Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale

Heather Westwood, Jess Kerr-Gaffney, Daniel Stahl, Kate Tchanturia, Heather Westwood, Jess Kerr-Gaffney, Daniel Stahl, Kate Tchanturia

Abstract

Objective: The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups.

Method: Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs.

Results: Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions.

Conclusion: Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.

Keywords: Alexithymia; Eating disorder; Emotion recognition; Meta-analysis; Systematic review.

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Systematic review search process.
Fig. 2
Fig. 2
Funnel plot of Anorexia Nervosa (AN) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 3
Fig. 3
Funnel plot of Anorexia Nervosa, Restricting subtype (AN-R) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 4
Fig. 4
Funnel plot of Anorexia Nervosa, Binge-Purge subtype (AN-BP) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 5
Fig. 5
Funnel plot of Bulimia Nervosa (BN) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 6
Fig. 6
Funnel plot of Binge Eating Disorder (BED) studies included in the meta-analysis to assess for publication bias. Each dot represents a study included in the meta-analysis, with the Y axis representing the size of each study and the X axis, each study's result.
Fig. 7
Fig. 7
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Anorexia Nervosa (AN) and Healthy Controls. CI, confidence interval.
Fig. 8
Fig. 8
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Anorexia Nervosa, Restricting subtype (AN-R) and Healthy Controls (HC) and between Anorexia Nervosa, Binge-Purge subtype (AN-BP) and HCs. CI, confidence interval.
Fig. 9
Fig. 9
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Bulimia Nervosa (BN) and Healthy Controls. CI, confidence interval.
Fig. 10
Fig. 10
Forest plot of mean TAS score: standardized mean effect size for differences (SMD) between Binge Eating Disorder (BED) and Healthy Controls. CI, confidence interval.
Fig. 11
Fig. 11
Forest plot of mean TAS subscale scores: standardized mean effect size for differences (SMD) between Anorexia Nervosa (AN) and Healthy Controls (HC). CI, confidence interval.
Fig. 12
Fig. 12
Forest plot of mean TAS subscale scores: standardized mean effect size for differences (SMD) between Anorexia Nervosa, Restricting subtype (AN-R) and Healthy Controls (HC). CI, confidence interval.
Fig. 13
Fig. 13
Forest plot of mean TAS subscale scores: standardized mean effect size for differences (SMD) between Bulimia Nervosa (BN) and Healthy Controls (HC). CI, confidence interval.

