Skip to main content Accessibility help
Hostname: page-component-8bbf57454-47mcc Total loading time: 0.301 Render date: 2022-01-24T04:06:17.076Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation

Published online by Cambridge University Press:  27 January 2010

A. Harrison*
Institute of Psychiatry, King's College London, UK
S. Sullivan
Institute of Psychiatry, King's College London, UK
K. Tchanturia
Institute of Psychiatry, King's College London, UK
J. Treasure
Institute of Psychiatry, King's College London, UK
*Address for correspondence: Mrs A. Harrison, Eating Disorders Research Unit, Department of Academic Psychiatry, 5th Floor, Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK. (Email:



Interpersonal processes, anxiety and emotion regulation difficulties form a key part of conceptual models of eating disorders (EDs), such as anorexia nervosa (AN) and bulimia nervosa (BN), but the experimental findings to support this are limited.


The Reading the Mind in the Eyes task, the Difficulties in Emotion Regulation Scale (DERS) and a computerized pictorial (angry and neutral faces) Stroop task were administered to 190 women [50 with AN, 50 with BN and 90 healthy controls (HCs)].


Those with an ED showed attentional biases to faces in general (medium effect), but specifically to angry faces over neutral faces (large effect) compared to HCs. The ED group also reported significantly higher emotion regulation difficulties (large effect) than HCs. There was a small difference between the ED and HC groups for the emotion recognition task (small-medium effect), particularly in the restricting AN (RAN) group. Depression and attentional bias to faces significantly predicted emotion regulation difficulties in a regression model.


The data provide support for conceptualizations of EDs that emphasize the role of emotional functioning in the development and maintenance of EDs. Further research will concentrate on exploring whether these findings are state or trait features of EDs.

