Emotional intelligence, empathy and alexithymia in anorexia nervosa during adolescence

Alexithymia-A Neglected Factor Influencing Educational Satisfaction and Psychological Wellbeing in Medical Students

ABSTRACT

Alexithymia presents a reduced ability to identify, express, and describe one's own emotions. In medical professionals, alexithymia is associated with increased burnout and substance use, as well as reduced altruistic behavior. Our aim was to examine the association between alexithymia and different sociodemographic, psychological, and somatic parameters among medical students. Participants included 186 third- and sixth-year students of the Faculty of Medicine in Belgrade, Serbia. Data were collected through an online survey, composed of 1) a general questionnaire (sociodemographic data, education satisfaction, grade point average, presence of psychological and somatic disorders), 2) Twenty-Item Toronto Alexithymia Scale, 3) Patient Health Questionnaire-9, and 4) Beck Anxiety Inventory. Third-year students had significantly higher rates of alexithymia compared with sixth-year students. Negative correlation was found between alexithymia and educational satisfaction ( r = -0.276**) and alexithymia and grade point average ( r = -0.186*). A positive correlation was found between alexithymia and depression ( r = 0.424**) and alexithymia and anxiety ( r = 0.338**). The negative impact of alexithymia on educational satisfaction and psychological health is pronounced in the population of medical students, indicating a need for preventive programs aimed in medical schools.

Effectiveness of Yoga as a Complementary Therapy for Anorexia Nervosa: A Systematic Review

Anorexia nervosa (AN) is a severe psychiatric condition associated with high disability and mortality. The purpose of the present manuscript is to critically summarize evidence about the effectiveness of yoga for this condition. A bibliographic search was conducted in the main database sources (PubMed, Embase, and Scopus). Articles in English about the effectiveness of yoga in AN were included. Two hundred thirty-three articles were initially identified and 5 articles were included in the present review. With the exception of one study, all had several methodological limitations such as the presence of confounding factors (e.g., psychiatric comorbidity) or a too limited sample of patients. However, globally yoga seems to ameliorate AN symptoms, especially those regarding emotional dysregulation. Yoga is a candidate complementary treatment for the management of AN, but more randomized controlled studies with larger samples and limited bias are necessary to draw robust conclusions. It would be also interesting to verify in comparative trials the effectiveness of yoga with respect to other treatments such as psychotherapy or the administration of pharmacological compounds. Finally, the practice should be modified adapting to the specific needs of this type of patient.

Potential mechanisms underlying the association between feeding and eating disorders and autism

There is a reliable association between autism and Feeding and Eating Disorders. Concerningly, where these two conditions co-occur, clinical outcomes of Feeding and Eating Disorders are significantly worse, and treatment less effective, than when the Feeding and Eating Disorders occur in neurotypical individuals. Problematically, the reason for the association between autism and Feeding and Eating Disorders is poorly understood, which constrains advances in clinical care. This paper outlines several possible mechanisms that may underlie the observed association and suggests ways in which they may be empirically tested. Mechanisms are split into those producing an artefactual association, and those reflecting a genuine link between conditions. Artefactual associations may be due to conceptual overlap in both diagnostic criteria and measurement, Feeding and Eating Disorders causing transient autistic traits, or the association being non-specific in nature. A genuine association between autism and Feeding and Eating Disorders may be due to common causal factors, autism directly or indirectly causing Feeding and Eating Disorders, and Feeding and Eating Disorders being a female manifestation of autism.

Emotional intelligence subdimensions as moderators in the association between body dissatisfaction and symptoms of eating disorders among female Mexican adolescents

OBJECTIVE

Strong empirical research has shown a relationship between body dissatisfaction and symptoms of eating disorders (ED) and the direct and combined influence of emotional factors and dimensions of emotional intelligence (EI) on ED symptoms. However, whether these emotional variables and competencies moderate the well-established relationship between body dissatisfaction and ED symptomatology has not yet been tested. Neither have studies of this nature been performed among high at-risk populations such as Mexican female adolescents. Thus, this research aimed to explore the moderator role of EI subdimensions in the relationship between body dissatisfaction and ED symptoms among female adolescents from Sinaloa, Mexico.

