Explicit and implicit emotional expression in bulimia nervosa in the acute state and after recovery

PLoS One. 2014 Jul 2;9(7):e101639. doi: 10.1371/journal.pone.0101639. eCollection 2014.

Abstract

Expression of emotional state is considered to be a core facet of an individual's emotional competence. Emotional processing in BN has not been often studied and has not been considered from a broad perspective. This study aimed at examining the implicit and explicit emotional expression in BN patients, in the acute state and after recovery. Sixty-three female participants were included: 22 BN, 22 recovered BN (R-BN), and 19 healthy controls (HC). The clinical cases were drawn from consecutive admissions and diagnosed according to DSM-IV-TR diagnostic criteria. Self reported (explicit) emotional expression was measured with State-Trait Anger Expression Inventory-2, State-Trait Anxiety Inventory, and Symptom Check List-90 items-Revised. Emotional facial expression (implicit) was recorded by means of an integrated camera (by detecting Facial Feature Tracking), during a 20 minutes therapeutic video game. In the acute illness explicit emotional expression [anxiety (p<0.001) and anger (p<0.05)] was increased. In the recovered group this was decreased to an intermediate level between the acute illness and healthy controls [anxiety (p<0.001) and anger (p<0.05)]. In the implicit measurement of emotional expression patients with acute BN expressed more joy (p<0.001) and less anger (p<0.001) than both healthy controls and those in the recovered group. These findings suggest that there are differences in the implicit and explicit emotional processing in BN, which is significantly reduced after recovery, suggesting an improvement in emotional regulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Anger
  • Anxiety / complications
  • Bulimia Nervosa / complications
  • Bulimia Nervosa / psychology*
  • Emotions*
  • Expressed Emotion
  • Female
  • Humans
  • Young Adult

Grants and funding

Financial support was received from the European Union (Framework-V Multicenter Research Grant, QCK1-1999-916), AGAUR (2009SGR1554) and Fondo de Investigación Sanitaria -FIS (FI12/00470, PI081573 and PI11/210). BF was supported by Ministerio de Ciencia e Innovación-MICINN Subprograma Juan de la Cierva (JCI-2011-09248). CIBERobn and CIBERSAM were both initiatives of Instituto de Salud Carlos III (Spain). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.