Original Articles
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Ashwin, C, Wheelwright, S, Baron-Cohen, S (2006). Attention bias to faces in Asperger syndrome: a pictorial emotion Stroop study. Psychological Medicine 36, 835843.CrossRefGoogle ScholarPubMed
Baron-Cohen, S, Wheelwright, S, Hill, J, Raste, Y, Plumb, I (2001). The ‘Reading the Mind in the Eyes’ test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry 42, 241251.CrossRefGoogle ScholarPubMed
Bland, JM, Altman, DG (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1, 307310.CrossRefGoogle ScholarPubMed
Campbell-Sills, L, Barlow, DH, Brown, TA, Hofmann, SG (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy 44, 12511263.CrossRefGoogle ScholarPubMed
Catanzaro, SJ, Mearns, J (1990). Measuring generalized expectancies for negative mood regulation: initial scale development and implications. Journal of Personality Assessment 54, 546563.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioural Sciences, 2nd edn. Academic Press: New York.Google Scholar
Cohen, J (1992). A power primer. Psychological Bulletin 112, 155159.CrossRefGoogle ScholarPubMed
Connan, F, Campbell, IC, Katzman, M, Lightman, SL, Treasure, J (2003). A neurodevelopmental model for anorexia nervosa. Physiology and Behavior 79, 1324.CrossRefGoogle ScholarPubMed
Connan, F, Troop, N, Landau, S, Campbell, IC, Treasure, J (2007). Poor social comparison and the tendency to submissive behavior in anorexia nervosa. International Journal of Eating Disorders 40, 733739.CrossRefGoogle ScholarPubMed
Craig, JS, Hatton, C, Craig, FB, Bentall, RP (2004). Persecutory beliefs, attributions and theory of mind: comparison of patients with paranoid delusions, Asperger's syndrome and healthy controls. Schizophrenia Research 69, 2933.CrossRefGoogle ScholarPubMed
Dobson, KS, Dozois, DJA (2004). Attentional biases in eating disorders: a meta-analytic review of Stroop performance. Clinical Psychology Review 23, 10011022.CrossRefGoogle ScholarPubMed
Fairburn, CG (1998). Eating disorders. In Essentials of Human Nutrition (ed. Mann, J. I. and Truswell, S.), pp. 371382. Oxford University Press: Oxford.Google Scholar
Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press: New York.Google ScholarPubMed
Fairburn, CG, Beglin, SJ (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders 16, 363370.Google ScholarPubMed
Fertuck, EA, Jekal, A, Song, I, Wyman, B, Morris, MC, Wilson, ST, Brodsky, BS, Stanley, B (2009). Enhanced ‘Reading the Mind in the Eyes’ in borderline personality disorder compared to healthy controls. Psychological Medicine 39, 19791988.CrossRefGoogle ScholarPubMed
Foa, EB, Huppert, JD, Leiberg, S, Langner, R, Kichic, R, Hajcak, G, Salkovskis, PM (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment 14, 485495.CrossRefGoogle ScholarPubMed
Forster, KI, Forster, JC (2003). DMDX: a Windows display program with millisecond accuracy. Behavior Research Methods, Instruments and Computers 35, 116124.CrossRefGoogle ScholarPubMed
Fox, JRE, Froom, K (2009). Eating disorders: a basic emotion perspective. Clinical Psychology and Psychotherapy 16, 328335.CrossRefGoogle ScholarPubMed
Fox, JRE, Harrison, A (2008). The relation of anger to disgust: the potential role of coupled emotions within eating pathology. Clinical Psychology and Psychotherapy 15, 8695.CrossRefGoogle ScholarPubMed
Fox, JRE, Power, MJ (2009). Eating disorders and multi-level models of emotion: an integrated model. Clinical Psychology and Psychotherapy 16, 240267.CrossRefGoogle Scholar
Gilboa-Schechtman, E, Avnon, L, Zubery, E, Jeczmien, P (2006). Emotional processing in eating disorders: specific impairment or general distress related deficiency? Depression and Anxiety 23, 331339.CrossRefGoogle ScholarPubMed
Godart, NT, Flament, MF, Curt, F, Perdereau, F, Jeammet, P (2003). Comorbidity between eating disorders and anxiety disorders. International Journal of Eating Disorders 23, 253270.Google Scholar
Golan, O, Baron-Cohen, S, Hill, J (2006). The Cambridge Mindreading (CAM) Face-Voice Battery: testing complex emotion recognition in adults with and without Asperger syndrome. Journal of Autism and Developmental Disorders 36, 169183.CrossRefGoogle ScholarPubMed
