Facial affect recognition in anorexia nervosa: is obsessionality a missing piece of the puzzle?

Objective: Socio-emotional difficulties are thought to be important maintaining factors of eating disorders. Several studies point to deficits in facial affect recognition in anorexia nervosa (AN). However, the majority of these studies fail to control for comorbidity and its effect on emotional processing. This study aims to explore how patients with AN recognize happiness and sadness in human faces, controlling for different comorbidities, namely anxiety, depression, and obsessive-compulsive symptoms.

Methods: Thirty patients with AN, and 40 healthy participants completed a facial emotion recognition task. This task measured discrimination accuracy, response bias and response time towards sad and happy faces presented at different durations (500 ms, 2000 ms). The associations between facial affect recognition and clinical symptoms and intelligence quotient were explored.

Results: Regression analysis showed that discrimination accuracy of sad faces presented for 500 ms was significantly associated with AN diagnosis, body mass index, and Obsessive-compulsive symptoms. However, the level of Obsessive-compulsive symptoms was the strongest predictor of a poor discrimination of briefly presented sad faces.

Conclusions: Our results support previous studies that report emotional processing deficits in AN with obsessionality playing a pivotal role in this deficit.