Alcoholism leads to early perceptive alterations, independently of comorbid depressed state: an ERP study.

INTRODUCTION: Alcoholism is associated with a deficit in the processing of emotional facial expressions (EFE) and with a delayed P3b component, partially mediated by earlier perceptive deficits (P100, N170). Since alcohol dependence often occurs with depression, we aim at investigating whether classical event-related potentials (ERP) alterations observed in alcoholism are modulated or not by depression. METHODS: Four groups (controls; alcoholics; depressed; alcoholics-depressed) of 12 participants performed two different discrimination tasks, a gender and an emotional one. They had to decide as quickly as possible about the gender or the emotion displayed by facial stimuli during an ERP recording session (32 channels). Reaction times (RTs), P100, N100, N170 and P3b were recorded. RESULTS: At the behavioural level, control participants discriminated EFE (but not gender) more rapidly than the three other groups. At the ERP level, the differences observed on RTs for emotional task were neurophysiologically indexed by a delayed P3b component. This delay was associated with earlier ERP alterations (P100, N100, N170), but only in participants suffering from alcohol dependence, in association or not with depression. DISCUSSION: On the one hand, individuals with alcoholism, associated or not with a comorbid depression, were impaired in the processing of EFE. This deficit was neurophysiologically indexed by early perceptive (P100, N100, N170) and decisional (P3b) alterations. On the other hand, non-alcoholic patients with depression only exhibited P3b impairment. These results lead to potential implications concerning the usefulness of the ERP for the differential diagnosis in psychiatry, notably concerning the comorbidities in alcoholism.     

Effect of impaired recognition and expression of emotions on frontocingulate cortices: an fMRI study of men with alexithymia

OBJECTIVE: Although the brain areas involved in emotional response and in the recognition of others' emotions have been reported, the neural bases of individual differences in affective style remain to be elucidated. Alexithymia, i.e., impairment of the ability to identify and communicate one's emotional state, influences how emotions are regulated. Alexithymia has been hypothesized to involve anterior cingulate dysfunction. Therefore, the authors searched for differential cerebral regional activation in response to emotional stimuli in subjects with alexithymia. METHOD: Two groups of eight men each were selected from 437 healthy subjects on the basis of high or low scores on the 20-item Toronto Alexithymia Scale. Using functional magnetic resonance imaging (fMRI), the authors compared the two groups for their regional cerebral activation in response to the presentation of pictures with validated positive or negative arousal capabilities. RESULTS: Men with alexithymia demonstrated less cerebral activation in the left mediofrontal-paracingulate cortex in response to highly negative stimuli and more activation in the anterior cingulate, mediofrontal cortex, and middle frontal gyrus in response to highly positive stimuli than men without alexithymia. CONCLUSIONS: These findings provide direct evidence that alexithymia, a personality trait playing a role in affect regulation, is linked with differences in anterior cingulate and mediofrontal activity during emotional stimuli processing.     

Gender differences in the association between alexithymia and emotional eating in obese individuals

OBJECTIVE: Women have been reported to use more emotion-regulation strategies than do men and to have more abilities to regulate their emotions in a different way. The aim of the present study was to examine gender differences in the relationships of alexithymia, negative mood, and the combination of alexithymia and negative mood with emotional eating in obese persons. METHODS: Four hundred thirteen obese individuals [343 females and 70 males, aged 18-60 years, mean=43.6 years, body mass index (BMI)=38.4+/-6.6 kg/m2] completed self-report questionnaires, including the Symptom Checklist-90 (SCL-90) questionnaire, the Dutch Eating Behavior Questionnaire (DEBQ), and the Toronto Alexithymia Scale (TAS). RESULTS: Hierarchical regression analysis showed a significant interaction between gender and alexithymia. More difficulty in identifying or describing feelings was specifically associated with more emotional eating in men. CONCLUSION: These findings suggest that alexithymia is more strongly involved in emotional eating of obese men than women. This offers indications for designing gender-specific treatments for emotional eating among obese persons.     

