Abstract
Previous work suggests people with anorexia nervosa (AN) display reduced facial expression of emotion. This may influence illness progression as blunted emotional reactions can negatively impact social relationships and increase isolation. The present study aimed to replicate and further build on previous findings by examining facial and brain responses to naturalistic, emotional films. In total, 141 women (71 AN/weight restored AN, 70 healthy comparison) completed two tasks in a fixed order: 1.) facial affect task and 2.) functional magnetic resonance imaging (fMRI) task. In both tasks, participants reacted to positive, neutral, and negative films, and rated their mood after each one. The effects of group and film category on facial expressions, brain responses, and mood ratings were examined. The AN group displayed reduced positive facial affect over time and lower self-reported mood in response to positive but not negative or neutral films. The fMRI task revealed no significant group differences in response to positive, neutral, or negative films. However, there was widespread activation of occipital, parietal, temporal, and frontal regions in response to the emotional films across groups. The behavioural findings replicate previously reported altered reactivity to positive films in AN. Additionally, task-related brain activation was observed in regions typically associated with the processing of naturalistic emotional stimuli, suggesting the task was valid. However, the lack of group differences during the fMRI task raises questions about whether the behavioural differences could be related to slower warming up to the task among those with AN.
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Acknowledgements
This research was funded in part by the Wellcome Trust [213578/Z/18/Z]. This research was supported by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC). KA is supported by the Medical Research Council grant no. MR/X030539/1 and the Medical Research Council/Arts and Humanities Research Council/Economic and Social Research Council Adolescence, Mental Health and the Developing Mind initiative as part of the EDIFY programme (grant no. MR/W002418/1).
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JL, KT, and SW contributed to Conceptualization. JL, KT, and KA contributed to Funding acquisition. OB, DH, KA, KT, and SW provided Resources. KT and SW provided Supervision. JL contributed to Investigation. JL and DH contributed to Formal analysis. JL Wrote the original draft. JL, OB, DH, KA, KT, and SW contributed to Writing – reviewing and editing.
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Leppanen, J., Bailey, O., Halls, D. et al. Evoked emotions in anorexia nervosa: neural and behavioural correlates of social-emotional processing. Transl Psychiatry (2026). https://doi.org/10.1038/s41398-026-03819-8
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DOI: https://doi.org/10.1038/s41398-026-03819-8
