Emotional reactivity and prosocial behaviour in response to witnessing social exclusion in adolescents with eating disorders and healthy controls.

ABSTRACT

BACKGROUND: Prosocial behaviour can promote positive social interactions and it is a key skill in adolescence. People with emotional problems or psychiatric disorders, such as people with eating disorders might have impairments in prosocial behaviour, due to broader documented difficulties in underlying processes (e.g., mentalizing). METHODS: The aim of this study was to examine prosocial behaviour in adolescents with eating disorders compared to healthy controls, using a computerised behavioural task. Adolescents (N = 123) including patients with eating disorders (n = 61) and healthy adolescents (n = 62) played a four-player computerised Prosocial Cyberball Game with three pre-programmed avatar players. During the task, participants witnessed the exclusion of one of the players, and subsequently had the opportunity to compensate for this by throwing the ball more often to the excluded player. Throughout the game, participants rated the level of negative emotion in themselves and in the excluded player. RESULTS: Patients made significantly fewer ball tosses towards the excluded player during the compensation round compared to healthy controls (large effect size). Patients reported a significantly smaller increase in negative emotion after witnessing the exclusion and a significantly smaller decrease in negative emotion following the compensation round (large effect sizes). Patients also estimated a smaller decrease in negative emotion in the excluded player following the compensation round (medium effect size). There were no significant associations between these outcomes and eating disorder psychopathology in patients. CONCLUSIONS: Compared to healthy adolescents, adolescent patients with eating disorders demonstrated less prosocial compensatory behaviour towards a computerised victim of social exclusion. In addition, they reported flatter negative emotion in themselves in response to witnessing and compensating for exclusion, and in the excluded player following compensation. If these findings are replicated, interventions to target these difficulties might contribute to improvements in social functioning in this patient group.

Prosocial behaviour (actions that benefit others) can promote positive social relationships. People with eating disorders may have impairments in prosocial behaviour because of difficulties in underlying processes (e.g., identifying emotions in oneself and in others). This study explored prosocial behaviour in 61 adolescents with eating disorders (77% anorexia nervosa) and 62 healthy adolescents, with an average age of 16. Each participant joined a 4-player computerised ball-tossing game with three pre-programmed avatars (i.e., only the participant was really playing the game; the three other avatars were not representing real players). Participants were initially included fairly in the game (i.e., the avatars were programmed to toss the ball equally to one another). In the next round, the participant merely observed the game (they could not actively participate). During this observation round, two of the avatars excluded the third avatar. In the final round, the participant was able to participate again, and could toss the ball to any of the three avatar players. Thus, the participant had the opportunity to compensate the avatar victim by tossing the ball more frequently to them. Throughout the game, the participant also rated the levels of negative emotion in themselves and in the avatar victim. After observing the exclusion, on average all participants tossed the ball more frequently to the avatar victim, but patients did so less frequently. Similarly, all participants reported more negative emotion, but this increase was smaller in patients. After the opportunity to compensate the victim, all participants reported less negative emotion in themselves and in the victim, but this decrease was smaller in patients. These outcomes were not linked to the severity of eating disorder symptoms in patients.