References

    1. Lesser I.M. A review of the alexithymia concept. Psychosom. Med. 1981;43:531–543.
    1. Li S., Zhang B., Guo Y., Zhang J. The association between alexithymia as assessed by the 20-item Toronto Alexithymia Scale and depression: a meta-analysis. Psychiatry Res. 2015;227:1–9.
    1. Roh D., Kim W.J., Kim C.H. Alexithymia in obsessive-compulsive disorder: clinical correlates and symptom dimensions. J. Nerv. Ment. Dis. 2011;199:690–695.
    1. O'Driscoll C., Laing J., Mason O. Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis. Clin. Psychol. Rev. 2014;34:482–495.
    1. Frewen P.A., Dozois D.J., Neufeld R.W., Lanius R.A. Meta-analysis of alexithymia in posttraumatic stress disorder. J. Trauma. Stress. 2008;21:243–246.
    1. Berthoz S., Hill E.L. The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder. Eur. Psychiatry J. Assoc. Eur. Psychiatrists. 2005;20:291–298.
    1. Gramaglia C., Ressico F., Gambaro E., Palazzolo A., Mazzarino M., Bert F. Alexithymia, empathy, emotion identification and social inference in anorexia nervosa: a case-control study. Eat. Behav. 2016;22:46–50.
    1. Martinez-Sanchez F., Ato-Garcia M., Ortiz-Soria B. Alexithymia—state or trait? Span. J. Psychol. 2003;6:51–59.
    1. Taylor G.J., Bagby R.M. New trends in alexithymia research. Psychother. Psychosom. 2004;73:68–77.
    1. Brewer R., Cook R., Cardi V., Treasure J., Bird G. Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia. R. Soc. Open Sci. 2015;2:140382.
    1. Treasure J., Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J. Eat. Disord. 2013;1:13.
    1. Pinna F., Sanna L., Carpiniello B. Alexithymia in eating disorders: therapeutic implications. Psychol. Res. Behav. Manag. 2015;8:1–15.
    1. Bagby R.M., Parker J.D., Taylor G.J. The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. J. Psychosom. Res. 1994;38:23–32.
    1. Mason O., Tyson M., Jones C., Potts S. Alexithymia: its prevalence and correlates in a British undergraduate sample. Psychol. Psychother. 2005;78:113–125.
    1. Ridout N., Thom C., Wallis D.J. Emotion recognition and alexithymia in females with non-clinical disordered eating. Eat. Behav. 2010;11:1–5.
    1. Courty A., Godart N., Lalanne C., Berthoz S. Alexithymia, a compounding factor for eating and social avoidance symptoms in anorexia nervosa. Compr. Psychiatry. 2015;56:217–228.
    1. Beadle J.N., Paradiso S., Salerno A., McCormick L.M. Alexithymia, emotional empathy, and self-regulation in anorexia nervosa. Ann. Clin. Psychiatry Off. J. Am. Acad. Clin. Psychiatrists. 2013;25:107–120.
    1. Nowakowski M.E., McFarlane T., Cassin S. Alexithymia and eating disorders: a critical review of the literature. J. Eat. Disord. 2013;1:21.
    1. Taylor G.J., Bagby R.M., Parker J.D. Cambridge University Press; 1999. Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness.
    1. Wise T.N., Simpson N., Sheridan M.J. Comparison of 26-item and 20-item versions of the Toronto Alexithymia Scale for psychiatric outpatients. Psychol. Rep. 2000;87:127–132.
    1. Taylor G.J., Bagby R.M., Parker J.D. The 20-Item Toronto Alexithymia Scale. IV. Reliability and factorial validity in different languages and cultures. J. Psychosom. Res. 2003;55:277–283.
    1. Suslow T., Donges U.S., Kersting A., Arolt V. 20-Item Toronto Alexithymia Scale: do difficulties describing feelings assess proneness to shame instead of difficulties symbolizing emotions? Scand. J. Psychol. 2000;41:329–334.
    1. Tull M.T., Medaglia E., Roemer L. An investigation of the construct validity of the 20-Item Toronto Alexithymia Scale through the use of a verbalization task. J. Psychosom. Res. 2005;59:77–84.
    1. Marchesi C., Ossola P., Tonna M., De Panfilis C. The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders. Compr. Psychiatry. 2014;55:972–978.
    1. Muller J., Buhner M., Ellgring H. Is there a reliable factorial structure in the 20-item Toronto Alexithymia Scale? A comparison of factor models in clinical and normal adult samples. J. Psychosom. Res. 2003;55:561–568.