Sex differences in brain activation to emotional stimuli: a meta-analysis of neuroimaging studies

Substantial sex differences in emotional responses and perception have been reported in previous psychological and psychophysiological studies. For example, women have been found to respond more strongly to negative emotional stimuli, a sex difference that has been linked to an increased risk of depression and anxiety disorders. The extent to which such sex differences are reflected in corresponding differences in regional brain activation remains a largely unresolved issue, however, in part because relatively few neuroimaging studies have addressed this issue. Here, by conducting a quantitative meta-analysis of neuroimaging studies, we were able to substantially increase statistical power to detect sex differences relative to prior studies, by combining emotion studies which explicitly examined sex differences with the much larger number of studies that examined only women or men. We used an activation likelihood estimation approach to characterize sex differences in the likelihood of regional brain activation elicited by emotional stimuli relative to non-emotional stimuli. We examined sex differences separately for negative and positive emotions, in addition to examining all emotions combined. Sex differences varied markedly between negative and positive emotion studies. The majority of sex differences favoring women were observed for negative emotion, whereas the majority of the sex differences favoring men were observed for positive emotion. This valence-specificity was particularly evident for the amygdala. For negative emotion, women exhibited greater activation than men in the left amygdala, as well as in other regions including the left thalamus, hypothalamus, mammillary bodies, left caudate, and medial prefrontal cortex. In contrast, for positive emotion, men exhibited greater activation than women in the left amygdala, as well as greater activation in other regions including the bilateral inferior frontal gyrus and right fusiform gyrus. These meta-analysis findings indicate that the amygdala, a key region for emotion processing, exhibits valence-dependent sex differences in activation to emotional stimuli. The greater left amygdala response to negative emotion for women accords with previous reports that women respond more strongly to negative emotional stimuli, as well as with hypothesized links between increased neurobiological reactivity to negative emotion and increased prevalence of depression and anxiety disorders in women. The finding of greater left amygdala activation for positive emotional stimuli in men suggests that greater amygdala responses reported previously for men for specific types of positive stimuli may also extend to positive stimuli more generally. In summary, this study extends efforts to characterize sex differences in brain activation during emotion processing by providing the largest and most comprehensive quantitative meta-analysis to date, and for the first time examining sex differences as a function of positive vs. negative emotional valence. The current findings highlight the importance of considering sex as a potential factor modulating emotional processing and its underlying neural mechanisms, and more broadly, the need to consider individual differences in understanding the neurobiology of emotion.     

De la non-expression à la surexpression des émotions ou comment l’expérience émotionnelle repose la question des liens entre sexe, alexithymie et répression

Objectives

Alexithymia, considered as a disorder of affect regulation, is well known for its consequences on the vulnerability to negative emotions, but nevertheless it raises the question of the repressive dimension according to Myers’ (1995) and Newton and Contrada’s (1994) researches. If, under certain conditions, alexithymia refers to this dimension we should observed traces of this repressive behaviour on emotional distress. We thus studied the influence of alexithymia scores on trait anxiety, state anxiety and depression, and this relatively to the gender of the participants.

Methodology

We first compared the mean scores of distress of our three groups of subjects (low alexithymia, N = 32; moderate alexithymia, N = 62, high alexithymia, N = 33) with the norms of the general population. Secondly, we studied the consequences of alexithymia intensity on depressive symptoms, trait and state anxiety, with regard to the gender differences. We used 1) the State-Trait Anxiety Inventory (Spielberger) to assess dispositional and acute anxiety, 2) the Center for Epidemiological Scale for Depression (Radloff) to evaluate depressive symptomatology and 3) the Toronto Alexithymia Scale (Bagby) for the alexithymia construct.

