Altered social attention in anorexia nervosa during real social interaction

Cognitive and emotional empathy in acute and remitted anorexia nervosa: a systematic review

Background

Impairments in empathy are well established in anorexia nervosa (AN). It is unclear, however, whether these deficits only occur in the acute phases of AN due to neurocognitive impacts of starvation (often referred to as context-dependent, or state-like), or if deficits remain once remission has been achieved (trait-like). This debate is commonly referred to as the 'state vs trait' debate.

Objective

This systematic review aims to summarise existing literature regarding empathy in AN, and to investigate whether empathy deficits in AN are state- or trait-based.

Method

A total of 1014 articles were identified, and seven articles remained after the screening process. These seven articles, comparing empathy across three groups (acute AN, remission of AN, and non-clinical controls), were evaluated and summarised in accordance with PRISMA guidelines. Articles were required to have included all three groups and report on either cognitive empathy and/or emotional empathy.

Results

The majority of studies were of satisfactory quality. The results identified were inconsistent, with few articles lending some support to the 'state' hypothesis and others producing nonsignificant results.

Conclusions

There is minimal literature comparing empathy in acute and remission phases of AN. While there were some inconsistencies in included articles, some data indicate that there may be slight improvements to emotional and cognitive empathy following recovery of AN. Further research is needed to better enrich knowledge regarding the role of state vs trait with regard to neurocognitive difficulties experienced by individuals with AN.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335669, identifier CRD42022335669.

Social cognition in female adults with Anorexia Nervosa: A systematic review

Deficits in interpersonal and social functioning are well established in females with Anorexia Nervosa (AN), and are thought to be key features involved in the onset and maintenance of the disease. Growing literature suggests these may be attributed to poor social cognitive processes. This systematic review evaluates whether differences in social cognition exist in adult females with AN. A total of 32 studies that compared females with AN against a healthy control group using social cognitive measures and/or questionnaires were analysed. The majority of studies were deemed to have a low or moderate risk of bias. Overall, empathy appears to be intact in AN, however greater emotion regulation difficulties, elevated alexithymia and reduced emotional awareness are evident in AN. Findings relating to emotion recognition and emotional Theory of Mind were inconsistent. The nature of the task appeared to influence the domains of cognitive ToM and social perception, warranting further research. These findings are discussed within the broader context of social cognitive models and AN rehabilitation.

Altered social cognition in a community sample of women with disordered eating behaviours: a multi-method approach

Prior work suggests that individuals with an eating disorder demonstrate task-based and overall differences in sociocognitive functioning. However, the majority of studies assessed specifically anorexia nervosa and often employed a single experimental paradigm, providing a piecemeal understanding of the applicability of various lab tasks in denoting meaningful differences across diverse individuals. The current study was designed to address these outstanding issues. Participants were undergraduate females who self-identified as having an official (n = 18) eating disorder diagnosis or disordered eating behaviours with no diagnosis (n = 18), along with a control group (n = 32). Participants completed three social tasks of increasing complexity with different outcome measures, namely a gaze cueing task, passive video-watching using eyetracking, and a task to measure preferred social distance. Results diverged as a function of group across tasks; only the control group produced typical social attention effects, the disordered eating group looked significantly more at faces, and the eating disorder group demonstrated a significantly larger preferred social distance. These results suggest variations in task efficacy and demonstrate that altered sociocognitive functioning extends beyond official eating disorder diagnosis.

The role of transients in action observation

A large number of studies have now described the various ways in which the observation of another person's dynamic movement can influence the speed with which the observer is able to prepare a motor action themselves. The typical results are most often explained with reference to theories that link perception and action. Such theories argue that the cognitive structures associated with each share common representations. Consequently, action preparation and action observation are often said to be functionally equivalent. However, the dominance of these theories in explaining action observation effects has masked the potential contribution from processes associated with the detection of low-level "transients" resulting from observing a body movement, such as motion and sound. In the present review, we describe work undertaken in one particular action observation phenomenon ("social inhibition of return") and show that the transient account provides the best explanation of the effect. We argue that future work should consider attention capture and orienting as a potential contributing factor to action observation effects more broadly.

