Patients Feel Emotions Intensely But Can Struggle to See Them in Others

People with multiple sclerosis (MS) have more difficulty recognizing emotions in others, and they experience emotions more intensely than healthy people, a small study found.

The study, “Emotional experience is increased and emotion recognition decreased in multiple sclerosis,” was published in Scientific Reports.

Emotions are essential for human connection and form the basis of a person’s social life. But people with MS often experience emotional disorders, such as bursting into laughter or tears for no apparent reason or being unable to accurately perceive emotions in others.

These symptoms, thought to derive from the brain damage due to the disease, carry social consequences that raise the risk for depression among patients.

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Understanding the emotional deficits of MS patients is key to developing therapeutic approaches, but it remains unclear whether patients are only unable to perceive others’ emotions or whether their response to those emotions is also altered.

To find out, a team based at the University of Strasbourg, France, and the French National Centre for Scientific Research examined the emotion recognition and experience in a group of 25 right-handed women with relapsing-remitting MS (RRMS) receiving interferon beta treatment. They compared their findings with those of age- and education level-matched healthy women serving as a control group.

The researchers used the Florida Affect Battery (FAB) to assess facial and emotion recognition in the two groups. FAB includes four subtests designed to evaluate how participants perceive happiness, sadness, anger, fear, and neutral emotions, as well as an additional non-emotional part of facial identification that is used to make sure participants do not have perceptive difficulties.

The emotional subtests include Facial Affect Discrimination, which determines whether two faces are expressing the same emotions; Facial Affect Naming, which requires that participants name emotions based upon pictures of the emotion; Facial Affect Selection, which involves selecting target facial expressions named by the examiner; and Facial Affect Matching, a test that requires matching the picture of an emotional face to another face with the same emotional expression.

In the non-emotion part of FAB, MS patients and controls scored similarly, indicating that neither group had perceptive difficulties or facial blindness. However, in the emotional subtests, patients provided significantly fewer correct answers than the control participants.

In particular, MS patients scored significantly worse in the Selection and Matching subtests, while the Discrimination and Naming subtests showed no significant difference between the groups.

However, MS patients had more difficulty discriminating between anger and neutral expressions and between anger and sadness in the Discrimination subtests.

They also made more errors with neutral faces, which were often perceived as an emotion in the Selection and Matching subtests. Additionally, MS patients incorrectly interpreted fear as anger.

“It seems likely that MS patients may have a specific impairment in analysing, identifying, and differentiating between emotional expressions, leading them to see emotion in neutral faces,” the researchers wrote.

The researchers then used the International Affective Picture System (IAPS) to evaluate patients’ emotions when faced with a picture known to elicit a specific emotional response in viewers. The IAPS database includes about 700 pictures, such as a woman at the beach, a basket, or a burn victim, and patients are asked to rate their experienced emotion both in valence (positive, negative, or neutral) and in arousal (calm to intense).

Results showed that MS group scores were more scattered, meaning more variety throughout the group, than those of the control group. This was true in terms of valence for positive, negative, and neutral pictures, but only for positive and negative pictures in terms of arousal.

Overall, results indicated that patients experienced the emotions more intensely than did controls, as they rated positive pictures as more positive/pleasant than the controls and negative pictures more negative/unpleasant.

In terms of arousal, the negative pictures were often rated as more intense by the MS patients than the controls.

These findings indicate that “MS subjects have a perturbation of their emotional experience,” the team wrote.

Additional tests demonstrated that scores on emotional FAB subtests were independent of the emotional experience reported by patients. However, these two emotional dimensions were each correlated with executive functions, such as attention. No correlation was found between disease characteristics — its severity and duration — and emotional disorders.

“In conclusion, patients with MS have difficulties in identifying emotions in other people and their emotional experience appears more scattered, with a global exacerbation of their emotional response,” the team wrote.

Since MS patients in this group were at an early stage of the disease, with few motor or cognitive defects, the researchers suggest that these emotional disorders could be “a central symptom of this pathology, present from the first stages of the disease.”