Recognition of facial expressions in obsessive–compulsive disorder

https://doi.org/10.1016/j.janxdis.2007.01.003Get rights and content

Abstract

Sprengelmeyer et al. [Sprengelmeyer, R., Young, A. W., Pundt, I., Sprengelmeyer, A., Calder, A. J., Berrios, G., et al. (1997). Disgust implicated in obsessive–compulsive disorder. Proceedings of the Royal Society of London, 264, 1767–1773] found that patients with OCD showed severely impaired recognition of facial expressions of disgust. This result has potential to provide a unique window into the psychopathology of OCD, but several published attempts to replicate this finding have failed. The current study compared OCD patients to normal controls and panic disorder patients on ability to recognize facial expressions of negative emotions. Overall, the OCD patients were impaired in their ability to recognize disgust expressions, but only 33% of patients showed this deficit. These deficits were related to OCD symptom severity and general functioning, factors that may account for the inconsistent findings observed in different laboratories.

Introduction

Accurate recognition of facial expressions is a critical element of humans’ social structure (Ekman, 1992), serving as a guide for social behaviour. Even toddlers gain important information from the facial expressions of others (La Barbera, Izard, Vietze, & Parisi, 1976; Sorce, Emde, Campos, & Klinnert, 1985; Young-Browne, Rosenfeld, & Horowitz, 1977). Adults across various cultures recognize six basic facial expressions of emotion: anger, disgust, fear, happiness, sadness, and surprise (Ekman, Levenson, & Friesen, 1983; Ekman, Sorenson, & Friesen, 1969; Izard, 1971), a finding that is reliable across numerous procedural variations (Boucher & Carlson, 1980; Izard, 1971).

Despite this apparent universal ability, individuals with some forms of psychopathology are impaired in their recognition of facial expressions, although the specific quality and meaning of these deficits is still poorly understood. Researchers have documented abnormalities in facial expression recognition in alcoholism (Kornreich et al., 2001a, Kornreich et al., 2001b), Alzheimer's disease (Hargrave, Maddock, & Stone, 2002), anorexia nervosa (Zonnevijlle-Bendek, van Goozen, Cohen-Kettenis, van Elburg, & van Engeland, 2002), bipolar disorder (Ketter & Lembke, 2002), criminal psychopathy (Kosson, Suchy, Mayer, & Libby, 2002), social phobia (Simonian, Beidel, Turner, Berkes, & Long, 2001), major depression (Rubinow & Post, 1992), schizophrenia (Addington & Addington, 1998; Archer, Hay, & Young, 1992; Heimberg, Gur, Erwin, Shtasel, & Gur, 1992), and obsessive–compulsive disorder (Sprengelmeyer et al., 1997), the subject of this investigation.

Even in the case of depression and schizophrenia, which have been more extensively studied, the precise nature of the deficits is unclear. Some studies report generally impaired recognition of facial expressions among those with major depression (Persad & Polivy, 1993) or schizophrenia (Lewis & Garver, 1995), which would suggest that the impairments reflect a general deficit in face processing or overall neurocognitive functioning, rather than expression recognition per se (Addington & Addington, 1998; Bryson, Bell, & Lysaker, 1997; Kerr & Neale, 1993). More typically, however, results point to problematic recognition of specific facial expressions in depression (Mikhailova, Vladimirova, Iznak, Tsusulkovskaya, & Sushko, 1996; Rubinow & Post, 1992) and schizophrenia (Davis & Gibson, 2000; Dougherty, Bartlett, & Izard, 1974; Kucharska-Pietura & Klimkowski, 2002; Muzekari & Bates, 1977; Walker, Marwit, & Emory, 1980). Notably, in a study with normal undergraduates, Rozin, Taylor, Ross, Bennette, and Hejmadi (2005) observed wide variability across participants in general ability to classify emotions depicted in facial expression but no evidence of individual differences in specific recognition deficits.

Although affect recognition deficits have been observed in both schizophrenia and depression, the findings show important differences with potential clinical implications. The impairments in the recognition of facial expressions are more severe in schizophrenia than in depression (Feinberg, Rifkin, Schaffer, & Walker, 1986; Heimberg et al., 1992). Impairment in affect recognition appears to improve upon symptom remission in depression (Mikhailova et al., 1996) but not in schizophrenia (Addington & Addington, 1998; Gaebel & Woelwer, 1992), although the deficits predict poor treatment outcome in depression (Geerts & Bouhuys, 1998).

In the case of obsessive–compulsive disorder (OCD), researchers have speculated that disgust may play a role in some forms of the disorder, particularly contamination-based types (Phillips, Senior, Fahy, & David, 1998a; Power & Dalgleish, 1997; Woody & Teachman, 2000). In 1997, Sprengelmeyer et al. tested 12 participants with OCD (primarily checking symptoms), 12 with Tourette's Syndrome (five of whom also showed prominent obsessive–compulsive behaviours), 8 anxiety disorder controls, and 40 normal controls on two tasks of facial expression recognition. OCD patients showed a marked deficit in recognition of disgust expressions and normal performance on expressions of anger, fear, happiness, sadness, and surprise. Intriguingly, Tourette's patients with prominent obsessive–compulsive behaviours demonstrated the disgust recognition impairment, while those without obsessive–compulsive behaviours did not. Sprengelmeyer et al. included a control task to rule out reluctance to choose the label “disgust” on the part of individuals with OCD.