METHODS

A total of 485 female adolescents aged 14-19 years old (M = 16.81, SD = 1.33) who were students in middle school, high school, and college completed questionnaires about body dissatisfaction, ED symptomatology, and EI. We conducted moderating analyses.

RESULTS

Subdimensions of EI significantly moderated the relationship between body dissatisfaction and symptoms of ED. For participants high in body dissatisfaction, lower levels in stress management ability and higher levels in the interpersonal EI and Adaptability EI dimensions were associated with higher levels of ED symptomatology.

DISCUSSION

Subdimensions of EI have an important role in moderating the association between body dissatisfaction and symptoms of ED. The findings of this study contribute to improving the knowledge about the role of emotional competencies in ED. Proposals for future research and to improve preventative approaches are discussed.

PUBLIC SIGNIFICANCE STATEMENT

This study shows the moderating role of EI dimensions in the well-established relationship between body dissatisfaction and ED symptomatology. The research was conducted with a population at high risk of ED: female adolescents in the northwest of Mexico. Results showed that low Stress management EI, high Adaptability EI, and high Interpersonal EI were associated with higher levels of ED symptomatology among participants with high (but not low) body dissatisfaction. These insightful results have theoretical and practical implications.

Investigating Functioning Profile of Adolescents with Anorexia before and during the COVID-19 Pandemic: A Cross-Sectional Study on Mentalizing, Alexithymia, and Impulsiveness

Anorexia nervosa (AN) usually emerges in adolescence when important changes occur in cognitive, emotional, and social processes. Mentalizing, alexithymia, and impulsiveness represent key dimensions for the understanding and interpretation of psychological difficulties in AN. The outbreak of the COVID-19 pandemic has impacted adolescents with AN, showing a worsening of the disease. The main aims of the present paper are (1) to compare adolescents with AN before and during the COVID-19 pandemic and (2) to explore the relationship between mentalizing, alexithymia, impulsiveness, and psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. One hundred and ninety-six AN female adolescents (N = 94 before COVID-19; N = 102 during COVID-19) participated in this study. The results show that adolescents with AN during the COVID-19 pandemic had a more impaired functioning profile than the before COVID-19 group. Mentalizing, alexithymia, and impulsiveness had a predictive role on psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. In conclusion, our data reveal that the COVID-19 pandemic has likely represented a stress condition that affects mental health; worsening the severity of adolescents with AN clinical condition. Lastly, predictive patterns suggest the existence of a link between difficulties in the ability to face the problems of the present time using effective strategies and the severity of psychological symptoms.

Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa

BACKGROUND

Anorexia nervosa (AN) is associated with impairments in socio-emotional functioning, including difficulties in interpersonal relationships as well as alexithymia (difficulties identifying and describing one's emotions). Although the onset of the disorder is mostly in adolescence, a developmental period in which interpersonal relationships to parents as well as peers undergo major changes, only few studies have investigated the quality of interpersonal relationships in adolescent AN patients. Furthermore, the mechanisms linking poor relationship quality to eating disorder psychopathology are not yet clarified, albeit some research suggests that alexithymia might play a pivotal role. The aims of the present study were investigating the quality of interpersonal relationships to parents and peers in adolescents with AN compared to healthy adolescents as well as exploring the mediating role of alexithymia in the association between relationship quality and eating disorder symptoms.

METHODS

Self-report questionnaires were used to assess relationship quality (Inventory of Parent and Peer Attachment) and alexithymia (Toronto Alexithymia Scale) in 12-18 year old female adolescents with AN (n = 35) in comparison to healthy adolescents (n = 40).

RESULTS

Adolescents with AN reported lower relationship quality to both of their parents and to peers compared to healthy controls. Relationship quality scores were negatively correlated to alexithymia as well as eating disorder symptoms. Alexithymia fully meditated the association between eating disorder symptoms and relationship quality to parents and partially mediated the association between eating disorder symptoms and relationship quality to peers.

CONCLUSION

The results indicate difficulties in interpersonal relationships among adolescents with AN and emphasize the role of peer relationships for adolescents' eating disorder psychopathology. Alexithymia seems to play an important role in explaining the link between quality of relationships and eating disorder psychopathology. Results suggest that treatment should not only focus on family relationships but also address relationships to peers as well as adolescents' competence in identifying and dealing with their emotions.