    1. Kooiman C.G., Spinhoven P., Trijsburg R.W. The assessment of alexithymia: a critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20. J. Psychosom. Res. 2002;53:1083–1090.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G., Group P Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J. Clin. Epidemiol. 2009;62:1006–1012.
    1. Programme C.A.S. Critical Appraisal Skills Programme; Oxford: CASP: 2013. CASP Case Control Checklist.
    1. Cochrane T.C. The Nordic Cochrane Centre; 2014. Review Manager 5.3.
    1. Cohen D. 2nd ed. Lawrence Erlbaum; Hillsdale, N.J: 1988. Statistical Power Analysis for the Behavioral Sciences.
    1. StataCorp . StataCorp LP; College Station, TX: 2013. Stata Statistical Software: Release 13.
    1. Sharp S. Meta-analysis regression. Stata Tech. Bull. 1998;7
    1. Duval S., Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–463.
    1. Steichen T. Nonparametric trim and fill analysis of publication bias in meta-analysis. Stata Tech. Bull. 2001;10
    1. Dapelo M.M., Hart S., Hale C., Morris R., Lynch T.R., Tchanturia K. Facial expression of positive emotions in individuals with eating disorders. Psychiatry Res. 2015;230:70–77.
    1. Higgins J.P., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.
    1. Collaboration TC . 2011. Cochrane Handbook for Systematic Reviews of Interventions v 5.1.0. [updated March 2011]
    1. De Panfilis C., Rabbaglio P., Rossi C., Zita G., Maggini C. Body image disturbance, parental bonding and alexithymia in patients with eating disorders. Psychopathology. 2003;36:239–246.
    1. Deborde A., Berthoz S., Wallier J., Fermanian J., Falissard B., Jeammet P. The Bermond-Vorst Alexithymia Questionnaire cutoff scores: a study in eating-disordered and control subjects. Psychopathology. 2008;41:43–49.
    1. Strigo I.A., Matthews S.C., Simmons A.N., Oberndorfer T., Klabunde M., Reinhardt L.E. Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: evidence of interoceptive dysregulation. Int. J. Eat. Disord. 2013;46:23–33.
    1. Rommel D., Nandrino J.L., Antoine P., Dodin V. Emotional differentiation and parental bonding in inpatients suffering from eating disorders. Br. J. Clin. Psychol./Br. Psychol. Soc. 2013;52:215–229.
    1. Speranza M., Corcos M., Stephan P., Loas G., Perez-Diaz F., Lang F. Alexithymia, depressive experiences, and dependency in addictive disorders. Subst. Use Misuse. 2004;39:551–579.
    1. Eizaguirre A.E., de Cabezon A.O.S., de Alda I.O., Olariaga L.J., Juaniz M. Alexithymia and its relationships with anxiety and depression in eating disorders. Personal. Individ. Differ. 2004;36:321–331.
    1. Bydlowski S., Corcos M., Jeammet P., Paterniti S., Berthoz S., Laurier C. Emotion-processing deficits in eating disorders. Int. J. Eat. Disord. 2005;37:321–329.
    1. Parling T., Mortazavi M., Ghaderi A. Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept? Eat. Behav. 2010;11:205–210.
    1. Torres S., Guerra M.P., Lencastre L., Miller K., Vieira F.M., Roma-Torres A. Alexithymia in anorexia nervosa: the mediating role of depression. Psychiatry Res. 2015;225:99–107.
    1. Amianto F., Bertorello A., Migliore F., Abbate-Daga G., Fassino S. Alexithymia in anorexia and bulimia: ubiquitous and primary trait? Cogent Psychol. 2016;3
    1. Aloi M., Rania M., Caroleo M., De Fazio P., Segura-Garcia C. Social cognition and emotional functioning in patients with binge eating disorder. Eur. Eat. Disord. Rev. J. Eat. Disord. Assoc. 2017;25:172–178.
    1. Tchanturia Davies H., Harrison A., JRE Fox, Treasure J., Schmidt U. Altered social hedonic processing in eating disorders. Int. J. Eat. Disord. 2012;45:962–969.
    1. Abbate-Daga G., Quaranta M., Marzola E., Amianto F., Fassino S. The relationship between alexithymia and intolerance of uncertainty in anorexia nervosa. Psychopathology. 2015;48:202–208.
