (REC), 20 with acute AN and 20 healthy controls (HC). The results indicated that the REC group exhibited Duchenne and non-Duchenne smiles with higher duration and intensity than the AN group, comparable to the HC group. The findings warrant longitudinal studies to confirm that reduced expressivity is linked to acute AN, ameliorating after recovery.

Deliberately generated and imitated facial expressions of emotions in people with eating disorders.

BACKGROUND: People with eating disorders have difficulties in socio emotional functioning that could contribute to maintaining the functional consequences of the disorder. This study aimed to explore the ability to deliberately generate (i.e., pose) and imitate facial expressions of emotions in women with anorexia (AN) and bulimia nervosa (BN), compared to healthy controls (HC). METHODS: One hundred and three participants (36 AN, 25 BN, and 42 HC) were asked to pose and imitate facial expressions of anger, disgust, fear, happiness, and sadness. Their facial expressions were recorded and coded. RESULTS: Participants with eating disorders (both AN and BN) were less accurate than HC when posing facial expressions of emotions. Participants with AN were less accurate compared to HC imitating facial expressions, whilst BN participants had a middle range performance. All results remained significant after controlling for anxiety, depression and autistic features. LIMITATIONS: The relatively small number of BN participants recruited for this study. CONCLUSIONS: The study findings suggest that people with eating disorders, particularly those with AN, have difficulties posing and imitating facial expressions of emotions. These difficulties could have an impact in social communication and social functioning. This is the first study to investigate the ability to pose and imitate facial expressions of emotions in people with eating disorders, and the findings suggest this area should be further explored in future studies.

Emotion Recognition in Blended Facial Expressions in Women with Anorexia Nervosa.

People with anorexia nervosa (AN) have difficulties in the social domain, and problems in the ability to recognise emotions in people's faces may contribute to these difficulties. This study aimed to investigate emotion recognition in women with AN and healthy controls (HC), using pictures of faces portraying blended emotions at different levels of ambiguity, which resemble real-life expressions more closely than prototypical expressions used in past studies. Seventy-seven participants (35 AN; 42 HC) completed the emotion recognition task. Results indicated that participants with AN were less accurate than HC recognising expressions of disgust, when shown less ambiguously. There were no differences in the recognition of other emotions. Participants with AN also showed response bias towards anger. These findings suggest a generally preserved ability to recognise emotions in women with AN, with the exception of disgust recognition. They also support previous findings of bias towards anger in AN patients.

Exploring emotion recognition in adults and adolescents with anorexia nervosa using a body motion paradigm.

OBJECTIVE: There is consistent evidence of difficulties in social cognition in adults with anorexia nervosa (AN), but less is known about adolescents. The aim of this study was to investigate the ability to recognise emotion expressed in body movement in adults and adolescents with AN. METHOD: One hundred and ninety-three females participated in the study (AN = 97: 61 adults and 36 adolescents). The performance of participants with AN on a body emotion recognition task was compared to age-matched healthy controls (HC = 96). RESULTS: AN participants were significantly worse than HC recognising sadness, with adolescent AN participants showing worse performance overall. There were no difficulties in the recognition of other emotions. DISCUSSION: The results partially support previous studies and the literature on facial emotion recognition, showing poorer recognition of sadness in AN. The results also suggest that difficulties in emotion recognition through body movements may be more subtle than other socio-emotional difficulties observed in AN.

Emotion and eating disorder symptoms in patients with anorexia nervosa: an experimental study.

OBJECTIVE: To evaluate the effect of negative emotion on self-reported eating disorder symptoms and objectively-measured eating behavior in patients with anorexia nervosa (AN). METHOD: Twenty-eight females with AN were randomized to a negative or neutral mood induction followed by a test meal. Participants completed assessments one week before the experimental session, before (pretest) and after (posttest) the mood induction, and after the test meal. RESULTS: Participants in the negative emotion condition had an increase in negative affect from pretest to posttest that was accompanied by significantly greater increases in self-reported eating disorder symptoms than were exhibited by participants in the neutral emotion condition, who had no increase in negative affect. There was no effect of emotion condition on eating behavior. DISCUSSION: Results suggest that negative emotions influence the expression of cognitive eating disorder symptoms in individuals with AN, which may have implications for the identification of treatment targets.

The clinical utility of personality subtypes in patients with anorexia nervosa.

OBJECTIVE: Elucidation of clinically relevant subtypes has been proposed as a means of advancing treatment research, but classifying anorexia nervosa (AN) patients into restricting and binge-eating/purging types has demonstrated limited predictive validity. This study aimed to evaluate whether an approach to classifying eating disorder patients on the basis of comorbid personality psychopathology has utility in predicting treatment response and readmission in patients with AN. METHOD: Data were collected from 154 AN patients (M [SD] age = 25.6[9.4] years; 95.5% female; 96.8% Caucasian) at admission, discharge, and 3 months postdischarge from intensive treatment. Latent profile analysis of personality traits assessed at admission was performed to classify participants into personality subtypes, which were then used to predict outcomes at discharge and risk of readmission. RESULTS: The best fitting model identified 3 personality subtypes (undercontrolled, overcontrolled, low psychopathology) that contributed significantly to multivariate models predicting study outcomes. Undercontrolled patients were more likely to have a poor outcome at discharge than overcontrolled (OR = 3.56, p = .01) and low psychopathology patients (OR = 11.23, p < .001). Undercontrolled patients also had a greater risk of discharge against medical advice (HR = 2.08, p = .02) and readmission than overcontrolled patients (HR = 3.76, p = .009). Binge-eating/purging versus restricting subtypes did not predict discharge against medical advice or readmission in the multivariate models. CONCLUSIONS: Findings support the clinical utility of personality subtypes in AN. Future work is needed to identify mechanisms that explain diminished treatment response in undercontrolled patients and to develop interventions for this high-risk group.