From Deficits in Emotional Intelligence to Eating Disorder Symptoms: A Sequential Path Analysis Approach Through Self-Esteem and Anxiety

Past studies have reported emotional intelligence (EI) as a relevant factor in development and maintenance of eating disorders (ED), as well as in increasing self-esteem and reducing anxiety. Similarly, research has showed that anxiety and self-esteem are positively and negatively associated to ED criteria, respectively. However, no prior studies have yet tested the multiple intervening roles of both self-esteem and anxiety as potential mediators of the association between EI and ED symptomatology. The present study aims to bridge these gaps by testing a sequential path model. Specifically, we examine the potential sequential mediation effects of self-esteem-anxiety on the link between EI and ED. A sample composed of 516 Spanish undergraduate students and community adults completed measures of EI, self-esteem, anxiety, and ED symptomatology. The results show that high levels of EI were positively associated with self-esteem and negatively associated with anxiety and ED symptoms. Anxiety was positively associated to ED symptoms, while self-esteem levels were negatively linked to ED symptoms. Moreover, path analyses showed that self-esteem and anxiety fully mediated the relationship between EI and ED symptoms in sequence. These findings suggest that EI plays a key role in reducing symptomatology of ED through increased self-esteem and reduced anxiety symptoms, providing novel evidence regarding psychological mechanisms through which EI contributes to a reduction of ED symptomatology. Implications for assessing and improving these psychological resources in ED preventive programs are discussed.

Emotional intelligence and eating disorders: a systematic review

BACKGROUND

Prior research indicates that deficits in emotional abilities are key predictors of the onset and maintenance of eating disorders (ED). As a relatively new emotion-related construct, emotional intelligence (EI) comprises a set of basic emotional abilities. Preliminary research suggests that deficits in EI are linked with disordered eating and other impulsive behaviours. Also, previous research reveals that emotional and socio-cognitive abilities, as well as ED symptomatology, varies across lifespan development. However, while the findings suggest promising results for the development of potential effective treatments for emotional deficits and disordered eating, it is difficult to summarise the relationship between EI and ED due to the diversity of theoretical approaches and variety of EI and ED measures.

OBJECTIVE

Our study, therefore, aimed to systematically review the current evidence on EI and ED in both the general and clinical populations and across different developmental stages.

METHODS

The databases examined were Medline, PsycInfo and Scopus, and 15 eligible articles were identified. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used.

RESULTS

All the studies reviewed indicated negative associations between EI and the dimensions of ED. Additionally, several mechanisms involved, namely adaptability, stress tolerance and emotional regulation were highlighted.

CONCLUSION

The systematic review suggests promising but challenging preliminary evidence of the associations between EI and the dimensions of ED across diverse stages of development. In addition, future research, practical implications and limitations are discussed.

LEVEL OF EVIDENCE I

Systematic review.

Prevalence of autism spectrum disorder and autistic traits in children with anorexia nervosa and avoidant/restrictive food intake disorder

BACKGROUND

Autism spectrum disorder (ASD) and feeding and eating disorders (FEDs) such as anorexia nervosa (AN) are strongly linked as evidenced by frequent comorbidity and overlapping traits. However, eating and social behaviors are shaped by culture, so it is critical to examine these associations in different populations. Moreover, FEDs are heterogeneous, and there has been no examination of autistic traits in avoidant/restrictive food intake disorder (ARFID).

METHODS

Therefore, we investigated the prevalence of ASD and autistic traits among Japanese children with AN (n = 92) or ARFID (n = 32) from a prospective multicenter cohort study using the Autism Spectrum Quotient Children's version (AQC) and Children's Eating Attitudes Test (ChEAT26).

RESULTS

ASD prevalence was high in both AN and ARFID (16.3 and 12.5%, respectively). The AN group exhibited significantly higher scores on all AQC subscales than an age-matched healthy control (HC) group, but there were no significant correlations between AQC scores and ChEAT26 scores. In the AFRID group, AQC scores did not differ from HCs, but significant correlations were found between total AQC and ChEAT26 scores and between several AQC and ChEAT26 subscales.

CONCLUSIONS

Both the AN and ARFID groups had high prevalence rates of ASD. The AN group showed a significantly higher degree of autistic traits than the HC group; however, no difference was found between the ARFID and HC groups. Clinicians need to be aware of these rates when working with children with ED.