    1. Adenzato M., Todisco P., Ardito R.B. Social cognition in anorexia nervosa: evidence of preserved theory of mind and impaired emotional functioning. PLoS One. 2012;7
    1. Bomba M., Marfone M., Brivio E., Oggiano S., Broggi F., Neri F. Autobiographical memory in adolescent girls with anorexia nervosa. Eur. Eat. Dis. Rev. J. Eat. Disord. Assoc. 2014;22:479–486.
    1. Bourke M.P., Taylor G.J., Parker J.D., Bagby R.M. Alexithymia in women with anorexia nervosa. A preliminary investigation. Br. J. Psychiatry J. Ment. Sci. 1992;161:240–243.
    1. D'Agata F., Caroppo P., Amianto F., Spalatro A., Caglio M.M., Bergui M. Brain correlates of alexithymia in eating disorders: a voxel-based morphometry study. Psychiatry Clin. Neurosci. 2015;69:708–716.
    1. Dapelo M.M., Surguladze S., Morris R., Tchanturia K. Emotion recognition in blended facial expressions in women with anorexia nervosa. Eur. Eat. Disord. Rev. 2016;24:34–42.
    1. de Groot J.M., Rodin G., Olmsted M.P. Alexithymia, depression, and treatment outcome in bulimia nervosa. Compr. Psychiatry. 1995;36:53–60.
    1. de Zwaan M., Biener D., Bach M., Wiesnagrotzki S., Stacher G. Pain sensitivity, alexithymia, and depression in patients with eating disorders: are they related? J. Psychosom. Res. 1996;41:65–70.
    1. de Zwaan M., Bach M., Mitchell J.E., Ackard D., Specker S.M., Pyle R.L. Alexithymia, obesity, and binge eating disorder. Int. J. Eat. Disord. 1995;17:135–140.
    1. Deborde A.S., Berthoz S., Wallier J.M., Fermanian J., Falissard B., Jeammet P. The Bermond-Vorst Alexithymia Questionnaire cutoff scores: a study in eating-disordered and control subjects. Psychopathology. 2008;41:43–49.
    1. Guttman H., Laporte L. Alexithymia, empathy, and psychological symptoms in a family context. Compr. Psychiatry. 2002;43:448–455.
    1. Jimerson D.C., Wolfe B.E., Franko D.L., Covino N.A., Sifneos P.E. Alexithymia ratings in bulimia nervosa: clinical correlates. Psychosom. Med. 1994;56:90–93.
    1. Kessler H., Schwarze M., Filipic S., Traue H.C., von Wietersheim J. Alexithymia and facial emotion recognition in patients with eating disorders. Int. J. Eat. Disord. 2006;39:245–251.
    1. Kuhnpast N., Gramann K., Pollatos O. Electrophysiologic evidence for multilevel deficits in emotional face processing in patients with bulimia nervosa. Psychosom. Med. 2012;74:736–744.
    1. Lule D., Schulze U.M., Bauer K., Scholl F., Muller S., Fladung A.K. Anorexia nervosa and its relation to depression, anxiety, alexithymia and emotional processing deficits. Eat. Weight Disord. EWD. 2014;19:209–216.
    1. Matsumoto J., Hirano Y., Numata N., Matzuzawa D., Murano S., Yokote K. Comparison in decision-making between bulimia nervosa, anorexia nervosa, and healthy women: influence of mood status and pathological eating concerns. J. Eat. Disord. 2015;3:14.
    1. Miyake Y., Okamoto Y., Onoda K., Shirao N., Okamoto Y., Yamawaki S. Brain activation during the perception of stressful word stimuli concerning interpersonal relationships in anorexia nervosa patients with high degrees of alexithymia in an fMRI paradigm. Psychiatry Res. 2012;201:113–119.
    1. Montebarocci O., Codispoti M., Surcinelli P., Franzoni E., Baldaro B., Rossi N. Alexithymia in female patients with eating disorders. Eat. Weight Disord. EWD. 2006;11:14–21.
    1. Nandrino J.L., Berna G., Hot P., Dodin V., Latree J., Decharles S. Cognitive and physiological dissociations in response to emotional pictures in patients with anorexia. J. Psychosom. Res. 2012;72:58–64.
    1. Nandrino J.L., Doba K., Lesne A., Christophe V., Pezard L. Autobiographical memory deficit in anorexia nervosa: emotion regulation and effect of duration of illness. J. Psychosom. Res. 2006;61:537–543.
    1. Pinaquy S., Chabrol H., Simon C., Louvet J.P., Barbe P. Emotional eating, alexithymia, and binge-eating disorder in obese women. Obes. Res. 2003;11:195–201.
