Explicit and implicit emotional expression in bulimia nervosa in the acute state and after recovery.

Salomé Tárrega,Valentina Cardi,Maher Ben-Moussa,Dimitri Konstantas,Roser Granero,Nadine Riesco,Ana B Fagundo,Janet Treasure,Isabel Sánchez,Jeppe Nielsen,Mikkel Lucas,Nikos Fakotakis,Cristina Giner-Bartolomé,Laura Forcano,José Antonio Fernández-Formoso,José M Menchón ,Richard Bults ,Th Lam ,Θεόδωρος Κωστούλας ,Nadia Magnenat Thalmann ,Juan José Villalaín Santamaría ,Susana Jiménez-Múrcia ,Josep Comín‐Colet ,Inés Wolz ,Fernando Fernández‐Aranda

doi:10.1371/journal.pone.0101639

Abstract

Expression of emotional state is considered to be a core facet of an individual's emotional competence. Emotional processing in BN has not been often studied and has not been considered from a broad perspective. This study aimed at examining the implicit and explicit emotional expression in BN patients, in the acute state and after recovery. Sixty-three female participants were included: 22 BN, 22 recovered BN (R-BN), and 19 healthy controls (HC). The clinical cases were drawn from consecutive admissions and diagnosed according to DSM-IV-TR diagnostic criteria. Self reported (explicit) emotional expression was measured with State-Trait Anger Expression Inventory-2, State-Trait Anxiety Inventory, and Symptom Check List-90 items-Revised. Emotional facial expression (implicit) was recorded by means of an integrated camera (by detecting Facial Feature Tracking), during a 20 minutes therapeutic video game. In the acute illness explicit emotional expression [anxiety (p<0.001) and anger (p<0.05)] was increased. In the recovered group this was decreased to an intermediate level between the acute illness and healthy controls [anxiety (p<0.001) and anger (p<0.05)]. In the implicit measurement of emotional expression patients with acute BN expressed more joy (p<0.001) and less anger (p<0.001) than both healthy controls and those in the recovered group. These findings suggest that there are differences in the implicit and explicit emotional processing in BN, which is significantly reduced after recovery, suggesting an improvement in emotional regulation.

Highlights

Concerns about weight and shape were central to early maintenance models of BN [1] but over time these models have been extended to include problems in social emotional functioning [2]
In order to examine for possible state or trait effects, the aim of the study was to examine the implicit emotional expression and explicit emotional expression in BN patients, in both acute and recovered state compared with healthy controls
Each vertical line begins in the anger mean score (45.0 for BN, 103.1 for recovered BN (R-BN) and 192.0 for healthy controls (HC)) and ends in the joy mean measure (951.9, 874.4 and 882.9 for each group); the longest horizontal-line for each group represents the mean difference between joy and anger expressions (951.9– 45.0 = 906.9 for BN, 874.4–103.1 = 771.3 for R-BN and 882.9– 192.0 = 690.9 for HC)

Summary

Introduction

Concerns about weight and shape were central to early maintenance models of BN [1] but over time these models have been extended to include problems in social emotional functioning [2]. A model using the SPAARS framework (schematic, propositional, analogical and associative representation systems) of emotional processing posits that eating disorder symptoms develop as a means of managing negative emotions such as anger by redirecting the emotion onto the self and body, in the form of selfdisgust/shame [3]. A meta analysis showed that people with bulimia nervosa had particular problems with social evaluative aspects of functioning (negative self evaluation, higher sensitivity to rank related issues, etc.) [5]. 0.300 0.313 eating disorders find negative self esteem and vigilance towards critical and dominant faces [6]. This may explain why anger is suppressed as suggested by SPAARS model as anger expression is less tolerated in those with subservient positions [7]

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Conclusion