Alexithymia, emotional empathy, and self-regulation in anorexia nervosa

Abstract

Background: Individuals with anorexia nervosa (AN) who are starved have poor awareness (alexithymia), reduced understanding of others' mental states (cognitive empathy), and difficulty regulating personal emotions (self-regulation). Despite its important role in social interaction, sympathy for others (emotional empathy) has not been measured in AN. Furthermore, it is unknown how restoring weight affects the relationship among alexithymia, empathy, and self-regulation in AN.

Methods: Women with AN were tested longitudinally during their starvation period (N = 26) and after weight was restored (N = 20) and compared with 16 age-matched healthy women. Alexithymia, empathy, and self-regulation were assessed with the Toronto Alexithymia Scale, the Interpersonal Reactivity Index, and items measuring self-regulation from the Minnesota Multiphasic Personality Inventory-2, respectively.

Results: Relative to comparison participants, individuals with AN during both starvation and weight restoration reported greater alexithymia and emotional empathy in one domain, personal distress (vicarious negative arousal to others' suffering). Among AN participants, personal distress was positively correlated with alexithymia and negatively correlated with self-regulation, when accounting for depression.

Conclusions: High levels of alexithymia and personal distress may be persistent features of AN because they do not resolve upon weight restoration. Greater personal distress in AN may be a function of poor emotional awareness and regulation.

Figure 1. Alexithymia in Participants with AN during Starvation and Weight Restoration Relative to Comparison Participants

Note. Alexithymia was measured by the Toronto Alexithymia Scale 20 (TAS-20) at Time 1 (the starvation phase of AN) and Time 2 (the weight restoration phase of AN) in participants with AN and healthy comparison participants. AN= participants with Anorexia Nervosa. HC= healthy comparison participants. Error bars reflect standard error.

Figure 2. Toronto Alexithymia Scale 20 Factor Scores in Participants with AN during Starvation and Weight Restoration Relative to Comparison Participants

Note. Alexithymia in AN during starvation (Time 1) and weight restoration (Time 2) relative to healthy comparison participants was measured by three factors from the Toronto Alexithymia Scale 20 (TAS-20) which are represented in the 3 panels: (2A) Factor 1: Difficulty Identifying Feelings—DIF, (2B) Factor 2: Difficulty Describing Feelings—DDF, and (2C) Factor 3: Externally Oriented Thinking—EOT. AN= participants with Anorexia Nervosa. HC= healthy comparison participants. Error bars reflect standard error.

Figure 3. Emotional Empathy in AN during Starvation and Weight Restoration Relative to Comparison Participants

Note. Emotional empathy was assessed by taking the average of the Empathic Concern and Personal Distress subscales for each participant on the Interpersonal Reactivity Index (IRI). This was measured at Time 1 (the starvation phase of AN) and Time 2 (the weight restoration phase of AN) in participants with AN and healthy comparison participants. AN= participants with Anorexia Nervosa. HC= healthy comparison participants. Error bars reflect standard error.

Figure 4. Poor Emotional Awareness/Regulation and Increased Emotional Empathy in Anorexia Nervosa

Note. TAS-20= Toronto Alexithymia Scale 20. MMPI-2= Minnesota Multiphasic Personality Inventory 2. IRI-PD= Interpersonal Reactivity Index, Personal Distress subscale.