Results

In the lower alexithymia group, the total mean scores of depression for men or women (men: 8.06 ± 7.06; women: 8.88 ± 6.84) were significantly lower than those in the general population (men: 12.73 ± 3.02; women: 13.97 ± 3.62). We obtained the same pattern of consequences of a low alexithymia with regard to trait anxiety (men: 32.73 ± 10.20 versus 41.86 ± 9.48; women: 37.17 ± 8.48 versus 45.09 ± 11.11). Finally, there was no difference between the lower alexithymia group mean scores and the general population references, regardless of gender. In addition, in our group of women, the higher the alexithymia mean scores, the more important were the depression (F(2,68) = 21.13, P ≤ 0.000), trait anxiety (F(2,68) = 12.51, P ≤ 0.000) and state anxiety (F(2,68) = 6.72, P ≤ 0.002) mean scores. The male participants did not show a particular vulnerability to the alexithymia intensity, except for trait anxiety in the moderate condition (t(43) = -2.30, P ≤ 0.026).

Conclusion

Our results support the reality of the emotional repression in the condition of lower alexithymia and raise the question of the links between alexithymia and gender. Indeed, emotional experience follows different and surprising ways, inviting us to think about the relevance of a differentiation of the type of alexithymia according to whether one is a man or a woman.     

ERP evidence for a sex-specific Stroop effect in emotional speech

The present study investigated the interaction of emotional prosody and word valence during emotional comprehension in men and women. In a prosody-word interference task, participants listened to positive, neutral, and negative words that were spoken with a happy, neutral, and angry prosody. Participants were asked to rate word valence while ignoring emotional prosody, or vice versa. Congruent stimuli were responded faster and more accurately as compared to incongruent emotional stimuli. This behavioral effect was more salient for the word valence task than for the prosodic task and was comparable between men and women. The event-related potentials (ERPs) revealed a smaller N400 amplitude for congruent as compared to emotionally incongruent stimuli. This ERP effect, however, was significant only for the word valence judgment and only for female listeners. The present data suggest that the word valence judgment was more difficult and more easily influenced by task-irrelevant emotional information than the prosodic task in both men and women. Furthermore, although emotional prosody and word valence may have a similar influence on an emotional judgment in both sexes, ERPs indicate sex differences in the underlying processing. Women, but not men, show an interaction between prosody and word valence during a semantic processing stage.     

Sex-related lateralized effect of emotional content on declarative memory: an event related potential study

Several studies suggest that emotional arousal can promote memory storage. In this study, we evaluated the effects of emotional content on declarative memory, utilizing an adaptation of two versions of the same story, with different arousing properties (neutral or emotional), which have been already employed in experiments involving the enhancing effects of emotions on memory retention. We used event related potentials (ERP) to evaluate whether there is a sex-related hemispheric lateralization of electrical potentials elicited by the emotional content of a story. We compared left and right hemisphere P300 waves, recorded in P3 and P4 electrode sites, in response to emotional or neutral stimuli in men and women. In the left hemisphere, emotional stimuli elicited a stronger P300 in women, compared to men, as indexed by both amplitude and latency measures; moreover, the emotional content of the story elicited a stronger P300 in the right hemisphere in men than in women. The better memory for the arousal material may be related to the differential P300 at encoding. These data indicate that both sex and cerebral hemisphere constitute important, interacting influences on neural correlates of emotion, and of emotionally influenced memory.     

Le changement psychologique d’hommes auteurs de violences conjugales après leur thérapie en groupe de responsabilisation

ObjectivesThe aim of our research was to examine the association between impulsivity, alexithymia and depression and the perpetration of physical and psychological intimate partner violence. We focused on these particular psychological characteristics in order to understand this phenomenon and its prevention and/or treatment. Our initial study of fifty-six male perpetrators showed domestic violence was associated with a high level of alexithymia and depression. Analyses showed they reported more depressive feelings, and more difficulties to express their emotions than did general population. To determine if reductions were noted about these psychological characteristics at the end of intervention program, the present study examined longitudinal data.Patients and methodsTwenty-four male offenders (voluntary or judicialized) were surveyed using self-report questionnaires and structured clinical interview to collect sociodemographic data and to assess specific psychological variables, namely emotional distress (Beck Depression Inventory), impulsive behavior (Barratt Impulsivity Scale 11) and alexithymia (Toronto Alexithymia Scale 20), the inability to experience and express subjective emotions. These men were examined before the start of therapeutic program (T1) and at the end of it (T2), after 42 hours of psychological support.ResultsFindings showed both alexithymia and depression were reduced after therapeutic management. Analyses showed male intimate partner violence offenders reported less difficulty to express their emotions and less depressive feelings at the end of their intervention program. However, we only observe a significant result for alexithymia and its dimension “difficulties identifying feelings”. Impulsivity, on the other side, remains unchanged between the two evaluation times for all participants after the therapeutic program.ConclusionOur findings suggested a strong link between alexithymia and domestic violence and showed the positive effect of specific therapeutic interventions on alexithymia and depression. We pointed out the fact that with the decrease of alexithymia, participants may have a better awareness of themselves and of their behavior. In conclusion, it is encouraging to note that specific treatment programs increase awareness about the problem of intimate partner violence.     

Cognitive and psychosocial correlates of alexithymia following traumatic brain injury

Changes in emotional and social behaviour are considered to be amongst the most common and debilitating consequences of traumatic brain injury (TBI). Little is known of the effects of TBI on alexithymia, which refers to impairment in aspects of understanding emotions. In the current study TBI patients (N=28) were compared with demographically matched healthy controls (N=31) on the Toronto Alexithymia Scale-20 (TAS-20), a measure that taps three distinct characteristics of the alexithymia concept; difficulty in identifying emotions, difficulty in describing emotions and externally oriented thinking. Patients and controls also completed measures of anxiety, depression, quality of life, and measures of fluency to assess executive function. Patients showed greater levels of alexithymia, in terms of difficulty identifying emotions and reduced introspection. Difficulty in identifying emotions was associated with poorer quality of life, even when depression and anxiety were controlled. Difficulty in identifying emotions was also uniquely associated with executive function deficits. Thus, although studies typically focus on aspects of cognitive change following head injury, these results lend support to Becerra et al.'s (Becerra, R., Amos, A., & Jongenelis, S. (2002). Organic alexithymia: a study of acquired emotional blindness. Brain Injury, 16, 633-645.) notion of an 'organic alexithymia', and suggest that more attention should be focused upon assessment of emotional change post-head injury.     

Individual differences in alexithymia and brain response to masked emotion faces

Alexithymia is considered a dimensional personality trait that refers to a cluster of deficits in the recognition, differentiation, and verbalization of emotions. Research on the neurobiology of alexithymia has focused hitherto on impairments in the controlled processing of emotional information. In the present study automatic brain reactivity to facial emotion was investigated as a function of alexithymia (as assessed by the 20-Item Toronto Alexithymia Scale - TAS-20). During 3 T fMRI scanning, pictures of sad, happy, and neutral facial expression masked by neutral faces were presented to 33 healthy women. A priori regions of interest in the whole brain analysis were cerebral structures that are known to be crucially involved in the emotion perception from the face. Independently from trait anxiety and depression TAS-20 alexithymia was negatively correlated with activation to masked sad and happy faces in several regions of interest (in particular, insula, superior temporal gyrus, middle occipital and parahippocampal gyrus). In addition, the TAS-20 score was negatively correlated with response of the left amygdala to masked sad faces. A reduced automatic reactivity of the amygdala and visual occipito-temporal areas could implicate less automated engagement in the encoding of emotional stimuli in high alexithymia. In addition, a low spontaneous insular and amygdalar responsivity in high alexithymia individuals could be related to an attenuation of basic emotional experiences which may contribute to problems in identifying and differentiating one's feelings.     

Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain

The aim of this study was to examine independent and combined influences of alexithymia and anxiety sensitivity on chest pain and life interference in patients with non-cardiac chest pain (NCCP). Theories of NCCP posit a central role for emotion in the experience of chest pain, however, studies have not examined how alexithymia characterized by a difficulty identifying or verbalizing emotions, may influence this relationship. This study examined 231 patients (56% females, M age = 50 years) with chest pain seeking cardiac evaluation, who showed no abnormalities during exercise tolerance testing. Forty percent (40%) scored at or above the moderate range of alexithymia. Whereas health care utilization was associated with elevated alexithymia among men, health care utilization was associated with elevated anxiety sensitivity among women. Hierarchical regression analyses revealed that alexithymia and anxiety sensitivity were both uniquely and independently associated with pain severity and life interference due to pain. Alexithymia-pain links were stronger for men compared to women. Secondary analyses conducted with a subsample suggest that alexithymia may be increasingly stable over time (i.e., 18-month follow-up). Findings are largely congruent with theoretical models of NCCP showing that personality and emotional factors are important in this medically unexplained syndrome.     

On the role of attention for the processing of emotions in speech: sex differences revisited

In a previous cross-modal priming study [A. Schirmer, A.S. Kotz, A.D. Friederici, Sex differentiates the role of emotional prosody during word processing, Cogn. Brain Res. 14 (2002) 228-233.], we found that women integrated emotional prosody and word valence earlier than men. Both sexes showed a smaller N400 in the event-related potential to emotional words when these words were preceded by a sentence with congruous compared to incongruous emotional prosody. However, women showed this effect with a 200-ms interval between prime sentence and target word whereas men showed the effect with a 750-ms interval. The present study was designed to determine whether these sex differences prevail when attention is directed towards the emotional content of prosody and word meaning. To this end, we presented the same prime sentences and target words as in our previous study. Sentences were spoken with happy or sad prosody and followed by a congruous or incongruous emotional word or pseudoword. The interval between sentence offset and target onset was 200 ms. In addition to performing a lexical decision, participants were asked to decide whether or not a word matched the emotional prosody of the preceding sentence. The combined lexical and congruence judgment failed to reveal differences in emotional-prosodic priming between men and women. Both sexes showed smaller N400 amplitudes to emotionally congruent compared to incongruent words. This suggests that the presence of sex differences in emotional-prosodic priming depends on whether or not participants are instructed to take emotional prosody into account.     

Impact of childhood trauma, alexithymia, dissociation, and emotion suppression on emotional Stroop task

Objective

Attentional bias to emotion- and illness-related information plays a prominent role in many mental disorders, particularly major depressive disorder and anxiety disorders. Using the emotional Stroop task we investigated which variables beyond aspects of patients' psychopathology might influence reaction times and interference in the Stroop test.

Methods

We investigated 82 psychosomatic inpatients and 39 healthy controls. Diagnosis of depressive disorders, anxiety disorders, and somatoform disorders were established using the Structured Clinical Interview for DSM-IV. Severity of depression, anxiety, somatic symptoms, as well as experiences of childhood trauma, alexithymia, dissociation and emotion suppression were assessed via questionnaires. The emotional Stroop test was performed by using neutral and negative words, words related to depression, anxiety and somatization, respectively, and individually chosen words, which were related to the main problems of the participants.

Results

In multivariate regression analyses, reaction times were best predicted by self-reported experiences of childhood trauma. Interference, by contrast, was predicted by emotion suppression, but only for negative words, anxiety-related words and individually relevant words. Against our hypothesis, measurements of psychopathology were not associated with Stroop performance.

Conclusions

The present study provides further support for the idea that the experience of childhood trauma influences adult neuropsychological performance. Furthermore, the findings suggest that the ability to suppress emotions may be an important predictor of attentional bias.     

Alexithymia in long-term survivors of childhood cancer

Objective: To investigate the incidence of alexithymia (difficulties in describing or recognizing one's own emotions, a limited fantasy life, and general constriction in the affective life) in a group of childhood cancer survivors and to explore medical determinants which predict alexithymia. Methods: Five years after completing therapy, 72 participants were asked to complete the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Results: Male cancer survivors scored significantly lower on overall alexithymia compared to healthy males. They also showed higher ability to fantasize, a higher emotional arousal, and were better able to verbalize their emotional reactions. The female survivors did not show differences compared to the normal female population. No medical determinant was associated with alexithymia. Conclusions: Stress due to childhood cancer does not affect the alexithymia scores of females. However, male cancer survivors score less alexithymic than age matched controls.     

Co-occurrence of Axis I and Axis II disorders in female and male patients with panic disorder with agoraphobia

Objective

The aim of this study is to compare female and male patients with panic disorder with agoraphobia (PDA) for the co-occurring Axis I and Axis II (personality) disorders, to better understand sex differences in PDA.

Methods

The Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders, Clinician Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders were administered to 157 consecutive outpatients (112 females and 45 males) with principal diagnosis of PDA, who sought treatment at the 2 anxiety disorders clinics. Women and men with PDA were then compared with regard to the type and frequency of the co-occurring Axis I and Axis II disorders.

Results

Women with PDA had a statistically greater tendency to receive co-occurring Axis I diagnoses and a greater number of Axis I diagnoses than men. Such a difference was not found for personality disorders. However, no sex difference was found for the mean number of co-occurring Axis I and Axis II diagnoses per patient. There were significantly more women with at least one co-occurring anxiety disorder. Women had a significantly higher frequency of specific phobia, whereas men were diagnosed with hypochondriasis and past alcohol abuse or dependence significantly more often. With regard to Axis II disorders, the only significant sex difference pertained to the higher frequency of dependent personality disorder among women.

Conclusions

The results of this study suggest that there are more similarities than differences between sexes in the co-occurring Axis I and Axis II disorders. Still, the relatively specific relationships between PDA and excessive alcohol use in men and between PDA and dependent personality traits and personality disorder in women seem important and have implications for clinical practice and treatment.     

Gender-specific association of alexithymia and norepinephrine/cortisol ratios. A preliminary report

OBJECTIVE: Alexithymia and posttraumatic stress disorder (PTSD) might share a neuroendocrine pattern characterized by increased urinary norepinephrine (N) and decreased cortisol (C) levels, resulting in a high N/C ratio, at least among male alcoholics. We aimed to explore if this association can also be found in other populations. METHODS: Twenty-four-hour urine samples were obtained from 12 major depressive disorder (MDD) patients and 23 healthy controls (HC) and tested for N and free C. Participants completed the 20-item Toronto Alexithymia Scale (TAS) and the Symptom Check List (SCL). RESULTS: Controlling for depression, the neuroendocrine parameters did not differ between the MDD and HC participants nor between women and men. The TAS was not associated with N, C or the N/C ratio in the MDD and HC participants nor in females alone. However, in men, the N/C ratio correlated significantly with the TAS (r = .80). CONCLUSIONS: Our preliminary findings indicate that alexithymia is associated with an increased noradrenergic activity and a decreased basal activity of the hypothalamic-pituitary-adrenal (HPA) axis among men. This gender difference may reflect divergent underlying neurobiological processes of alexithymia in men and women.     

Régulation des émotions, dépression et conduites à risques : l’alexithymie, un facteur modérateur

The repetitive involvement in risk-taking behaviour is a major cause of somatic damage or accidents in adolescents and young adults. Previous research points out the importance of psychological factors such as personality variables and cognitive-emotional functioning. In this field, relationships between risk-taking, anxiety and depression have been well-established. However, few studies take into account emotion-regulation processes as implicated in risk-taking. According to Bonnet et al. (2003), risk-taking behaviours are similar to those of coping strategies for subjects maintaining a homeostatic state. Another perspective considers risk-taking as a consequence of an emotional processing deficit, a trait called alexithymia. Following this hypothesis, the aim of this study was to test a) differences between risk-takers and non risk-takers in depressive disorder and alexithymic functioning, b) relations between emotional functioning, depression and risk-taking. Two groups were formed from a sample of 259 subjects, aged from 18 to 25: an RT group (Risk-Taking, N = 123), and an NRT group (Non Risk-Taking, N = 136). Participants completed a risk-taking questionnaire (elaborated by the authors especially for this study), the Toronto Alexithymia Scale (TAS-20) and the Center for Epidemiologic Studies Depression Scale (CES-D). Our results show significant differences between the two groups: risk-takers seem to present more depressive symptoms than controls (P < 0.0001), and to be more alexithymic (P < 0.0001). Strong correlations (from 0.59 to 0.44) were found between alexithymia, depression and risk-taking behaviours. Finally in a model explaining 43% of the variance of risk-taking behaviours (R² = 0.43; F(3.258) = 66.103, P < 0.0001), multiple regression shows that alexithymia and depression might be risk factors for such conducts. There may be several interpretations of our results. In the first one, alexithymia could be considered as a part of a general depressive syndrome, which may be at the origin of the problematic behaviours. In this case, risk-taking would be used in order to diminish or suppress negative emotions. But this interpretation is not satisfying, because both depression and alexithymia have similar effects on risk-taking, and because we have been able to propose a statistical model in which alexithymia is a variable that explains depressive symptoms. These remarks lead us to consider alexithymia as a moderating variable, which allows subjects to avoid negative emotions, which cannot be processed. This process maintains risk-takers in a depressive state that they try to treat using risk-taking behaviours as illusory attempts to avoid negative feelings. Finally, limits and need for further research are discussed. In conclusion, our results point out the importance of emotional variables in the study and treatment of subjects involved in risk-taking behaviour.     

Facial emotion recognition in schizophrenia: when and why does it go awry?

OBJECTIVE: Schizophrenia patients demonstrate impaired emotional processing that may be due, in part, to impaired facial emotion recognition. This study examined event-related potential (ERP) responses to emotional faces in schizophrenia patients and controls to determine when, in the temporal processing stream, patient abnormalities occur. METHOD: 16 patients and 16 healthy control participants performed a facial emotion recognition task. Very sad, somewhat sad, neutral, somewhat happy, and very happy faces were each presented for 100 ms. Subjects indicated whether each face was "Happy", "Neutral", or "Sad". Evoked potential data were obtained using a 32-channel EEG system. RESULTS: Controls performed better than patients in recognizing facial emotions. In patients, better recognition of happy faces correlated with less severe negative symptoms. Four ERP components corresponding to the P100, N170, N250, and P300 were identified. Group differences were noted for the N170 "face processing" component that underlies the structural encoding of facial features, but not for the subsequent N250 "affect modulation" component. Higher amplitude of the N170 response to sad faces was correlated with less severe delusional symptoms. Although P300 abnormalities were found, the variance of this component was explained by the earlier N170 response. CONCLUSION: Patients with schizophrenia demonstrate abnormalities in early visual encoding of facial features that precedes the ERP response typically associated with facial affect recognition. This suggests that affect recognition deficits, at least for happy and sad discrimination, are secondary to faulty structural encoding of faces. The association of abnormal face encoding with delusions may denote the physiological basis for clinical misidentification syndromes.     

Childhood abuse, alexithymia and personality disorder

I examined the relationships among childhood abuse, alexithymia, and personality disorder. Participants were 60 adults who were receiving outpatient psychotherapy. Both the participants and their therapists used the Toronto Alexithymia Scale to provide independently information concerning the client's level of alexithymia. The therapists provided information concerning DSM-III-R personality disorder diagnoses, and participants completed portions of the Personality Diagnostic Questionnaire—Revised. Information concerning childhood abuse history was obtained from the therapists. As expected, childhood abuse, alexithymia, and personality disorder were all associated with each other. The abilities to identify and communicate emotions were differentially associated with childhood abuse and personality disorder.