Speed of Processing Time Slowing in Eating Disorders

We applied Brinley ( 1965 ) plot analysis to the eating disorders field. Across 23 studies and 165 experimental conditions [experienced by a total of 773 eating disorder (ED) participants, including anorexia nervosa (AN), binge eating (BE), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS) and 995 controls], the best-fit regression equation was Y (ED) = 1.08 X (CONTROL) - 31. This equation accounted for 98.2% of the variance. Thus, the ED subjects were only 1.08 times slower than the control subjects, suggesting little processing speed slowing in ED. We also examined simple reaction time [SRT; Y (ED) = .91 X (CONTROL) + 63; variance accounted for = 93.6%] and choice reaction time (CRT; Y (ED) = 1.12X (CONTROL) - 43, variance accounted for = 99.7%). These slopes are significantly different. ED subjects are more impacted when the task involves a decision component (CRT) than when it does not (SRT).

Attention networks in adolescent anorexia nervosa

Anorexia nervosa (AN) usually develops during adolescence when considerable structural and functional brain changes are taking place. Neurocognitive inefficiencies have been consistently found in adults with enduring AN and were suggested to play a role in maintaining the disorder. However, such findings are inconsistent in children and adolescents with AN. The current study conducted a comprehensive assessment of attention networks in adolescents with AN who were not severely underweight during the study using an approach that permits disentangling independent components of attention. Twenty partially weight-restored adolescents with AN (AN-WR) and 24 healthy adolescents performed the Attention Network Test which assesses the efficiency of three main attention networks-executive control, orienting, and alerting. The results revealed abnormal function in the executive control network among adolescents with AN-WR. Specifically, adolescents with AN-WR demonstrated superior ability to suppress attention to task-irrelevant information while focusing on a central task. Moreover, the alerting network modulated this ability. No difference was found between the groups in the speed of orienting attention, but reorienting attention to a target resulted in higher error rates in the AN-WR group. The findings suggest that adolescents with AN have attentional abnormalities that cannot be explained by a state of starvation. These attentional dysregulations may underlie clinical phenotypes of the disorder such as increased attention of details.

Body-part compatibility effects are modulated by the tendency for women to experience negative social comparative emotions and the body-type of the model

Although exposure to physique-salient media images of women’s bodies has been consistently linked with negative psychological consequences, little is known about the cognitive processes that lead to these negative effects. The present study employed a novel adaptation of a computerized response time (RT) task to (i) assess implicit cognitive processing when exposed to the body of another individual, and (ii) examine individual differences in social comparative emotions that may influence the cognitive processing of human bodies. Adult females with low (n = 44) or high (n = 23) tendencies for comparative emotions completed a task in which they executed responses to coloured targets presented on the hands or feet of images of ultra-thin, average-size, and above average-size female models. Although the colour of the target is the only relevant target feature, it is typically found that the to-be-ignored location of the target on the body of the model influences RTs such that RTs are shorter when the target is on a body-part that is compatible with the responding limb (e.g., hand response when target was on hand) than on a body-part that is incompatible with the responding limb (e.g., hand response when target was on foot). Findings from the present study revealed that the magnitude of the body-part compatibility effect (i.e., the index of the cognitive processing of the model) was modulated by tendencies for affective body-related comparisons. Specifically, women who were prone to experiencing social comparative emotions demonstrated stronger and more consistent body-part compatibility effects across models. Therefore, women with higher social comparison tendencies have heightened processing of bodies at a neurocognitive level and may be at higher risk of the negative outcomes linked with physique-salient media exposure.

Control over interfering memories in eating disorders

INTRODUCTION

Recent studies have suggested that patients suffering from either anorexia nervosa (AN) or bulimia nervosa (BN) exhibit abnormal performance in the ability to control cognitive interference in response selection.

METHOD

We assessed the status of cognitive control in episodic memory by addressing the ability to inhibit interfering memories. To this end, we used the retrieval-practice paradigm, which allows for measuring both the beneficial and the detrimental effects of memory practice. The latter phenomenon, known as retrieval-induced forgetting (RIF), is thought to reflect an adaptive inhibitory mechanism aimed at reducing competition in memory retrieval. Twenty-seven healthy controls and 27 patients suffering from eating disorders (either AN or BN) performed a retrieval-practice paradigm and a control task addressing general reactivity and filled a self-report questionnaire on impulsivity.

RESULTS

No differences between patients and healthy controls were observed for the beneficial effects of practice. The same pattern also emerged for RIF. However, when patients with AN and BN were analyzed separately, a clear dissociation emerged: patients with AN displayed no hint of RIF, whereas patients with BN showed an intact memory suppression performance. No group differences emerged in the control task.

CONCLUSIONS

Our findings suggest a specific impairment in the ability to suppress interfering memories in patients with AN, thus extending current evidence of cognitive control deficits in AN to episodic memory.