Social cognition in children at familial high-risk of developing an eating disorder.

Radha Kothari,Janet Treasure,Nadia Micali,Manuela Barona

doi:10.3389/fnbeh.2015.00208

Abstract

Objective: Diagnosis of an eating disorder (ED) has been associated with differences in social cognition. To date research investigating social cognition and ED has mainly employed patient and recovered samples. It is therefore unclear whether differences in social cognition are present prior to onset of ED, potentially contributing to development, or whether differences observed are a consequence of the disorder. We aimed to further explore whether individuals at high-risk for ED present social cognition characteristics previously found in ED groups.Methods: Our sample was drawn from a population-based cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC). Data on maternal ED behaviors over the lifetime were collected through in-depth clinical interviews (n = 1128) conducted using the Structured Clinical Interview for DSM disorders (SCID), and were used to categorize mothers according to ED behaviors over the lifetime: Restricting and Excessive Exercising (n = 58), Purging (n = 70), Binge-eating (n = 72), Binging and Purging (n = 66), no ED (n = 862). High-risk status of children was determined using these maternal lifetime behavioral phenotypes. Children at high-risk (maternal ED exposure) were compared to children at low-risk (born to mothers with no ED) on three measures of social cognition: the Social Communication Disorders Checklist (SCDC) (n = 922), the faces subtest of the Diagnostic Analysis of Non-Verbal Accuracy (DANVA) (n = 722), and the Emotional Triangles Task (n = 750).Results: Children at high-risk for ED showed poorer performance on measures of social cognition compared to children at low-risk. Maternal lifetime binge-eating, and maternal lifetime binging and purging were associated with poorer social communication in children (OR: 2.4, 95% CI: 1.0, 5.7, p = 0.05; and OR: 2.7, 95% CI: 1.1, 6.5, p = 0.03 respectively). Maternal binging and purging was also found to be associated with differential facial emotion processing and poorer recognition of fear from social motion cues (B: −0.7, 95% CI: −1.1, −0.2, p = 0.004).Discussion: Children at high-risk for ED showed slight differences in some areas of social cognition when compared to children at low-risk. Characteristic patterns in social cognition are present in children at high-risk for ED, particularly among children whose mothers have binge-eating and purging behaviors over the lifetime. Our findings support the hypothesis that these differences may be part of an intermediate phenotype for ED: perhaps contributing to development, or perhaps indexing a shared liability with psychiatric disorders characterized by abnormal social cognition.

Highlights

Diagnosis of an eating disorder (ED) has been associated with difficulties in various aspects of socio-emotional processing: including emotion recognition, emotion regulation, interpersonal functioning, and theory of mind; both in the ill state and in recovery (Oldershaw et al, 2011a; Treasure et al, 2012; Dejong et al, 2013; Goddard and Treasure, 2013)
It is worth noting that the percentage of children of non-white ethnicity was low for all groups in all samples, as is the case for the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort as a whole (Boyd et al, 2012; Fraser et al, 2013)
Our findings show that children at high-risk for ED show differences in social cognition compared to those at low genetic risk; the exploratory nature of this study and the small differences observed mean that further research is required to determine the reliability of this finding

Summary

Introduction

Diagnosis of an eating disorder (ED) has been associated with difficulties in various aspects of socio-emotional processing: including emotion recognition, emotion regulation, interpersonal functioning, and theory of mind; both in the ill state and in recovery (Oldershaw et al, 2011a; Treasure et al, 2012; Dejong et al, 2013; Goddard and Treasure, 2013). Research employing neuroimaging techniques has provided evidence for differences in socio-emotional processing among ED patients in areas of the brain that are associated with eating and food, providing evidence for neural correlates of the socio-emotional difficulties observed among those with ED. Studies show that the neurocircuitry involved in the processing of food stimuli is altered among ED patients with regard to both reward and inhibition: ED patients appear to show an imbalance between the ventral neural system and the dorsal system (Friederich et al, 2013). The altered circuitry observed may contribute to both the deregulated eating and the deregulated social and emotional function characteristic of ED. ED shows high comorbidity with other psychiatric disorders that have been associated with difficulties in social cognition. Perhaps due to the wealth of evidence highlighting the importance of social cognition in ED, several theoretical models have implicated social and emotional difficulties as playing a key role in the development and maintenance of ED (Connan et al, 2003; Kaye, 2008; Hatch et al, 2010; Treasure et al, 2012)

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Discussion

Conclusion