    1. Pollatos O., Herbert B.M., Schandry R., Gramann K. Impaired central processing of emotional faces in anorexia nervosa. Psychosom. Med. 2008;70:701–708.
    1. Pollatos O., Kurz A.L., Albrecht J., Schreder T., Kleemann A.M., Schopf V. Reduced perception of bodily signals in anorexia nervosa. Eat. Behav. 2008;9:381–388.
    1. Pollatos O., Georgiou E. Normal interoceptive accuracy in women with bulimia nervosa. Psychiatry Res. 2016;240:328–332.
    1. Schmidt U., Jiwany A., Treasure J. A controlled study of alexithymia in eating disorders. Compr. Psychiatry. 1993;34:54–58.
    1. Sexton M.C., Sunday S.R., Hurt S., Halmi K.A. The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients. Int. J. Eat. Disord. 1998;23:277–286.
    1. Speranza M., Corcos M., Loas G., Stephan P., Guilbaud O., Perez-Diaz F. Depressive personality dimensions and alexithymia in eating disorders. Psychiatry Res. 2005;135:153–163.
    1. Sureda B., Valdes M., Jodar T., de Pablo J. Alexithymia, type A behaviour and bulimia nervosa. Eur. Eat. Disord. Rev. 1999;7:286–292.
    1. Svaldi J., Caffier D., Tuschen-Caffier B. Emotion suppression but not reappraisal increases desire to binge in women with binge eating disorder. Psychother. Psychosom. 2010;79:188–190.
    1. Taylor G.J., Parker J.D., Bagby R.M., Bourke M.P. Relationships between alexithymia and psychological characteristics associated with eating disorders. J. Psychosom. Res. 1996;41:561–568.
    1. Torres S., Guerra M.P., Lencastre L., Roma-Torres A., Brandao I., Queiros C. Cognitive processing of emotions in anorexia nervosa. Eur. Eat. Disord. Rev. J. Eat. Disord. Assoc. 2011;19:100–111.
    1. Troop N.A., Schmidt U.H., Treasure J.L. Feelings and fantasy in eating disorders: a factor analysis of the Toronto Alexithymia Scale. Int. J. Eat. Disord. 1995;18:151–157.
    1. Zeeck A., Stelzer N., Linster H.W., Joos A., Hartmann A. Emotion and eating in binge eating disorder and obesity. Eur. Eat. Disord. Rev. 2011;19:426–437.
    1. Zonnevijlle-Bender M.J., van Goozen S.H., Cohen-Kettenis P.T., van Elburg A., van Engeland H. Do adolescent anorexia nervosa patients have deficits in emotional functioning? Eur. Child Adolesc. Psychiatry. 2002;11:38–42.
    1. Zonnevylle-Bender M.J., van Goozen S.H., Cohen-Kettenis P.T., van Elburg A., de Wildt M., Stevelmans E. Emotional functioning in anorexia nervosa patients: adolescents compared to adults. Depression Anxiety. 2004;19:35–42.
    1. Dapelo M.M., Hart S., Hale C., Morris R., Tchanturia K. Expression of positive emotions differs in illness and recovery in anorexia nervosa. Psychiatry Res. 2016;246:48–51.
    1. Mattila A.K., Salminen J.K., Nummi T., Joukamaa M. Age is strongly associated with alexithymia in the general population. J. Psychosom. Res. 2006;61:629–635.
    1. Speranza M., Loas G., Guilbaud O., Corcos M. Are treatment options related to alexithymia in eating disorders? Results from a three-year naturalistic longitudinal study. Biomed. Pharmacother. = Biomed. Pharmacother. 2011;65:585–589.
    1. Speranza M., Loas G., Wallier J., Corcos M. Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study. J. Psychosom. Res. 2007;63:365–370.
    1. Brockmeyer T., Holtforth M.G., Bents H., Kammerer A., Herzog W., Friederich H.C. Starvation and emotion regulation in anorexia nervosa. Compr. Psychiatry. 2012;53:496–501.
    1. Swift L., Stephenson R., Royce J. The 20-item Toronto Alexithymia Scale: validation of factor solutions using confirmatory factor analysis on physiotherapy out-patients. Psychol. Psychother. Theory Res. Pract. 2006;79:83–88.
    1. Haviland M.G., Warren W.L., Riggs M.L. An observer scale to measure alexithymia. Psychosomatics. 2000;41:385–392.
    1. Berthoz S., Perdereau F., Godart N., Corcos M., Haviland M.G. Observer- and self-rated alexithymia in eating disorder patients: levels and correspondence among three measures. J. Psychosom. Res. 2007;62:341–347.