Gratz, KL, Gunderson, JG (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy 37, 2535.CrossRefGoogle ScholarPubMed
Gratz, KL, Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment 26, 4154.CrossRefGoogle Scholar
Gross, JJ, John, OP (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology 85, 348362.CrossRefGoogle ScholarPubMed
Hallerbäck, MU, Lugnegård, T, Hjärthag, F, Gillberg, C (2009). The Reading the Mind in the Eyes Test: test–retest reliability of a Swedish version. Cognitive Neuropsychiatry 14, 127143.CrossRefGoogle ScholarPubMed
Halmi, KA, Eckert, E, Marchi, P, Sampugnaro, V, Apple, R, Cohen, J (1991). Comorbidity of psychiatric diagnoses in anorexia nervosa. Archives of General Psychiatry 48, 712718.CrossRefGoogle ScholarPubMed
Harrison, A, Sullivan, S, Tchanturia, K, Treasure, J (2009). Emotion recognition and regulation in anorexia nervosa. Clinical Psychology and Psychotherapy 16, 348356.CrossRefGoogle ScholarPubMed
Havet-Thomassin, V, Allain, P, Etcharry-Bouyx, F, Le Gall, D (2006). What about theory of mind after severe brain injury? Brain Injury 20, 8391.CrossRefGoogle ScholarPubMed
Hefter, RL, Manoach, DS, Barton, JJ (2005). Perception of facial expression and facial identity in subjects with social developmental disorders. Neurology 65, 16201625.CrossRefGoogle ScholarPubMed
Hochberg, Y (1988). A sharper Bonferroni procedure for multiple tests of significance. Biometrika 75, 800802.CrossRefGoogle Scholar
Ioannou, K, Fox, JRE (2009). Perception of threat from emotions and its role in poor emotional expression within eating pathology. Clinical Psychology and Psychotherapy 16, 336347.CrossRefGoogle ScholarPubMed
Irani, F, Platek, SM, Panyavin, IS, Calkins, ME, Kohler, C, Siegel, SJ, Schachter, M, Gur, RE, Gur, RC (2006). Self face recognition and theory of mind in patients with schizophrenia and first-degree relatives. Schizophrenia Research 88, 151160.CrossRefGoogle ScholarPubMed
Johansson, L, Ghaderi, A, Andersson, G (2005). Stroop interference for food- and body-related words: a meta-analysis. Eating Behaviors 6, 271281.CrossRefGoogle ScholarPubMed
Kelemen, O, Keri, S, Must, A, Benedek, G, Janka, Z (2004). No evidence for impaired ‘theory of mind’ in unaffected first-degree relatives of schizophrenia patients. Acta Psychiatrica Scandinavica 110, 146149.CrossRefGoogle ScholarPubMed
Kettle, JWL, O'Brien-Simpson, L, Allen, NB (2008). Impaired theory of mind in first episode schizophrenia: comparison with community, university and depressed controls. Schizophrenia Research 99, 96–102.CrossRefGoogle ScholarPubMed
Kucharska-Pietura, K, Nikolaou, V, Masiak, M, Treasure, J (2004). The recognition of emotion in the faces and voice of anorexia nervosa. International Journal of Eating Disorders 35, 4247.CrossRefGoogle ScholarPubMed
Lee, L, Harkness, KL, Sabbagh, MA, Jacobson, JA (2005). Mental state decoding abilities in clinical depression. Journal of Affective Disorders 86, 247258.CrossRefGoogle ScholarPubMed
Losh, M, Piven, J (2006). Social-cognition and the broad autism phenotype: identifying genetically meaningful phenotypes. Journal of Child Psychology and Psychiatry 48, 105112.CrossRefGoogle Scholar
Lovibond, PF, Lovibond, SH (1995 a). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy 33, 335343.CrossRefGoogle ScholarPubMed
Lovibond, SH, Lovibond, PF (1995 b). Manual for the Depression Anxiety Stress Scales. Psychology Foundation: Sydney.Google Scholar
McManus, F, Waller, G, Chadwick, P (1996). Biases in the processing of different forms of threat in bulimic and comparison women. Journal of Nervous and Mental Disease 184, 547554.CrossRefGoogle ScholarPubMed
Meyer, C, Serpell, L, Waller, G, Murphy, F, Treasure, J, Leung, N (2005). Cognitive avoidance in the strategic processing of ego threats among eating-disordered patients. International Journal of Eating Disorders 38, 3036.CrossRefGoogle Scholar
Murphy, D (2006). Theory of mind in Asperger's syndrome, schizophrenia and personality disordered forensic patients. Cognitive Neuropsychiatry 11, 99–111.CrossRefGoogle ScholarPubMed
