The Use of Facial Expressions in an Investigation of Emotion Labeling Accuracy within a Sample of Eating Disordered and Non-Eating Disordered Women
Lisa Lilenfeld
Georgia State University
Background
Prior research has suggested that women with eating disorders have an "emotional dysregulation" which often manifests itself as a deficit in modulating emotions. Hilde Bruch (1962) has proposed that a lack of interoceptive awareness is a fundamental deficit among those suffering from anorexia nervosa. "Interoceptive awareness" refers to the ability to recognize and label one's own internal emotional state. In fact, an inability to accurately recognize, label, and respond to different emotional states is thought to be at the core of anorexia nervosa (Bruch, 1978; Selvini-Palazzoli, 1978).
There are limited means of measuring this clinical impression. Perhaps the best known scale is a part of the Eating Disorders Inventory (EDI; Garner, Olmstead & Polivy, 1983) which is a multi-scale measure designed to assess psychological and behavioral traits in anorexia nervosa and bulimia. One of the eight EDI scales is Interoceptive Awareness, which measures a deficiency in accurately identifying emotions and other internal states. Examples of items from this scale include, "I get confused about what emotion I am feeling" and "When I am upset, I don't know if I am sad, frightened or angry." Studies have shown that both anorexia and bulimia nervosa patients have elevations of the interoceptive awareness scale in comparison to normal control subjects, weight-preoccupied subjects, non-eating disordered psychiatric patients, and recovered eating disordered patients (Garner, Garfinkel & O'Shaughnessy, 1985; Rosen, Murkofsky, Steckler & Sklonick, 1989; Mickalide & Andersen, 1985; Thompson, 1988; Garner, Olmstead, Polivy & Garfinkel, 1984; Norring & Sohlberg, 1988; Hurley, Palmer & Stretch, 1990). The EDI is a scale in which subjects self-rate their perceptions about themselves. It is not certain whether elevated scores on this scale truly reflect a defect in accurately perceiving a person's own emotional states or is a measure whose scores are elevated secondary to depression, poor self esteem, or other factors. Moreover, it is not certain whether people with eating disorders have a deficiency in accurately perceiving emotional states which generalizes to being unable to perceive the emotional states of others. Thus, we sought to develop a better method of assessing affective regulation.
Specific Aims
The major aim of this study was to investigate whether this deficit in accurately recognizing and labeling different emotional states is present when eating disordered subjects observe the emotional states of others, as determined by their responses to universally agreed upon facial expressions. Such a deficit in their ability to accurately perceive and respond to others' emotions has been hypothesized, but never formally operationalized. The methodology of the current study enabled such operationalization. In addition, using anorexic, bulimic, and bulimic-anorexic patient groups allowed for the distinction between a more general deficit across all eating disordered women as suggested by the current research using the EDI, versus one which is specific to those suffering from anorexia nervosa, as originally suggested by Bruch (1973). Finally, it was hoped that information gleaned from this study might shed light on the nature of internal emotional, as well as external social manifestations of the illness and potentially suggest new treatment approaches to address such deficits.
Methods
This pilot study included 60 subjects, 15 per cell to provide adequate power to detect large group differences (Cohen, 1992). The four groups were restricting anorexics, bulimic-anorexics, normal-weight bulimics, and normal controls, between the ages of 14 and 40. Subjects were recruited from the Western Psychiatric Institute & Clinic inpatient unit (The Center for Overcoming Problem Eating), the outpatient Eating Disorders Clinic, and the University of Pittsburgh community. Similar percentages of inpatients and outpatients were represented in each group.
Materials included 110 slides of male and female human faces previously chosen to represent seven different emotions (happiness, sadness, fear, surprise, disgust, anger, neutrality). There were between 14 and 18 examples of each of the seven emotions varying in the degree to which they are prototypic representations of each emotion. Slides were presented in the same order to each subject, with the same emotion never occurring twice in a row. Each slide was presented for 10 seconds, during which time the subjects were asked to determine which emotion the face most represents.
Subjects also completed the Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI) , and the Eating Disorders Inventory (EDI) after completing the emotion rating task previously described. The entire procedure took approximately 50 minutes. Subjects were reimbursed $25 for their time.
Group differences in percentage of emotions correctly identified were compared using univariate analysis of variance (ANOVA) and post-hoc t-tests, as appropriate. To investigate the possible effects of depressive and anxiety symptoms on task performance, correlations between both BDI scores as well as STAI scores, and percentage of faces correctly labeled were calculated. To investigate the effect of severity of eating disorder pathology on task performance, correlations between EDI scores and percentage of faces correctly labeled were also calculated.
Results
No significant differences across the four groups were observed in percentage of emotions correctly identified when all emotions together were examined, as well as when individual emotions were examined.
References
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Garner, D.M., Olmstead, M.P. & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2(2), 15- 34.
Garner, D.M., Olmstead, M.P., Polivy, J. & Garfinkel, P.E. (1984). Comparison between weight-preoccupied women and anorexia nervosa. Psychosomatic Medicine, 46(3), 255-266.
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Thompson, J.K. (1988). Similarities among bulimia nervosa patients categorized by current and historical weight: implications for the classification of eating disorders. International Journal of Eating Disorders, 7(2), 185-189.
Received: May 14, 2002
Posted: May 14, 2002
Manuscript Correspondence to:
Lisa Rachelle Riso Lilenfeld, Ph.D.
Department of Psychology
Georgia State University
Atlanta, GA 30303