Elsevier

Psychiatry Research

Volume 102, Issue 3, 24 July 2001, Pages 235-248
Psychiatry Research

Impaired emotional facial expression recognition in alcoholism compared with obsessive-compulsive disorder and normal controls

https://doi.org/10.1016/S0165-1781(01)00261-XGet rights and content

Abstract

Emotional facial expression (EFE) decoding skills have been shown to be impaired in recovering alcoholics (RA). The aim of the present study is to replicate these results and to explore whether these abnormalities are specific to alcoholism using two control groups: non-patient controls (NC) and patients with obsessive-compulsive disorder (OC). Twenty-two alcoholic patients at the end of their detoxification process (RA) were compared to 22 OC and 22 NC matched for age, sex and education level. They were presented with 12 photographs of facial expressions portraying different emotions: happiness; anger; and fear. Each emotion was displayed with mild (30%) and moderate (70%) intensity levels. Each EFE was judged on 8 scales labeled happiness, sadness, fear, anger, disgust, surprise, shame and contempt. For each scale, subjects rated the estimated intensity level. RA were less accurate in EFE decoding than OC and NC, particularly for anger and happiness expressions. RA overestimated the emotional intensity for mild intensity level expressions compared with both OC and NC while no significant differences emerged for moderate intensity level expressions. Deficits in EFE decoding skills seem to be specific to RA when compared with OC. Comparison with other psychopathological groups is still needed. Possible consequences of EFE decoding deficits in RA include distorted interpersonal relationships.

Introduction

Emotional facial expression (EFE) recognition has been shown to be severely impaired in recovering alcoholics (RA) (Philippot et al., 1999). RA made significantly more errors in identifying the emotion displayed by a face than non-patient controls, with a special bias toward overattribution of anger and contempt. RA also systematically overestimated the intensity of the emotions portrayed by the faces. Moreover, RA did not perceive this decoding deficit. These impairments seemed to remit only partially with abstinence (Kornreich et al., in press), as decoding biases for anger and disgust were present in mid- to long-term abstinent patients while intensity overestimation disappeared. Clinical implications of EFE recognition deficit could involve interpersonal relationship impairments since the decoding of non-verbal cues constitutes an essential process in normal communication and interaction regulation (Patterson, 1999).

The aim of the present study is to confirm our previous findings in RA and to explore if the observed decoding EFE pattern is specific to this population. Indeed, a major methodological consideration in alcoholism research involves the ability to show that an observed effect is specific to alcoholism. To demonstrate such specificity, alcoholics must differ on the studied dimension from control groups with other behavior problems as well as from ‘non-patient’ control groups (Sher et al., 1999). At this stage, two non-alcoholic control groups were therefore included in the present study, one with psychopathology, namely obsessive-compulsive disorder (OCD), and one with no psychopathology.

We chose an OCD control group because alcoholism and OCD display symptomatic similarities but do not share common etiologies. In particular, several investigators have noted similarities between urges and desires to abuse alcohol and OCD. Researchers in the field of alcoholism have characterized alcohol abusers as having a ‘compulsion’ to use alcohol (Edwards and Gross, 1976, Caetano, 1985, Modell et al., 1992, Roberts et al., 1999). It has also been suggested that the craving for alcohol seen in alcohol abusers resembles obsessive thought patterns (Modell et al., 1992, Anton et al., 1995). However, the life-time risk for OCD among close relatives of alcoholics is 1.4%, which does not support the existence of a common genotype for the two disorders (Schuckit et al., 1995). Therefore, OCD appears relevant as a psychopathological control group.

Section snippets

Participants

Twenty-two inpatients (9 men and 13 women), diagnosed with alcohol dependence according to DSM IV criteria (American Psychiatric Association, 1994) were recruited in the psychiatric ward of a large University Hospital in Brussels, Belgium, at the end of their detoxification process. They were in their third week of an in-patient stay and, hence, abstinent for 2–3 weeks. They were not receiving any psychotropic medication at the time of assessment.

Twenty-two outpatients suffering from OCD

Results

Statistical analyses did not reveal any significant correlation between depression or anxiety scores, on the one hand, and decoding accuracy or intensity scores, on the other hand. Therefore, it was not necessary to control for their effects (e.g. with analysis of covariance). Likewise, no main significant gender effect or interaction was observed. Therefore, all subsequent analyses were collapsed across these factors. Finally, for RA, and for OC, no significant correlation emerged between

Discussion

Our results show markedly reduced accuracy in EFE decoding in RA compared to OC and NC. The OC group obtained the same results as the NC group (see Fig. 2). The RA accuracy deficits were mostly seen for the 70%-intensity level EFE and for anger and happiness expressions but not for fear expressions. Regarding intensity estimation, results indicated different profiles between RA on the one hand and NC and OC on the other hand (see Fig. 3). This suggests that OCD patients and recovering

Acknowledgments

The study presented in this article has been made possible by grants from the ‘Fonds National de la Recherche Scientifique de Belgique’ FNRS 3.4613.01.

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