Visual Attention to Ambiguous Emotional Faces in Eating Disorders: Role of Alexithymia

Eating disorders (EDs) are often accompanied by social–emotional problems. Recently, alexithymia has been suggested to explain objective emotion processing deficits in EDs. We tested if elevated levels of alexithymia may explain emotional face-processing problems in a mixed ED group (N = 24, 19 with anorexia and five with bulimia), comparing them with high-alexithymic (N = 25) and low-alexithymic healthy controls (N = 25). Participants judged the mixture ratio of clear and ambiguous facial emotion blends while eye movements were recorded. The ED group was less accurate judging ambiguous blends containing anger or disgust and attended less to the faces compared with low-alexithymic controls. Reduced attention to faces, in particular the eye region, was linked to confusion with ambiguous anger and disgust in the ED group only. Although significant group differences only emerged compared with low-alexithymic controls, the visual attention patterns underlying the ED group's problems with subtle anger and disgust expressions were not driven by alexithymia.