Macro- and micro-structural cerebellar and cortical characteristics of cognitive empathy towards fictional characters in healthy individuals

Few investigations have analyzed the neuroanatomical substrate of empathic capacities in healthy subjects, and most of them have neglected the potential involvement of cerebellar structures. The main aim of the present study was to investigate the associations between bilateral cerebellar macro- and micro-structural measures and levels of cognitive and affective trait empathy (measured by Interpersonal Reactivity Index, IRI) in a sample of 70 healthy subjects of both sexes. We also estimated morphometric variations of cerebral Gray Matter structures, to ascertain whether the potential empathy-related peculiarities in cerebellar areas were accompanied by structural differences in other cerebral regions. At macro-structural level, the volumetric differences were analyzed by Voxel-Based Morphometry (VBM)- and Region of Interest (ROI)-based approaches, and at a micro-structural level, we analyzed Diffusion Tensor Imaging (DTI) data, focusing in particular on Mean Diffusivity and Fractional Anisotropy. Fantasy IRI-subscale was found to be positively associated with volumes in right cerebellar Crus 2 and pars triangularis of inferior frontal gyrus. The here described morphological variations of cerebellar Crus 2 and pars triangularis allow to extend the traditional cortico-centric view of cognitive empathy to the cerebellar regions and indicate that in empathizing with fictional characters the cerebellar and frontal areas are co-recruited.

The Relationship between Emotional Intelligence, Obesity and Eating Disorder in Children and Adolescents: A Systematic Mapping Review

Eating and weight disorders often develop early in life and cause a long-standing significant health burden. Given the documented role of emotional intelligence (EI) in shaping the body image and predicting the onset of eating disorders, knowledge of the mechanisms involved in EI among youth is fundamental to designing specific interventions for screening and prevention of obesity and eating disorders (EDs). The present systematic mapping review was aimed to explore and quantify the nature and distribution of existing research investigating the impact of EI on EDs in young people. A systematic search for relevant articles was conducted using PubMed, Scopus, PsycINFO and Web of Science databases. The Appraisal tool for Cross-Sectional Studies (AXIS) was used to assess the included studies’ methodological quality. The included studies’ results were mapped based on stratification by age groups (children, preadolescents, and adolescents), population (clinical vs. non-clinical) and disordered eating outcomes. Nine studies were included, supporting the association between EI and body image dissatisfaction, ED risk and bulimic symptomatology, but not with anorexic symptoms. Research on children and clinical populations was scant. Further studies are needed to deepen the role of EI in the genesis and maintenance of EDs.

Eating Behavior of Brazilian College Students: Influences of Lifestyle, Negative Affectivity, and Personal Characteristics

In this study we proposed to estimate the impact of lifestyle, negative affectivity, and college students' personal characteristics on eating behavior. We aimed to verify that negative affectivity moderates the relationship between lifestyle and eating behavior. We assessed eating behaviors of cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE)) with the Three-Factor Eating Questionnaire-18. We assessed lifestyle with the Individual Lifestyle Profile, and we assessed negative affectivity with the Depression, Anxiety and Stress Scale-21. We constructed and tested (at p < .05) a hypothetical causal structural model that considered global (second-order) and specific (first-order) lifestyle components, negative affectivity and sample characteristics for each eating behavior dimension. Participants were 1,109 college students (M age = 20.9, SD = 2.7 years; 65.7% females). We found significant impacts of lifestyle second-order components on negative affectivity (β = -0.57-0.19; p < 0.001-0.01) in all models. Physical and psychological lifestyle components impacted directly only on CR (β=-0.32-0.81; p < 0.001). Negative affectivity impacted UE and EE (β = 0.23-0.30; p < 0.001). For global models, we found no mediation pathways between lifestyle and CR or UE. For specific models, negative affectivity was a mediator between stress management and UE (β=-0.07; p < 0.001). Negative affectivity also mediated the relationship between thoughts of dropping an undergraduate course and UE and EE (β = 0.06-0.08; p < 0.001). Participant sex and weight impacted all eating behavior dimensions (β = 0.08-0.34; p < 0.001-0.01). Age was significant for UE and EE (β=-0,14- -0.09; p < 0.001-0.01). Economic stratum influenced only CR (β = 0.08; p = 0.01). In sum, participants' lifestyle, negative emotions and personal characteristics were all relevant for eating behavior assessment.