The findings presented by Sprengelmeyer et al. (1997) have attracted attention not only for their pattern of results but also for their magnitude. Every individual with OCD was impaired in the recognition of disgust, whereas no participant without clinically significant obsessive–compulsive behaviours showed this impairment. Moreover, OCD patients showed specific impairment in the recognition of disgust, rather than a general pattern of poor performance on the task. Some observers have suggested that the effect may occur only among a subset of individuals with OCD—perhaps those with contamination concerns (Power & Dalgleish, 1997; Woody & Tolin, 2002). Other researchers have pointed to brain functioning in OCD, with imaging results thus far pointing toward the basal ganglia and anterior insula (Phillips, Young et al., 1998; Phillips et al., 1997; Sprengelmeyer, Rausch, Eysel, & Przuntek, 1998).

Despite the unusually strong effect observed by Sprengelmeyer and his colleagues, no other research team has replicated the result. Parker, McNally, Nakayama, and Wilhelm (2004) used procedures that were very close to those used by Sprengelmeyer, with the addition of new models for the facial expressions. They found no overall differences in performance between the OCD and normal control groups. Buhlmann, McNally, Etcoff, Tuschen-Caffier, and Wilhelm (2004) reported similar performance for individuals with OCD and normal controls on a recognition task of prototypical emotional expressions. Although Rozin et al. (2005) used a normal sample, they conducted an analysis examining 26 individuals who scored in the clinical range on the Obsessive Compulsive Inventory (Foa, Kozak, Salkovskis, Coles, & Amir, 1998). These individuals actually recognized disgust expressions better than did participants with lower scores.

The Sprengelmeyer et al. (1997) study was intriguing, but without replication it simply remains mysterious. Several of the replication attempts described above were underpowered by ordinary standards, although the initial Sprengelmeyer results yielded such large effects that even very small samples would be expected to replicate them. Parker et al. (2004) raised one interesting clue. Although they failed to replicate the overall results, Parker et al. described one individual, the most severe OCD patient in the sample, who showed marked impairment in recognition of disgust, suggesting that severity of OCD may be an important element of the effect.

Unfortunately, severity of symptoms was not detailed in the Sprengelmeyer et al. (1997) study. The study also provided little information on other diagnostic issues such as how diagnosis was determined, which comorbid conditions were present, or types of OCD symptoms beyond checking. The present study aimed to replicate the Sprengelmeyer et al. finding, using a sample of individuals with OCD who were seeking treatment in anxiety specialty clinics as well as adding methodological controls such as structured clinical interviews for diagnosis and symptom severity assessment. Because individuals with depression show deficits in the recognition of facial expressions of emotion, we also examined the role of comorbid depression.

Although we adhered closely to the method presented by Sprengelmeyer et al. in many ways, we changed the stimuli to test the robustness of the finding. This study used two models (one male and one female) from the Ekman and Friesen (1976) set, neither of which was the one used by Sprengelmeyer et al. The most common error for Sprengelmeyer's OCD participants was to select anger in place of disgust when naming facial expressions, an error also observed in normal samples (Ekman & Friesen, 1976; Rozin et al., 2005). The Sprengelmeyer et al. stimuli were prepared by morphing each facial expression with two others to increase the difficulty of the task. In the case of disgust stimuli, the expression was morphed with anger or sadness, but not fear. Stimuli in the current study included all possible morphed combinations of disgust, anger, fear and sadness although only the prototypical facial expressions were analyzed.

Section snippets

Participants

Three different samples were tested. Individuals with primary OCD (n = 40) and those with primary panic disorder (n = 36) were recruited from anxiety disorder specialty clinics in Vancouver, Canada and Hartford, Connecticut. On the basis of an initial evaluation with a structured clinical interview, clinical participants with a primary diagnosis of OCD or panic disorder (without history of OCD) were invited to participate in the study.

Many OCD patients also met criteria for major depression

Results

The primary question of interest in this study was whether OCD patients differ from those with panic and from normal controls in their ability to recognize facial expressions of disgust. Frequency of correct facial expression identifications was tabulated for each participant, across trials for each of the four pure facial expressions. Hit rate was the dependent variable in 3 × 4 repeated measures ANOVA, with one within-subjects factor (stimulus expression: anger, disgust, fear, and sadness) and

Discussion

OCD patients were significantly less accurate at recognizing facial expressions of disgust as compared to the normal and panic disorder comparison groups. OCD patients were also significantly less accurate in recognizing disgust in comparison to their recognition of three other negative emotions. These results supported the initial hypotheses but are contrary to two published failures to replicate these deficits among patients with OCD (Buhlmann et al., 2004, Parker et al., 2004). Given the

Acknowledgements

This research was supported in part by a grant to the second author from the Social Sciences and Humanities Research Council of Canada. We would like to thank Wolfgang Linden and Mark Schaller for their helpful comments on an earlier version of this manuscript, which served as the first author's master's thesis. Finally, we gratefully acknowledge the assistance of the late James Grossman, who prepared the stimuli.

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      Some studies also use morphed faces (i.e., two emotions in a single face) either as filler stimuli to increase task difficulty (e.g., Corcoran, Woody, & Tolin, 2008), or to evaluate recognition accuracy for ambiguous faces (e.g., Sprengelmeyer et al., 1997). Results have been mixed, with some studies identifying significant deficits in disgust recognition (e.g., Sprengelmeyer et al., 1997), some showing no differences in disgust recognition (e.g., Bozikas et al., 2009), some demonstrating deficits, but only among certain subsets of people with OCD (Corcoran et al., 2008), and others demonstrating a perceptual bias for disgust in ambiguous faces (Jhung et al., 2010). A recent meta-analysis (Daros et al., 2014) demonstrated that people with OCD generally show reduced recognition of facial expressions overall and negative facial expressions specifically, compared to people without OCD, with the greatest effects for disgust and anger.

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