Are you angry at me? Negative interpretations of neutral facial expressions are linked to child maltreatment but not to posttraumatic stress disorder

Figures & data

Table 1. Participants’ characteristics.

	PTSD (N = 39)		TC (N = 44)		HC (N = 35)
	N	%	N	%	N	%	Group comparisons^b
Female gender	29	74	15	66	9	74	ns
Interpersonal trauma	29	74	14	32	0	0	PTSD > TC^a
Type II trauma (long-lasting/repeated)	25	64	5	11	0	0	PTSD > TC^a
	M	SD	M	SD	M	SD
Age	38.7	12.8	36.5	12.0	36.6	10.2	ns
School years	11.4	2.6	12.1	3.3	12.4	3.3	ns
BDI^c	24.5	8.8	3.3	3.3	2.6	5.0	PTSD > TC^a, PTSD > HC^a
PDS^d	36.3	8.7	8.7	7.1	-	-	PTSD > TC^a
CTQ^e emotional abuse	13.5	6.6	6.7	3.1	6.8	3.1	PTSD > TC^a, PTSD > HC^a
CTQ physical abuse	9.8	5.3	6.2	2.5	5.4	0.9	PTSD > TC^a, PTSD > HC^a
CTQ sexual abuse	15.2	8.3	6.2	3.1	5.3	0.9	PTSD > TC^a, PTSD > HC^a
CTQ emotional neglect	16.9	5.5	11.3	5.2	9.6	4.5	PTSD > TC^a, PTSD > HC^a
CTQ physical neglect	9.9	3.8	7.0	2.7	6.2	1.5	PTSD > TC^a, PTSD > HC^a
NOET^f	3.5	1.6	2.0	1.0	-	-	PTSD > TC^a
TAS-20^g	56.2	12.4	37.2	8.1	37.4	8.7	PTSD > TC^a, PTSD > HC^a
RSDI^h	3.5	4.8	0.30	0.8	0.3	1.0	PTSD > TC^a, PTSD > HC^a

^ap < .001

^bPTSD: Posttraumatic stress disorder; TC: Traumatized healthy controls

HC: Non-traumatized healthy controls; ns: not significant

^cBDI: Beck Depression Inventory

^dPDS: Posttraumatic Diagnostic Scale (modified according to DSM-5)

^eCTQ: Childhood Trauma Questionnaire

^fNOET: Number of experienced trauma types

^gTAS-20: Toronto Alexithymia Scale

^hRSDI: Responses to Script-Driven Imagery Scale

Table 2. Recognition accuracy of neutral expressions: Model fit (AIC) and effect statistics (Z score, P-values, odds ratios) for models with alternate grouping variables (GVs).

DV	GV	AIC	Z	P	PH	1-β	OR, 95% CI
ACC	Diagnostic group	635.30	−1.42	0.155	1.000	0.35	0.71 [0.44, 1.14]
	CTQ sexual abuse	624.20	−3.39	0.001	0.010*	0.90	0.46 [0.29, 0.72]
	CTQ physical neglect	630.79	−2.57	0.010	0.090	0.69	0.56 [0.36, 0.87]
	CTQ emotional abuse	632.67	−2.17	0.030	0.240	0.55	0.61 [0.39, 0.95]
	Interpersonal	635.08	−1.21	0.225	1.000	0.18	0.76 [0.48, 1.19]
	CTQ physical abuse	635.34	−1.43	0.153	1.000	0.34	0.72 [0.46, 1.13]
	CTQ emotional neglect	635.97	−1.18	0.237	1.000	0.28	0.75 [0.47, 1.21]
	NOET	636.02	0.90	0.368	1.000	0.12	1.25 [0.77, 2.05]
	TAS	636.48	−1.17	0.242	1.000	0.27	0.76 [0.47, 1.21]
	RSDI	636.64	0.73	0.464	1.000	0.09	1.18 [0.76, 1.85]
DV	GV	AIC	T	P	PH	1-β	D, 95% CI
RT	Diagnostic group	1711.03	0.86	0.392	1.000	0.15	0.18 [−0.22, 0.57]
	CTQ emotional neglect	1702.28	2.66	0.009	0.089	0.84	0.48 [0.10, 0.85]
	CTQ emotional abuse	1705.74	2.15	0.034	0.305	0.69	0.38 [0.01, 0.75]
	CTQ physical neglect	1705.76	2.13	0.035	0.305	0.76	0.39 [0.01, 0.76]
	CTQ physical abuse	1706.79	1.95	0.054	0.376	0.69	0.36 [−0.02, 0.72]
	CTQ sexual abuse	1707.27	1.78	0.078	0.470	0.20	0.36 [−0.03, 0.74]
	TAS	1708.59	−1.57	0.119	0.596	0.48	−0.29 [−0.66, 0.08]
	RSDI	1709.37	−1.40	0.165	0.659	0.38	−0.27 [−0.67, 0.13]
	NOET	1711.03	0.86	0.391	1.000	0.16	0.18 [−0.22, 0.58]
	interpersonal	1711.37	0.72	0.471	1.000	0.12	0.14 [−0.24, 0.52]

