Teens with PTSD, Conduct Disorder May Misinterpret Facial Expressions

Teens with symptoms of post-traumatic stress disorder (PTSD) are more likely to misinterpret sad and angry facial expressions as fearful, while teens with symptoms of conduct disorder tend to see sad faces as angry, according to a new study by researchers at the Steinhardt School of Culture, Education, and Human Development at New York University (NYU).

“Our findings suggest that exposure to stress and trauma can have acute emotional impacts that simply translate to misidentification of important affective cues,” said Dr. Shabnam Javdani, assistant professor of applied psychology at NYU Steinhardt, who led the study with Dr. Naomi Sadeh of the University of Delaware.

Teens who have experienced trauma are at greater risk for both PTSD and conduct disorder, behavioral, and emotional problems characterized by callousness or aggression towards others.

These conditions often co-occur and can have a significant impact on the well-being and healthy development of adolescents. If left untreated, these disorders increase the risk of substance use, mental health problems, and harm to oneself or others.

Prior research has shown that young people with PTSD and conduct disorder symptoms have impaired emotional processing which is often associated with aggressive behavior and poor social functioning. These interpersonal problems may be linked to the misinterpretation of social cues conveyed through facial expressions.

For the study, the researchers examined how young people with PTSD and conduct disorder symptoms processed facial expressions. The study involved 371 teens (aged 13-19) with emotional and behavioral problems who were enrolled in therapeutic day schools in Chicago or Providence, R.I.

After completion of a structured diagnostic assessment, 85 percent of the teen participants were found to have at least one conduct disorder symptom, and 30 percent met the criteria for a diagnosis of conduct disorder. Also, 17 percent of the teens had at least one PTSD symptom, and 12.4 percent met the criteria for a PTSD diagnosis. Overall, 17 percent of those studied had symptoms of both PTSD and conduct disorder.

Next the teens completed a facial affect recognition task. In general, youth with emotional and behavioral problems had more trouble correctly identifying angry faces compared to fearful or sad faces. In particular, teens with higher levels of PTSD symptoms were more likely to mistake sad and angry emotions for fear.

“Fear is particularly relevant for understanding PTSD, as the disorder has been associated with a ‘survival mode’ of functioning characterized by an overactive fight-or-flight response and increased threat perception,” said Javdani.

In contrast, teens with conduct disorder did not have trouble recognizing angry or fearful faces, but had a harder time recognizing sad expressions. In fact, they were more likely to misinterpret sad faces as angry faces. This suggests that teens with higher levels of conduct disorder may be less effective at recognizing others’ sadness, pain, and suffering.

“Difficulty interpreting displays of sadness and misidentifying sadness as anger may contribute to the impaired affective bonding, low empathy, and callous behavior observed in teens with conduct disorder,” said Javdani.

The researchers believe that enhancing the accuracy of recognizing facial expressions may be an important treatment goal for youth with symptoms of PTSD and conduct disorder.

The findings are published in the journal Child and Adolescent Mental Health.

Source: New York University