    1. Haviland M.G., Warren W.L., Riggs M.L., Gallacher M. Psychometric properties of the Observer Alexithymia Scale in a clinical sample. J. Pers. Assess. 2001;77:176–186.
    1. Meganck R., Vanheule S., Desmet M., Inslegers R. The Observer Alexithymia Scale: a reliable and valid alternative for alexithymia measurement? J. Pers. Assess. 2010;92:175–185.
    1. Bagby R.M., Taylor G.J., Parker J.D., Dickens S.E. The development of the Toronto Structured Interview for Alexithymia: item selection, factor structure, reliability and concurrent validity. Psychother. Psychosom. 2005;75:25–39.
    1. Balottin L., Nacinovich R., Bomba M., Mannarini S. Alexithymia in parents and adolescent anorexic daughters: comparing the responses to TSIA and TAS-20 scales. Neuropsychiatr. Dis. Treat. 2014;10:1941–1951.
    1. Lavender J.M., Wonderlich S.A., Engel S.G., Gordon K.H., Kaye W.H., Mitchell J.E. Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: a conceptual review of the empirical literature. Clin. Psychol. Rev. 2015;40:111–122.
    1. Gratz K.L., Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J. Psychopathol. Behav. 2004;26:41–54.
    1. Lane R.D., Quinlan D.M., Schwartz G.E., Walker P.A., Zeitlin S.B. The levels of emotional awareness scale - a cognitive-developmental measure of emotion. J. Pers. Assess. 1990;55:124–134.
    1. Oldershaw A., Hambrook D., Tchanturia K., Treasure J., Schmidt U. Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosom. Med. 2010;72:73–79.
    1. Bora E., Kose S. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: a specific impairment of cognitive perspective taking in anorexia nervosa? Int. J. Eat. Disord. 2016;49:739–749.
    1. Brockmeyer T., Pellegrino J., Munch H., Herzog W., Dziobek I., Friederich H.C. Social cognition in anorexia nervosa: specific difficulties in decoding emotional but not nonemotional mental states. Int. J. Eat. Disord. 2016;49:883–890.
    1. Castro L., Davies H., Hale L., Surguladze S., Tchanturia K. Facial affect recognition in anorexia nervosa: is obsessionality a missing piece of the puzzle? Aust. N. Z. J. Psychiatry. 2010;44:1118–1125.
    1. Oldershaw A., Hambrook D., Stahl D., Tchanturia K., Treasure J., Schmidt U. The socio-emotional processing stream in Anorexia Nervosa. Neurosci. Biobehav. Rev. 2011;35:970–988.
    1. Davies H., Swan N., Schmidt U., Tchanturia K. An experimental investigation of verbal expression of emotion in anorexia and bulimia nervosa. Eur. Eat. Disord. Rev. 2012;20:476–483.
    1. Harrison A., Sullivan S., Tchanturia K., Treasure J. Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation. Psychol. Med. 2010;40:1887–1897.
    1. Krug I., Bulik C.M., Vall-Llovera O.N., Granero R., Aguera Z., Villarejo C. Anger expression in eating disorders: clinical, psychopathological and personality correlates. Psychiatry Res. 2008;161:195–205.
    1. Dapelo M.M., Bodas S., Morris R., Tchanturia K. Deliberately generated and imitated facial expressions of emotions in people with eating disorders. J. Affect. Disord. 2016;191:1–7.
    1. Tchanturia K., Doris E., Fleming C. Effectiveness of Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in group format: a naturalistic pilot study. Eur. Eat. Disord. Rev. 2014;22:200–205.
    1. Tchanturia K., Doris E., Mountford V., Fleming C. Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry. 2015;15:53.
    1. Wildes J.E., Marcus M.D., Cheng Y., McCabe E.B., Gaskill J.A. Emotion acceptance behavior therapy for anorexia nervosa: a pilot study. Int. J. Eat. Disord. 2014;47:870–873.
    1. Pollatos O., Kurz A.L., Albrecht J., Schreder T., Kleemann A.M., Schopf V. Reduced perception of bodily signals in anorexia nervosa. Eat. Behav. 2008;9:381–388.
    1. Pollatos O., Herbert B.M., Schandry R., Gramann K. Impaired central processing of emotional faces in anorexia nervosa. Psychosom. Med. 2008;70:701–708.

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