DV = dependent variable

ACC = response accuracy

RT = reaction time

Bold = better model fit than diagnostic model

GV = Grouping variable

CQT = Childhood Trauma Questionnaire

NOET = number of traumatic events

TAS-20 = Toronto Alexithymia Scale

RSDI = Responses to Script-Driven Imagery Scale

P = Probability under H₀

P_H = Bonferroni-holm corrected probability under H₀

_* = P_H < .050

OR = Odds ratio

D = Cohen’s d

CI = confidence interval

1-β = statistical power

Odds ratios/Cohen’s ds refer to the comparisons between the groups with the highest and lowest traumatic burden, alexithymia or dissociation (e.g. PTSD vs HC, high CTQ vs. low CTQ, high alexithymia vs. low alexithymia, high dissociation vs. low dissociation)

Table 3. Confusions of neutral with other emotional expressions: Effect statistics (Z score, P-values, odds ratios) for the standard model and models with better model fit.

Stimulus	Response	GV	Z	P	PH	1-β	OR, 95% CI
Neutral	Anger	Diagnostic group	1.47	0.142	0.284	0.32	1.97 [0.80, 4.89]
		CTQ sexual abuse	3.07	0.002	0.011*	0.83	3.37 [1.55, 7.33]
		CTQ physical neglect	2.94	0.003	0.013*	0.85	3.44 [1.51, 7.85]
		CTQ emotional abuse	1.79	0.073	0.219	0.44	2.13 [0.93, 4.85]
		interpersonal	−1.05	0.295	0.295	0.18	0.57 [0.20, 1.63]
Neutral	Contempt	Diagnostic group	1.69	0.091	0.183	0.42	2.36 [0.87, 6.42]
		CTQ sexual abuse	2.97	0.003	0.015*	0.86	2.97 [1.45, 6.09]
		CTQ physical neglect	2.77	0.006	0.022*	0.78	2.76 [1.35, 5.66]
		CTQ emotional abuse	2.46	0.014	0.042*	0.74	2.51 [1.21, 5.23]
		interpersonal	0.58	0.563	0.563	0.10	1.35 [0.49, 3.72]
Neutral	Fear	Diagnostic group	−0.47	0.639	1.000	0.09	0.82 [0.35, 1.90]
		CTQ sexual abuse	1.32	0.185	0.742	0.34	1.65 [0.79, 3.47]
		CTQ physical neglect	0.24	0.812	1.000	0.07	1.10 [0.52, 2.32]
		CTQ emotional abuse	0.71	0.478	1.000	0.11	1.30 [0.63, 2.70]
		interpersonal	−1.84	0.066	0.331	0.40	0.40 [0.15, 1.06]
Neutral	Sadness	Diagnostic group	0.75	0.456	0.912	0.10	1.35 [0.62, 2.94]
		CTQ sexual abuse	1.67	0.095	0.474	0.46	1.62 [0.92, 2.84]
		CTQ physical neglect	1.35	0.178	0.534	0.28	1.49 [0.83, 2.67]
		CTQ emotional abuse	1.58	0.113	0.474	0.34	1.59 [0.90, 2.82]
		interpersonal	0.74	0.46	0.912	0.11	1.33 [0.62, 2.84]
Neutral	Shame	Diagnostic group	−2.22	0.026	0.131	0.55	0.33 [0.12, 0.88]
		CTQ sexual abuse	0.42	0.673	0.958	0.08	1.21 [0.50, 2.88]
		CTQ physical neglect	−1.78	0.075	0.224	0.43	0.47 [0.21, 1.08]
		CTQ emotional abuse	−1.99	0.046	0.186	0.48	0.44 [0.20, 0.99]
		interpersonal	−0.71	0.479	0.958	0.06	0.73 [0.30, 1.76]
Neutral	Disgust	Diagnostic group	0.08	0.935	1.000	0.00	1.07 [0.22, 5.31]
		CTQ sexual abuse	1.46	0.143	0.572	0.18	2.96 [0.69, 9.63]
		CTQ physical neglect	1.86	0.063	0.317	0.25	4.73 [0.92, 0.00]
		CTQ emotional abuse	0.31	0.757	1.000	0.08	1.25 [0.31, 5.01]
		interpersonal	−1.27	0.205	0.616	0.08	0.24 [0.03, 2.17]
Neutral	Surprise	Diagnostic group	−0.33	0.741	1.000	0.02	0.82 [0.25, 2.67]
		CTQ sexual abuse	1.03	0.303	1.000	0.19	1.79 [0.59, 5.41]
		CTQ physical neglect	0.7	0.485	1.000	0.10	1.49 [0.48, 4.60]
		CTQ emotional abuse	−0.39	0.694	1.000	0.06	0.80 [0.26, 2.46]
		interpersonal	−0.64	0.524	1.000	0.08	0.54 [0.08, 3.60]
Neutral	Joy	Diagnostic group	0.77	0.443	1.000	0.07	1.54 [0.51, 4.59]
		CTQ sexual abuse	−0.4	0.689	1.000	0.05	0.80 [0.26, 2.41]
		CTQ physical neglect	−0.58	0.563	1.000	0.10	0.73 [0.24, 2.15]
		CTQ emotional abuse	−1.23	0.22	1.000	0.21	0.53 [0.19, 1.47]
		interpersonal	−0.78	0.438	1.000	0.14	0.53 [0.11, 2.62]
Neutral	Pride	Diagnostic group	−1.04	0.301	1.000	0.06	0.41 [0.07, 2.23]
		CTQ sexual abuse	0.19	0.847	1.000	0.17	1.15 [0.29, 4.60]
		CTQ physical neglect	−0.4	0.687	1.000	0.01	0.78 [0.23, 2.67]
		CTQ emotional abuse	1.67	0.094	0.471	0.13	3.14 [0.82, 9.02]
		interpersonal	−0.6	0.549	1.000	0.05	0.63 [0.14, 2.83]

GV = Grouping variable

CQT = Childhood Trauma Questionnaire

P = Probability under H₀

P_H = Bonferroni-holm corrected probability under H₀

*p < .05

1-β = statistical power

OR = Odds ratio

CI = confidence interval

Effect statistics and Odds ratios refer to the comparisons between the groups with the highest and lowest traumatic burden (e.g. PTSD vs HC, high CTQ vs. low CTQ)

Figure 1. Confusions in diagnostic groups and for groups based on CTQ-subscales sexual abuse, physical neglect, and emotional abuse. Error bars indicate standard errors (calculated on link level and transformed back to response level). Neutral expressions were mistaken as pride or disgust in so few cases that models could not be fitted.

*P_H < .050

Table A1. Group sizes for model fit comparisons.

GV	Group descriptions	N1	N2
Diagnostic group	HC/TC vs. PTSD	77	37
CTQ sexual abuse	low vs. high	73	41
CTQ physical neglect	low vs. high	62	52
CTQ emotional abuse	low vs. high	57	57
interpersonal	no trauma or non-interpersonal trauma vs. interpersonal trauma	73	41
CTQ physical abuse	low vs. high	62	52
CTQ emotional neglect	low vs. high	55	59
NOET	0,1 or 2 vs. 3 or more	79	35
TAS-20	low vs. high	55	59
RSDI	low vs. high	80	34

Bold = better model fit than diagnostic model

GV = Grouping variable

CQT = Childhood Trauma Questionnaire

NOET = number of traumatic events

TAS-20 = Toronto Alexithymia Scale

RSDI = Responses to Script-Driven Imagery Scale

Table A2. Confusions of other emotional expressions with neutral: Effect Statistics (Z score, P-values, odds ratios) for the Standard Model and Models with better Model Fit.

Stimulus	Response	GV	Z	P	PH	1-β	OR [95% CI]
Anger	Neutral	Diagnostic group	−0.05	0.962	1.000	0.07	0.99 [0.58, 1.69]
		CTQ sexual abuse	−0.70	0.485	1.000	0.14	0.84 [0.51, 1.37]
		CTQ physical neglect	0.09	0.927	1.000	0.04	1.02 [0.65, 1.59]
		CTQ emotional abuse	−1.46	0.145	0.723	0.29	0.73 [0.48, 1.12]
		interpersonal	0.57	0.569	1.000	0.08	1.14 [0.72, 1.81]
Contempt	Neutral	Diagnostic group	−1.04	0.300	0.300	0.17	0.78 [0.49, 1.25]
		CTQ sexual abuse	−1.88	0.060	0.238	0.45	0.70 [0.48, 1.01]
		CTQ physical neglect	−1.59	0.113	0.238	0.29	0.75 [0.53, 1.07]
		CTQ emotional abuse	−2.16	0.030	0.152	0.55	0.68 [0.48, 0.96]
		interpersonal	−1.80	0.071	0.238	0.36	0.67 [0.43, 1.04]
Fear	Neutral	Diagnostic group	1.41	0.158	0.633	0.27	1.86 [0.79, 4.38]
		CTQ sexual abuse	2.39	0.017	0.085	0.68	2.36 [1.17, 4.78]
		CTQ physical neglect	−0.23	0.821	1.000	0.07	0.91 [0.42, 1.99]
		CTQ emotional abuse	0.57	0.566	1.000	0.10	1.23 [0.60, 2.53]
		interpersonal	1.21	0.228	0.683	0.24	1.76 [0.70, 4.40]
Sadness	Neutral	Diagnostic group	0.15	0.881	1.000	0.04	1.05 [0.57, 1.93]
		CTQ sexual abuse	−0.13	0.895	1.000	0.06	0.96 [0.56, 1.66]
		CTQ physical neglect	−0.55	0.581	1.000	0.08	0.86 [0.52, 1.45]
		CTQ emotional abuse	−0.87	0.384	1.000	0.17	0.80 [0.48, 1.32]
		interpersonal	1.18	0.237	1.000	0.22	1.42 [0.79, 2.55]
Shame	Neutral	Diagnostic group	0.25	0.800	1.000	0.08	1.06 [0.68, 1.64]
		CTQ sexual abuse	−0.60	0.549	1.000	0.07	0.88 [0.58, 1.34]
		CTQ physical neglect	−1.23	0.217	1.000	0.22	0.79 [0.55, 1.15]
		CTQ emotional abuse	−0.42	0.675	1.000	0.10	0.92 [0.64, 1.33]
		interpersonal	−0.22	0.823	1.000	0.09	0.95 [0.62, 1.45]
Disgust	Neutral	Diagnostic group	−0.01	0.996	1.000	0.02	1.00 [0.59, 1.68]
		CTQ sexual abuse	0.23	0.815	1.000	0.09	1.06 [0.64, 1.76]
		CTQ physical neglect	0.31	0.754	1.000	0.07	1.07 [0.69, 1.68]
		CTQ emotional abuse	−0.77	0.440	1.000	0.15	0.85 [0.55, 1.29]
		interpersonal	0.04	0.969	1.000	0.06	1.01 [0.60, 1.71]
Surprise	Neutral	Diagnostic group	1.34	0.180	0.540	0.35	1.68 [0.79, 3.58]
		CTQ sexual abuse	2.25	0.025	0.123	0.61	2.09 [1.10, 3.98]
		CTQ physical neglect	0.52	0.604	1.000	0.07	1.20 [0.60, 2.38]
		CTQ emotional abuse	1.88	0.060	0.241	0.53	1.82 [0.97, 3.40]
		interpersonal	0.48	0.632	1.000	0.07	1.23 [0.53, 2.82]
Joy	Neutral	Diagnostic group	1.64	0.101	0.503	0.40	1.63 [0.91, 2.90]
		CTQ sexual abuse	1.63	0.102	0.503	0.36	1.48 [0.93, 2.36]
		CTQ physical neglect	0.90	0.370	0.971	0.15	1.23 [0.78, 1.96]
		CTQ emotional abuse	0.74	0.462	0.971	0.11	1.19 [0.75, 1.86]
		interpersonal	0.99	0.324	0.971	0.17	1.34 [0.75, 2.39]
Pride	Neutral	Diagnostic group	1.02	0.308	1.000	0.21	1.49 [0.69, 3.22]
		CTQ sexual abuse	0.77	0.443	1.000	0.15	1.33 [0.64, 2.76]
		CTQ physical neglect	1.17	0.242	1.000	0.25	1.50 [0.76, 2.96]
		CTQ emotional abuse	1.10	0.270	1.000	0.22	1.46 [0.75, 2.86]
		interpersonal	−1.25	0.211	1.000	0.19	0.58 [0.25, 1.36]

GV = Grouping variable

CQT = Childhood Trauma Questionnaire

P = Probability under H₀

P_H = Bonferroni-holm corrected probability under H₀

*p < .05

1-β = statistical power

OR = Odds ratio

CI = confidence interval

Effect statistics and Odds ratios refer to the comparisons between the groups with the highest and lowest traumatic burden (e.g. PTSD vs HC, high CTQ vs. low CTQ)