Nelson, HE, Willison, J (1991). National Adult Reading Test Manual, 2nd edn. NFER-Nelson: Windsor.Google Scholar
Ochsner, K (2008). The social-emotional processing stream: five core constructs and their translational potential for schizophrenia and beyond. Biological Psychiatry 64, 4861.CrossRefGoogle ScholarPubMed
Oldershaw, A (2009). Emotional Theory of Mind in Anorexia Nervosa: State or Trait? Ph.D. thesis, Institute of Psychiatry, King's College London.Google Scholar
Pollatos, O, Herbert, BM, Schandry, R, Gramann, K (2008). Impaired central processing of emotional faces in anorexia nervosa. Psychosomatic Medicine 70, 701708.CrossRefGoogle ScholarPubMed
Posner, MI, Petersen, SE (1990). The attention system of the human brain. Annual Review of Neuroscience 13, 2542.CrossRefGoogle ScholarPubMed
Power, M, Dalgleish, T (1997). Cognition and Emotion: From Order to Disorder. Psychology Press: Hove.Google Scholar
Quinton, S (2004). Processing of five types of ‘threat’ information in female dieters and non-dieters. European Eating Disorders Reviews 6, 266276.3.0.CO;2-D>CrossRefGoogle Scholar
Rosenthal, R (1991). Meta-Analytic Procedures for Social Research, revised edn. Sage: Newbury Park, CA.CrossRefGoogle Scholar
Russell, TA, Schmidt, U, Doherty, L, Young, V, Tchanturia, K (2009). Aspects of social cognition in anorexia nervosa: affective and cognitive theory of mind. Psychiatry Research 168, 181185.CrossRefGoogle ScholarPubMed
Salovey, P, Mayer, JD, Goldman, SL, Turvey, C, Palfai, TP (1995). Emotional attention, clarity, and repair: exploring emotional intelligence using the Trait Meta-Mood Scale. In Emotion, Disclosure, and Health (ed. Pennebaker, J. W.), pp. 125154. American Psychological Association: Washington, DC.CrossRefGoogle Scholar
Sansone, R, Levitt, J, Sansone, L (2004). The prevalence of personality disorders among those with eating disorders. Eating Disorders 13, 7–21.CrossRefGoogle Scholar
Schmidt, U, Treasure, J (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology 45, 343366.CrossRefGoogle ScholarPubMed
Smith, G (2003). Anorexia and Bulimia in the Family: One Parent's Practical Guide to Recovery. Wiley Blackwell: UK.Google Scholar
Tiller, JM, Sloane, G, Schmidt, U, Troop, N, Power, M, Treasure, J (1997). Social support in patients with anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders 21, 3138.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Troop, NA, Allan, S, Treasure, J, Katzman, M (2003). Social comparison and submissive behaviour in eating disorder patients. Psychology and Psychotherapy: Theory, Research and Practice 76, 237249.CrossRefGoogle ScholarPubMed
Ward, A, Ramsey, R, Turnbull, S, Benedettini, M, Treasure, J (2000). Attachment patterns in eating disorders: the past in the present. International Journal of Eating Disorders 28, 370376.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Whiteside, U, Chen, E, Neighbors, C, Hunter, D, Lo, T, Larimer, M (2007). Difficulties regulating emotions: do binge eaters have fewer strategies to modulate and tolerate negative affect? Eating Behaviors 8, 162169.CrossRefGoogle ScholarPubMed
Zonnevijlle-Bender, MJ, van Goozen, SH, Cohen-Kettenis, PT, van Elburg, A, van Engeland, H (2002). Do adolescent anorexia nervosa patients have deficits in emotional functioning? [Erratum]. European Child and Adolescent Psychiatry 11, 99.CrossRefGoogle Scholar
Zonnevylle-Bender, MJ, van Goozen, SH, Cohen-Kettenis, PT, van Elburg, A, de Wildt, M, Stevelmans, E, van Engeland, H (2004 a). Emotional functioning in anorexia nervosa patients: adolescents compared to adults. Depression and Anxiety 19, 3542.CrossRefGoogle ScholarPubMed
Zonnevylle-Bender, MJ, van Goozen, SH, Cohen-Kettenis, PT, van Elburg, TA, van Engeland, H (2004 b). Emotional functioning in adolescent anorexia nervosa patients – a controlled study. European Child and Adolescent Psychiatry 13, 2834.CrossRefGoogle ScholarPubMed
Zucker, NL, Losh, M, Bulik, CM, LaBar, KS, Piven, J, Pelphrey, KA (2007). Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychological Bulletin 133, 976–1006.CrossRefGoogle ScholarPubMed
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *