Misreading the facial signs: specific impairments and error patterns in recognition of facial emotions with negative valence in borderline personality disorder

Patients with borderline personality disorder (BPD) exhibit impairment in labeling of facial emotional expressions. However, it is not clear whether these deficits affect the whole domain of basic emotions, are valence-specific, or specific to individual emotions. Whether BPD patients' errors in a facial emotion recognition task create a specific pattern also remains to be elucidated. Our study tested two hypotheses: first, we hypothesized, that the emotion perception impairment in borderline personality disorder is specific to the negative emotion domain. Second, we hypothesized, that BPD patients would show error patterns in a facial emotion recognition task more commonly and more systematically than healthy comparison subjects. Participants comprised 33 inpatients with BPD and 32 matched healthy control subjects who performed a computerized version of the Ekman 60 Faces test. The indices of emotion recognition and the direction of errors were processed in separate analyses. Clinical symptoms and personality functioning were assessed using the Symptom Checklist-90-Revised and the Young Schema Questionnaire Long Form. Results showed that patients with BPD were less accurate than control participants in emotion recognition, in particular, in the discrimination of negative emotions, while they were not impaired in the recognition of happy facial expressions. In addition, patients over-attributed disgust and surprise and under-attributed fear to the facial expressions relative to controls. These findings suggest the importance of carefully considering error patterns, besides measuring recognition accuracy, especially among emotions with negative affective valence, when assessing facial affect recognition in BPD.     

Perception of emotions from faces and voices following unilateral brain damage

The importance of the right hemisphere in emotion perception in general has been well documented but its precise role is disputed. We compared the performance of 30 right hemisphere damaged (RHD) patients, 30 left hemisphere damaged (LHD) patients, and 50 healthy controls on both facial and vocal affect perception tasks of specific emotions. Brain damaged subjects had a single episode cerebrovascular accident localised to one hemisphere. The results showed that right hemisphere patients were markedly impaired relative to left hemisphere and healthy controls on test performance: labelling and recognition of facial expressions and recognition of emotions conveyed by prosody. This pertained at the level of individual basic emotions, positive versus negative, and emotional expressions in general. The impairment remained highly significant despite covarying for the group's poorer accuracy on a neutral facial perception test and identification of neutral vocal expressions. The LHD group were only impaired relative to controls on facial emotion tasks when their performance was summed over all the emotion categories and before age and other cognitive factors were taken into account. However, on the prosody test the LHD patients showed significant impairment, performing mid-way between the right hemisphere patients and healthy comparison group. Recognition of positive emotional expressions was better than negative in all subjects, and was not relatively poorer in the LHD patients. Recognition of individual emotions in one modality correlated weakly with recognition in another, in all three groups. These data confirm the primacy of the right hemisphere in processing all emotional expressions across modalities--both positive and negative--but suggest that left hemisphere emotion processing is modality specific. It is possible that the left hemisphere has a particular role in the perception of emotion conveyed through meaningful speech.     

Perception of facial expressions of emotion in bipolar disorder

OBJECTIVES: Some studies have reported deficits in the perception of facial expressions among depressed individuals compared with healthy controls, while others have reported negative biases in expression perception. We examined whether altered perception of emotion reflects an underlying trait-like effect in affective disorder by examining facial expression perception in euthymic bipolar patients. METHODS: Sensitivity to six different facial expressions, as well as accuracy of emotion recognition, was examined among 17 euthymic bipolar patients and 17 healthy controls using an interactive computer program. RESULTS: No differences were found between euthymic bipolar patients and controls in terms of sensitivity to any particular emotion. Although initial analysis of the data suggested impairment in the recognition of fear among the patients, identification of this emotion was not relatively impaired compared with that of the other emotions. CONCLUSIONS: The study did not find any conclusive evidence for trait-like deficits in the perception of facially conveyed emotions in bipolar disorder. Altered perception of facial expressions that has been found to accompany depressed mood may instead reflect mood-congruent biases.     

Perception of emotional facial expressions at different intensities in early-symptomatic Huntington's disease

BACKGROUND: While there is abundant evidence that patients with Huntington's disease (HD) have an impairment in the recognition of the emotional facial expression of disgust, previous studies have only examined emotion perception using full-blown facial expressions. OBJECTIVE: The current study examines the perception of facial emotional expressions in HD at different levels of intensity to investigate whether more subtle deficits can be detected, possible also in other emotions. METHOD: We compared early symptomatic HD patients with healthy matched controls on emotion perception, presenting short video clips of a neutral face changing into one of the six basic emotions (happiness, anger, fear, surprise, disgust and sadness) with increasing intensity. Overall face perception ability as well as depressive symptoms were taken into account. RESULTS: A specific impairment in recognizing the emotions disgust and anger was found, which was present even at low emotion intensities. CONCLUSION: These results extend previous findings and support the use of more sensitive emotion perception paradigms, which enable the detection of subtle neurobehavioral deficits even in the pre- and early symptomatic stages of the disease.     

Emotional perception deficits in amyotrophic lateral sclerosis.

OBJECTIVE: Cognitive deficits associated with frontal lobe dysfunction can occur in amyotrophic lateral sclerosis (ALS), particularly in individuals with bulbar ALS who can also suffer pathologic emotional lability. Because frontal pathophysiology can alter emotional perception, we examined whether emotional perception deficits occur in ALS, and whether they are related to depressive or dementia symptoms. METHODS: Bulbar ALS participants (n=13) and age-matched healthy normal controls (n=12) completed standardized tests of facial emotional and prosodic recognition, the Geriatric Depression Scale, and the Mini-Mental State Examination. Participants identified the basic emotion (happy, sad, angry, afraid, surprised, disgusted) that matched 39 facial expressions and 28 taped, semantically neutral, intoned sentences. RESULTS: ALS patients performed significantly worse than controls on facial recognition but not on prosodic recognition. Eight of 13 patients (62%) scored below the 95% confidence interval of controls in recognizing facial emotions, and 3 of these patients (23% overall) also scored lower in prosody recognition. Among the 8 patients with emotional perceptual impairment, one-half did not have depressive, or memory or cognitive symptoms on screening, whereas the remainder showed dementia symptoms alone or together with depressive symptoms. CONCLUSIONS: Emotional recognition deficits occur in bulbar ALS, particularly with emotional facial expressions, and can arise independent of depressive and dementia symptoms or comorbid with depression and dementia. These findings expand the scope of cognitive dysfunction detected in ALS, and bolsters the view of ALS as a multisystem disorder involving cognitive and also motor deficits.     

Social-emotion recognition in borderline personality disorder

Borderline personality disorder (BPD) is characterized by interpersonal disturbances, but the neurocognitive aspects of these symptoms are poorly understood. We hypothesized that patients with BPD have impaired perception of emotional expressions, which are related to symptoms of interpersonal dysfunction. To control potential confounding factors, this study excluded subjects with comorbid diagnoses known to be associated with impaired affect perception. We tested 43 outpatients with BPD and 26 healthy controls on emotion recognition tasks (facial, prosodic, and integrated facial/prosodic), nonemotional facial feature recognition, and interpersonal antagonism (Buss-Durkee Hostility Index). Patients with BPD showed normal ability to recognize isolated facial or prosodic emotions but had impaired recognition of emotions in integrated facial/prosodic stimuli, as well as impaired discrimination of nonemotional facial features. In patients with BPD, impaired recognition of integrated emotional stimuli was associated with interpersonal antagonism, particularly suspiciousness and assaultiveness. These results suggest that patients with BPD have deficits in higher order integration of social information, which may be related to some of the more serious symptoms of the disorder.     

Facial expression of emotions in borderline personality disorder and depression

Borderline personality disorder (BPD) is characterized by marked problems in interpersonal relationships and emotion regulation. The assumption of emotional hyper-reactivity in BPD is tested regarding the facial expression of emotions, an aspect highly relevant for communication processes and a central feature of emotion regulation. Facial expressions of emotions are examined in a group of 30 female inpatients with BPD, 27 women with major depression and 30 non-patient female controls. Participants were videotaped while watching two short movie sequences, inducing either positive or negative emotions. Frequency of emotional facial expressions and intensity of happiness expressions were examined, using the Emotional Facial Action Coding System (EMFACS-7, Friesen & Ekman, EMFACS-7: Emotional Facial Action Coding System, Version 7. Unpublished manual, 1984). Group differences were analyzed for the negative and the positive mood-induction procedure separately. Results indicate that BPD patients reacted similar to depressed patients with reduced facial expressiveness to both films. The highest emotional facial activity to both films and most intense happiness expressions were displayed by the non-clinical control group. Current findings contradict the assumption of a general hyper-reactivity to emotional stimuli in patients with BPD.     

Defective emotion recognition in early HD is neuropsychologically and anatomically generic

Huntington's disease (HD) is an inherited neurodegenerative disorder that classically presents with motor, cognitive and psychiatric symptoms. However, other abnormalities also occur in this condition, notably deficient recognition of facial emotional expressions. Deficits in emotion recognition impact significantly on the lives of HD patients and their families and thus it is important to clarify the onset and pattern of impairment. This study investigated facial emotion recognition in a large cohort of early HD patients, and premanifest gene-carriers. We used voxel-based morphometry (VBM) to examine the neuroanatomical correlates of emotion recognition performance. Forty patients with early HD, 21 premanifest gene carriers and 20 controls were assessed using 24 faces from the Ekman Pictures of Facial Affect, and volumetric brain MRI. The HD group was significantly worse than controls at recognising, surprise, disgust, anger and fear, and worse than the premanifest group at recognising disgust and anger. When patient data were expressed as z-scores, recognition of anger was significantly worse than disgust in the early HD group. In the VBM analysis, these deficits were associated with common regional atrophy: impaired recognition of surprise, disgust, anger and fear were all associated with striatal volume loss. Fear was associated with additional atrophy of the right insula and left and right lateral orbitofrontal cortex. Even in early HD there is a wide-ranging impairment in recognition of negative emotions denoting 'threat'. Our findings implicate a generic fronto-subcortical network in the pathogenesis of these emotion recognition deficits.     

Emotion recognition bias for contempt and anger in body dysmorphic disorder

Body dysmorphic disorder (BDD) patients are preoccupied with imagined defects or flaws in appearance (e.g., size or shape of nose). They are afraid of negative evaluations by others and often suffer significant morbidity including hospitalization and suicide attempts. Many patients experience ideas of reference, e.g., they often believe others take special notice of their "flaw". Facial expressions play an important role in conveying negative or positive feelings, and sympathy or rejection. In this study, we investigated emotion recognition deficits in 18 BDD patients and 18 healthy controls. Participants were presented with two questionnaires accompanying facial photographs. One questionnaire included self-referent scenarios ("Imagine that the bank teller is looking at you. What is his facial expression like?"), whereas the other one included other-referent scenarios ("Imagine that the bank teller is looking at a friend of yours," etc.), and participants were asked to identify the corresponding emotion (e.g., anger, contempt, neutral, or surprise). Overall, BDD patients, relative to controls, had difficulty identifying emotional expressions in self-referent scenarios. They misinterpreted more expressions as contemptuous and angry in self-referent scenarios than did controls. However, they did not have significantly more difficulties identifying emotional expressions in other-referent scenarios than controls. Thus, poor insight and ideas of reference, common in BDD, might be related to a bias for misinterpreting other people's emotional expressions as negative. Perceiving others as rejecting might reinforce concerns about one's personal perceived ugliness and social desirability.     

Major depressive disorder skews the recognition of emotional prosody

Objective

Major depressive disorder (MDD) is associated with abnormalities in the recognition of emotional stimuli. MDD patients ascribe more negative emotion but also less positive emotion to facial expressions, suggesting blunted responsiveness to positive emotional stimuli. To ascertain whether these emotional biases are modality-specific, we examined the effects of MDD on the recognition of emotions from voices using a paradigm designed to capture subtle effects of biases.

Methods

Twenty-one MDD patients and 21 healthy controls (HC) underwent clinical and neuropsychological assessments, followed by a paradigm featuring pseudowords spoken by actors in five types of emotional prosody, rated on continuous scales.

Results

Overall, MDD patients performed more poorly than HC, displaying significantly impaired recognition of fear, happiness and sadness. Compared with HC, they rated fear significantly more highly when listening to anger stimuli. They also displayed a bias toward surprise, rating it far higher when they heard sad or fearful utterances. Furthermore, for happiness stimuli, MDD patients gave higher ratings for negative emotions (fear and sadness). A multiple regression model on recognition of emotional prosody in MDD patients showed that the best fit was achieved using the executive functioning (categorical fluency, number of errors in the MCST, and TMT B-A) and the total score of the Montgomery-Asberg Depression Rating Scale.

Conclusions

Impaired recognition of emotions would appear not to be specific to the visual modality but to be present also when emotions are expressed vocally, this impairment being related to depression severity and dysexecutive syndrome. MDD seems to skew the recognition of emotional prosody toward negative emotional stimuli and the blunting of positive emotion appears not to be restricted to the visual modality.     

The contribution of semantic memory to the recognition of basic emotions and emotional valence: Evidence from the semantic variant of primary progressive aphasia

ABSTRACT

There is compelling evidence that semantic memory is involved in emotion recognition. However, its contribution to the recognition of emotional valence and basic emotions remains unclear. We compared the performance of 10 participants with the semantic variant of primary progressive aphasia (svPPA), a clinical model of semantic memory impairment, to that of 33 healthy participants using three experimental tasks assessing the recognition of: 1) emotional valence conveyed by photographic scenes, 2) basic emotions conveyed by facial expressions, and 3) basic emotions conveyed by prosody sounds. Individuals with svPPA showed significant deficits in the recognition of emotional valence and basic emotions (except happiness and surprise conveyed by facial expressions). However, the performance of the two groups was comparable when the performance on tests assessing semantic memory was added as a covariate in the analyses. Altogether, these results suggest that semantic memory contributes to the recognition of emotional valence and basic emotions. By examining the recognition of emotional valence and basic emotions in individuals with selective semantic memory loss, our results contribute to the refinement of current theories on the role of semantic memory in emotion recognition.     

Effects of diazepam on facial emotion recognition

OBJECTIVE: There have been few studies of the pharmacologic modulation of facial emotion recognition. The present study aimed to replicate and extend the finding that recognition of facial anger was selectively impaired by diazepam. The hypothesis was that, in comparison with placebo, diazepam would impair the recognition of facial anger in healthy volunteers, but not the recognition of 5 other basic emotions: happiness, surprise, fear, sadness and disgust. DESIGN: A randomized, counterbalanced, double-blind, placebo-controlled, within-subjects comparison of diazepam with placebo. SETTING: A university psychopharmacology research unit. PARTICIPANTS: Healthy male (n = 6) and female (n = 22) volunteers, aged 18-45 years. PROCEDURES: Subjects were tested on 2 tasks following the administration of diazepam, 15 mg, and placebo on separate occasions. In the first "multimorph" task, images of facial expressions were morphed to produce continua between the neutral and full expressions of 6 basic emotions. Accuracy and identification thresholds were assessed for stimuli in which the intensity of expression gradually increased. In the second "emotional hexagon" task, facial expressions were morphed between pairs of emotions. Single images were presented, and accuracy and speed of response were assessed. RESULTS: Diazepam produced broad impairments in response accuracy, recognition thresholds and response speed on the facial emotion tasks that were not limited to angry expressions. CONCLUSIONS: The present study found that diazepam, 15 mg, impaired facial emotion recognition, but not selectively. In the emotional hexagon task, a reaction-time analysis suggested that the identification of facial anger might be differentially sensitive to variations in stimulus duration, complicating the interpretation of this paradigm.     

Evidence for altered amygdala activation in schizophrenia in an adaptive emotion recognition task

Deficits in social cognition seem to present an intermediate phenotype for schizophrenia, and are known to be associated with an altered amygdala response to faces. However, current results are heterogeneous with respect to whether this altered amygdala response in schizophrenia is hypoactive or hyperactive in nature. The present study used functional magnetic resonance imaging to investigate emotion-specific amygdala activation in schizophrenia using a novel adaptive emotion recognition paradigm. Participants comprised 11 schizophrenia outpatients and 16 healthy controls who viewed face stimuli expressing emotions of anger, fear, happiness, and disgust, as well as neutral expressions. The adaptive emotion recognition approach allows the assessment of group differences in both emotion recognition performance and associated neuronal activity while also ensuring a comparable number of correctly recognized emotions between groups. Schizophrenia participants were slower and had a negative bias in emotion recognition. In addition, they showed reduced differential activation during recognition of emotional compared with neutral expressions. Correlation analyses revealed an association of a negative bias with amygdala activation for neutral facial expressions that was specific to the patient group. We replicated previous findings of affected emotion recognition in schizophrenia. Furthermore, we demonstrated that altered amygdala activation in the patient group was associated with the occurrence of a negative bias. These results provide further evidence for impaired social cognition in schizophrenia and point to a central role of the amygdala in negative misperceptions of facial stimuli in schizophrenia.     

A quantitative analysis of facial emotion recognition in obsessive–compulsive disorder

Obsessive–Compulsive Disorder (OCD) is characterized by persistent and unwanted obsessions generally accompanied by ritualistic behaviors or compulsions. Previous research proposed specific disgust facial emotion recognition deficits in patients with OCD. This research however, remains largely inconsistent. Therefore, the results of 10 studies contrasting facial emotion recognition accuracy in patients with OCD (n=221) and non-psychiatric controls (n=224) were quantitatively reviewed and synthesized using meta-analytic techniques. Patients with OCD were less accurate than controls in recognizing emotional facial expressions. Patients were also less accurate in recognizing negative emotions as a whole; however, this was largely due to significant differences in disgust and anger recognition specifically. The results of this study suggest that patients with OCD have difficulty recognizing specific negative emotions in faces and may misclassify emotional expressions due to symptom characteristics within the disorder. The contribution of state-related emotion perception biases to these findings requires further clarification.     

Facial perception bias in patients with major depression

This study used a morphed categorical perception facial expression task to evaluate whether patients with depression demonstrated deficits in distinguishing boundaries between emotions. Forty-one patients with depression and 41 healthy controls took part in this study. They were administered a standardized set of morphed photographs of facial expressions with varying emotional intensities between 0% and 100% of the emotion, in 10% increments to provide a range of intensities from pleasant to unpleasant(e.g. happy to sad, happy to angry) and approach-avoidance (e.g. angry to fearful). Compared with healthy controls, the patients with depression demonstrated a rapid perception of sad expressions in happy-sad emotional continuum and demonstrated a rapid perception of angry expressions in angry-fearful emotional continuum. In addition, when facial expressions shifted from happy to angry, the depressed patients had a clear demarcation for the happy-angry continuum. Depressed patients had a perceptual bias towards unpleasant versus pleasant expressions and the hypersensitivity to angry facial signals might influence the interaction behaviors between depressed patients and others.     

Hemispheric asymmetries and prosodic emotion recognition deficits in Parkinson's disease

While Parkinson's disease (PD) has traditionally been described as a movement disorder, there is growing evidence of cognitive and social deficits associated with the disease. However, few studies have looked at multi-modal social cognitive deficits in patients with PD. We studied lateralization of both prosodic and facial emotion recognition (the ability to recognize emotional valence from either tone of voice or from facial expressions) in PD. The Comprehensive Affect Testing System (CATS) is a well-validated test of human emotion processing that has been used to study emotion recognition in several major clinical populations, but never before in PD. We administered an abbreviated version of CATS (CATS-A) to 24 medicated PD participants and 12 age-matched controls. PD participants were divided into two groups, based on side of symptom onset and unilateral motor symptom severity: left-affected (N = 12) or right-affected PD participants (N = 12). CATS-A is a computer-based button press task with eight subtests relevant to prosodic and facial emotion recognition. Left-affected PD participants with inferred predominant right-hemisphere pathology were expected to have difficulty with prosodic emotion recognition since there is evidence that the processing of prosodic information is right-hemisphere dominant. We found that facial emotion recognition was preserved in the PD group, however, left-affected PD participants had specific impairment in prosodic emotion recognition, especially for sadness. Selective deficits in prosodic emotion recognition suggests that (1) hemispheric effects in emotion recognition may contribute to the impairment of emotional communication in a subset of people with PD and (2) the coordination of neural networks needed to decipher temporally complex social cues may be specifically disrupted in PD.     

Impaired facial emotion recognition and reduced amygdalar volume in schizophrenia

Structural abnormalities of the amygdala and impaired facial emotion recognition have been reported in schizophrenia. Most studies demonstrated reduced amygdalar volumes in schizophrenia patients, and difficulty in recognizing negative facial emotions has also been reported. However, findings on the deficit in facial emotion recognition have been inconsistent, and the relationships between this impairment and amygdalar volume reduction remain unclear. In this study, we investigated these relationships by performing volumetric analysis of the amygdala and evaluation of facial emotion recognition performance in the same subjects with schizophrenia. The sample group comprised 20 schizophrenia patients and 20 matched healthy controls. We measured the volumes of the amygdalae with high-resolution magnetic resonance imaging (MRI) at 3.0 Tesla. Additionally, we included a task that evaluated the subjects' ability to recognize the intensity of basic facial emotions. We found that impaired facial emotion recognition in schizophrenia patients is emotion-specific (sadness, surprise, disgust, and anger). Moreover, the volume of each amygdala on either side of the brain was reduced. Finally, we found a correlation between left amygdalar volume and the recognition of sadness in facial expressions. This study demonstrated that amygdala dysfunction may contribute to impaired facial emotion recognition in schizophrenia.     

Recognition of emotion from facial,prosodic and written verbal stimuli in Parkinson's disease

Although the basal ganglia are thought to be important in recognizing emotion, there is contradictory evidence as to whether patients with Parkinson's disease (PD) have deficits in recognizing facial expressions. In addition, few studies have examined their ability to recognize emotion from non-visual stimuli, such as voices. We examined the ability of PD patients and age-matched controls to recognize emotion in three different modalities: facial, prosodic, and written verbal stimuli. Compared to controls, PD patients showed deficits in recognizing fear and disgust in facial expressions. These impairments were not seen in their recognition of prosodic or written verbal stimuli. This modality-specific deficit suggests that the neural substrates for recognizing emotion from different modalities are not fully identical.     

An analysis of categorical perception of facial emotion in schizophrenia

BACKGROUND: Emotion perception deficits have been extensively documented in schizophrenia and are associated with poor social functioning. Yet fundamental questions about the nature and scope of these impairments remain unanswered from commonly used experimental tasks. An alternative categorical perception paradigm that focuses on distinguishing boundaries between emotions was used to evaluate whether schizophrenia patients demonstrate atypical patterns of categorical perception and a negativity bias in the identification of ambiguous facial expressions. METHOD: 47 schizophrenia outpatients and 31 nonpsychiatric controls completed a forced-choice emotion identification task. Stimuli consisted of a series of digitized facial images that were morphed in 10% signal intensity increments along continua between pairs of emotions (happy-sad; fearful-happy; angry-fearful; angry-sad) and presented in a random order. For each emotion continuum, measures of the response slope and the location of the boundary shift point between emotions were calculated for each group. RESULTS: The schizophrenia group demonstrated significantly shallower response curves than controls across all emotion continua. Despite these generally less precise demarcations between emotions, patients did not significantly differ from controls in the location of the shift point between emotions on any of the continua. CONCLUSIONS: Schizophrenia patients demonstrated impaired categorical perception of facial expressions with generally less sharp categorizations of ambiguous stimuli to one emotion category or another. However, patients did not demonstrate a negativity bias in their processing of ambiguous facial expressions. The emotional continuum paradigm can help to clarify the nature and boundaries of affect perception deficits in schizophrenia.     

Facial emotion recognition in myotonic dystrophy type 1 correlates with CTG repeat expansion

Objective

To investigate the ability of patients with myotonic dystrophy type 1 to recognise basic facial emotions. We also explored the relationship between facial emotion recognition, neuropsychological data, personality, and CTG repeat expansion data in the DM‐1 group.

Methods

In total, 50 patients with DM‐1 (28 women and 22 men) participated, with 41 healthy controls. Recognition of facial emotional expressions was assessed using photographs of basic emotions. A set of tests measured cognition and personality dimensions, and CTG repeat size was quantified in blood lymphocytes.

Results

Patients with DM‐1 showed impaired recognition of facial emotions compared with controls. A significant negative correlation was found between total score of emotion recognition in a forced choice task and CTG repeat size. Furthermore, specific cognitive functions (vocabulary, visuospatial construction ability, and speed) and personality dimensions (reward dependence and cooperativeness) correlated with scores on the forced choice emotion recognition task.

Conclusion

These findings revealed a CTG repeat dependent facial emotion recognition deficit in the DM‐1 group, which was associated with specific neuropsychological functions. Furthermore, a correlation was found between facial emotional recognition ability and personality dimensions associated with sociability. This adds a new clinically relevant dimension in the cognitive deficits associated with DM‐1.