Cognitive and Emotional Empathy in Anorexia Nervosa: The Role of Attachment Insecurity, Intrapersonal, and Interpersonal Emotional Competences

The present research examined a model that evaluates the mediating role of both intrapersonal and interpersonal emotional competences (ECs) between attachment insecurity and the cognitive and emotional dimensions of empathy in patients with anorexia nervosa (AN). Women with AN completed the Experiences in Close Relationships Scale, the Profile of Emotional Competence, the Interpersonal Reactivity Index, the State-Trait Anxiety Inventory, and the Beck Depression Inventory. The results revealed that intrapersonal EC mediated the relationships between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and emotional empathy in patients with AN. Importantly, a high emotional empathy in AN was associated with increased depression and anxiety symptoms. The results also indicated that a high level of attachment avoidance was indirectly associated with lower cognitive empathy through lower levels of interpersonal EC in AN. The present study emphasizes the importance of differentiating affective empathy from cognitive empathy and suggests clinical interventions in patients with AN.

A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research

The term "alexithymia" was introduced in the lexicon of psychiatry in the early '70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the '80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.

Emotion regulation, emotion recognition, and empathy in adolescents with anorexia nervosa

PURPOSE

Emotional functions may play an important role in anorexia nervosa (AN). The onset of the disorder generally occurs during adolescence, which is a critical period of emotional development. However, most studies that evaluated emotional functions in AN were conducted in adult patients. The aim of this study was to evaluate emotion regulation, emotion recognition, and empathy skills in adolescent girls with AN by controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security on emotional functions.

METHODS

Thirty-two adolescent girls with AN and 32 healthy counterparts completed the Difficulties in Emotion Regulation Scale, the Reading the Mind in the Eyes Test, Toronto Alexithymia Scale-20, and the Child and Adolescent KA-SI Empathic Tendency Scale-Adolescent Form.

RESULTS

The results revealed that adolescents with AN were found to have more difficulties in emotion regulation, higher alexithymic tendencies, and lower empathy skills compared with the control group. However, emotion recognition was not found to be significantly different between the two groups. These results were the same when controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security except for empathy skills. Alexithymia and depressive symptoms were significantly related to emotion regulation difficulties in adolescents with AN.

CONCLUSIONS

Considering the results, it seems that emotion regulation and alexithymia may play a crucial role in the development and maintenance of AN. Accordingly, it is necessary to focus on the improvement of these skills during the treatment of AN. Furthermore, interventions promoting these skills during adolescence may be preventive.

LEVEL OF EVIDENCE

Level III, case-control study.

The behavioral and affective profile of inpatient adolescent girls with restrictive anorexia nervosa

BACKGROUND

A better understanding of the individual difficulties reported by adolescents presenting with anorexia nervosa seems like an interesting avenue to refine our understanding of their psychological functioning.

OBJECTIVE

This study aimed to: (1) describe the behavioral and affective profile of difficulties of inpatient adolescent girls presenting a restricting type of anorexia (ANR); and (2) investigate the presence of a relationship between behavioral and affective problems and severity of the disorder.

METHODS

The sample consisted of 52 inpatient adolescent girls presenting an ANR. The youth self report assessed the behavioral and emotional profile of difficulties of participants while the Eating Disorder Risk Composite of the Eating Disorder Inventory measured the symptomatology of the disorder. A ratio between body mass index at admission and at the end of the treatment served as an indicator of weight gain.

RESULTS

The sample presented an internalized profile of problems. Individual differences were found and three profiles of difficulties were present in the sample: normative, pure internalizing and mixed (clinical on the internalizing and externalizing clusters).

CONCLUSION

This study provides information on the heterogeneity of this specific population otherwise quite similar and demonstrates how severity of the disorder can be associated with a wide range of other behavioral and affective difficulties.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Exploring the role of emotional intelligence on disorder eating psychopathology

PURPOSE

This study aims to explore the role of Emotional Intelligence (EI) and specific facets that may underpin the aetiology of disordered eating attitudes and behaviours, as a means to understand what aspects of these deficits to target within treatments.

