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Emotional Theory of Mind and Emotional Awareness in Recovered Anorexia Nervosa Patients

From the King’s College London (A.O., D.H., K.T., U.S.), Institute of Psychiatry, Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, London, UK; and the Department of Academic Psychiatry (J.T.), Guy’s, King’s and St. Thomas’ Medical School, London, UK.

Address correspondence and reprint requests to Anna Oldershaw, Section of Eating Disorders (P059), Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK. E-mail: a.oldershaw{at}iop.kcl.ac.uk

Objectives: To examine whether an impaired ability to infer emotion in people with autism spectrum disorder (ASD) and difficulty with emotional theory of mind (eToM) are limited to the ill state or if this condition is a stable deficit that persists with recovery in adults with anorexia nervosa (AN). This is in keeping with observations of similarities between the disorders.

Methods: Twenty-four participants fully recovered from AN were compared against a sample of currently ill AN patients (n = 40) and healthy controls (HCs) (n = 47) on forced-choice tasks assessing emotion recognition, basic or advanced eToM in other people, using sensory stimuli and on a written task measuring eToM ability for the self as well as for others.

Results: Recovered participants performed well on eToM tasks and were significantly better than currently ill patients at inferring emotions in the self and in others. However, participants recovered from AN had some slight impairment in emotion recognition relative to HCs, particularly when recognizing positive emotions.

Conclusions: These findings indicate almost complete normalization of emotion recognition ability as well as the restoration of eToM in recovered patients, despite the observation of difficulties in both domains in currently ill patients. Findings suggest that similarities between AN and ASD in poor eToM are restricted to the currently ill AN state and such difficulties in AN may be a factor of starvation.

Key Words: anorexia nervosa • theory of mind • social cognition • emotion • recovery • starvation

Abbreviations: AN = anorexia nervosa; ASD = autism spectrum disorder; recAN = recovered anorexia nervosa; HC = healthy control; ToM = theory of mind; eToM = emotional theory of mind; BMI = body mass index; IQ = intelligence quotient; ANCOVA = analysis of covariance.

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