Visual scanning during emotion recognition in long‐term recovered anorexia nervosa: An eye‐tracking study

Abstract

Objective: To examine Facial Emotion Recognition (FER) and visual scanning behavior (eye-tracking) during FER in women long-term recovered from teenage-onset anorexia nervosa (recAN) with and without autism spectrum disorder (±ASD) and age-matched comparison women (COMP), using a sensitive design with facial emotion expressions at varying intensities in order to approximate real social contexts.Method: Fifty-seven 38-47-year-old women (26 recAN of whom six with ASD, 31 COMP) participated in the study. They completed a non-verbal FER task, consisting of matching basic emotions at different levels of expression intensity with full emotional expressions. Accuracy, response time and visual scanning behavior were measured.Results: There were no differences between recAN-ASD and COMP in FER accuracy and visual scanning behavior during FER, including eye viewing and hyperscanning. In an exploratory analysis, recAN+ASD were more accurate than recAN-ASD in identifying expressions at low intensity, but not at medium or high expression intensity.Accuracy was not associated with the extent of attention to the eye region.Discussion: Our data indicate that women long-term recovered from adolescentonset AN do not have deficits in basic FER ability and visual scanning behavior during FER. However, the presence of comorbid ASD might affect face processing in recovered AN. Future studies investigating basic FER in acute and recovered AN and other conditions need to ensure that the stimuli used are sensitive enough to detect potential deficits. K E Y W O R D Sanorexia nervosa, autism spectrum disorder, emotion recognition, eye tracking, facial expression

Emotion Recognition Abilities in Adults with Anorexia Nervosa are Associated with Autistic Traits

“…This raises the possibility that difficulties in emotion recognition sometimes associated with EDs are a result of differences in spontaneous social attention, rather than misinterpretation of emotional displays. Finally, Dinkler et al [28] found no differences in eye movements between those recovered from AN and HCs, and accuracy was not associated with attention to facial features. Together, these findings suggest there may be differences in the relationship between emotion recognition and attention in the acute stage of AN compared to the recovered stage or those who have never had an ED.…”

“…Given the profound effects of ASD on social cognitive abilities, it is perhaps surprising that very few studies have examined the impact of ASD traits on emotion recognition in individuals with AN. Dinkler and colleagues [28] reported that individuals recovered from AN with comorbid ASD were more accurate at recognising low intensity emotional expressions than those without ASD, who did not differ from HCs. However, due to the very small sample size in the AN+ASD group (n = 6), analyses were treated as exploratory only.…”

“…However, very few studies have examined emotion recognition performance in those recovered from AN, and results are equally mixed. While some report performance similar to that of HCs [28], others have reported poorer emotion recognition abilities, similar to those who are acutely unwell [20,29]. It is therefore not known whether potential differences in emotion recognition abilities are a result of the ill state in AN.…”

Exploring Relationships Between Autism Spectrum Disorder Symptoms and Eating Disorder Symptoms in Adults With Anorexia Nervosa: A Network Approach

“…A few of these studies also examined associations with illness duration, finding that those with high ASD traits had not been ill for a significantly longer period of time than those with low ASD traits (29,33). Finally, a significant proportion of individuals recovered from AN also show elevated ASD traits compared to HCs (27,30,34). Therefore, it seems the association between ASD and AN is not a product of starvation, yet the exact nature of the relationship remains unclear.…”

“…Indeed, Westwood and colleagues (45) reported that individuals with AN and high ASD traits showed higher levels of cognitive rigidity and set-shifting difficulties than individuals with low ASD traits. As well as a significant proportion of individuals with AN showing high levels of ASD traits on dimensional measures, a number of studies have found that 8%-29% meet full diagnostic criteria for ASD (34,41,(46)(47)(48)(49). Given that social difficulties are an important predictor of poor outcomes in AN (43,(50)(51)(52), another possibility is that those with comorbid ASD and AN have particularly poor outcomes due to the social communication difficulties associated with ASD.…”