METHODS

Participants were recruited from the UK and Ireland. Among the sample of 355 participants, 84% were women and 16% were men. Regarding age, 59% were between 18 and 29, 30% were between 30 and 49, and 11% were 50 or older. Using a cross-sectional design, participants completed the Schutte Self-Report Emotional Intelligence Test to measure levels of trait EI and The Eating Attitudes Test (EAT-26) as a measure of eating disorder risk and the presence of disordered eating attitudes.

RESULTS

EAT-26 scores were negatively correlated with total EI scores and with the following EI subscales: appraisal of own emotions, regulation of emotions, utilisation of emotions, and optimism. Also, compared to those without an eating disorder history, participants who reported having had an eating disorder had significantly lower total EI scores and lower scores on four EI subscales: appraisal of others emotions, appraisal of own emotions, regulation of emotions, and optimism.

CONCLUSIONS

Considering these findings, EI (especially appraisal of own emotions, regulation of emotions, and optimism) may need to be addressed by interventions and treatments for eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Cognitive and Affective Empathy in Eating Disorders: A Systematic Review and Meta-Analysis

Background: Recent models of eating disorders (EDs) have proposed social and emotional difficulties as key factors in the development and maintenance of the illness. While a number of studies have demonstrated difficulties in theory of mind and emotion recognition, little is known about empathic abilities in those with EDs. Further, few studies have examined the cognitive-affective empathy profile in EDs. The aim of this systematic review and meta-analysis was to provide a synthesis of empathy studies in EDs, and examine whether those with EDs differ from healthy controls (HC) on self-reported total, cognitive, and affective empathy. Methods: Electronic databases were systematically searched for studies using self-report measures of empathy in ED populations. In total, 17 studies were identified, 14 of which could be included in the total empathy meta-analysis. Eight of the 14 studies were included in the cognitive and affective empathy meta-analyses. Results: Meta-analyses showed that while total empathy and affective empathy scores did not differ between those with anorexia nervosa (AN) and HC, those with AN had significantly lower cognitive empathy scores compared to HCs (small effect size). Meta-analyses of Interpersonal Reactivity Index sub-scores revealed that AN had significantly lower Fantasy scores than HC (small effect size), indicating that those with AN have more difficulty in identifying themselves with fictional characters. Only 3 studies examined empathy in those with bulimia nervosa (BN) or binge eating disorder (BED). Conclusions: The lowered cognitive empathy and intact affective empathy profile found in AN is similar to that found in other psychiatric and neurodevelopmental conditions, such as autism spectrum disorder (ASD). These findings add to the literature characterizing the socio-emotional phenotype in EDs. Future research should examine the influence of comorbid psychopathology on empathy in EDs.

Alexithymia predicts maladaptive but not adaptive emotion regulation strategies in adolescent girls with anorexia nervosa or depression

BACKGROUND

Among adolescent girls, anorexia nervosa (AN) and major depression (MD) are common and often comorbid mental health problems. Both disorders are characterised by difficulties in recognising and verbalising (alexithymia) as well as regulating one's emotions, but research in adolescent patients is scarce and little is known about the relation between alexithymia and difficulties in emotion regulation. The aims of this study were to investigate alexithymia and emotion regulation skills in adolescents with AN, adolescents with MD, and healthy adolescents, and to determine whether alexithymia functions as a predictor for emotion regulation skills.

METHODS

Emotion regulation strategies, alexithymia, and depressive symptoms were assessed by questionnaire measures in 12-18 year old girls with AN (n = 26), girls with MD (n = 25), and healthy girls (n = 35). Groups were compared with respect to the these variables and multiple regression analyses were calculated separately for adaptive and maladaptive emotion regulation strategies in order to examine if alexithymia predicted emotion regulation over and above age and depressive symptoms.

RESULTS

Girls with AN or MD both reported using adaptive emotion regulation strategies less frequently and maladaptive emotion regulation skills more frequently as well as higher levels of alexithymia compared to healthy girls. Alexithymia positively predicted maladaptive emotion regulation strategies, while depressive symptoms negatively predicted adaptive emotion regulation strategies.

CONCLUSIONS

The results suggest that different mechanisms may underlie the lack of adaptive and the surplus of maladaptive emotion regulation strategies in adolescent psychiatric patients.