Looking in the Mirror: Vocal Arousal and Affective Reactions during Mirror Exposure in Women with Anorexia Nervosa and Bulimia Nervosa

Objectives : Although mirror exposure improves treatment outcomes in women with eating disorders, it remains uncertain how the cognitive, emotional, and physiological reactions evoked by this technique differ between women with anorexia nervosa and women with bulimia nervosa. Moreover, it is unclear whether vocal arousal is a psychophysiological correlate of these reactions and how the specific emotions elicited by looking at one’s body change during mirror exposure. Methods : Thus, a total of N = 136 women ( n = 39 with anorexia nervosa, n = 24 with bulimia nervosa, and n = 73 healthy controls) first underwent a non-activating baseline, followed by a mirror exposure condition with the task to freely describe aloud arising thoughts and feelings towards their body. Self-reported arousal, emotional valence, and specific emotions were assessed before, in the middle of, and after each condition. Furthermore, we analyzed fundamental frequency ( f 0 ) as a marker of vocally encoded emotional arousal. Results : Women with both forms of eating disorder showed stronger increases in self-reported arousal and equally high levels of f 0 in contrast to women without eating disorders. Fear increased in all women, while guilt, hostility, and sadness only increased in women with eating disorders. Conclusion : In sum, findings suggest heightened emotional activation and vocal arousal evoked by mirror exposure, particularly in women with eating disorders. In mirror exposure therapy, addressing varied body-related emotions alongside fear might enhance therapeutic success.