Automatic processes in Anorexia Nervosa and obesity

Present project is a longitudinal study to the role of dysfunctional
information processing in anorexia nervosa (AN) and obesity among adolescents.
Because little research has been done in this area, the project was inspired by
recent research on addiction where inability to restrict is the core problem.
Recent models of addiction attribute a central role to attentional bias and
automatic approach tendencies. Similar processes could play a role in obese
people. However, opposite processes can play an eminent role in the ability of
AN patients to restrict their food intake. In two relatively independent lines
of research the hypothesis will be tested that AN patients are indeed
characterized by a tendency to direct their attention away from food and / or
the absence of automatic approach tendencies. In the third line of research
implicit self-esteem will be tested. More specifically will be examined whether
anorexia patients are characterized by a low (implicit) self-esteem and wheter
this is even further reduced when they judge themselves on their appearance.
1. Attentional bias. Recent research with the exogenous cueing task (ECT) has
shown that restrained eaters are characterized by a reduced (spatial) attention
to high-calorie food items. On this basis the hypothesis will be tested that
adolescents with AN focus in a similar way their attention less to food items
and obese person will focus more than controls. This pattern helps anorexics
logically to maintain their food restriction but makes it more difficult for
obese people. If attentional bias (AB) has indeed the presumed crucial role in
the onset and persistence of AN and obesity, this will normalize under
influence of a successful treatment and a residual AB will be a predictor of
relapse. To determine this, the indices of eating pathology and AB are measured
at baseline, after 1 year and after 3 years follow up. Attentional processes
have besides a spatial component also a temporal dimension. If food stimuli are
longer present in the working memory, they will probably processed deeper and
this will in turn increase the chance of craving. Variation in temporal AB
could therefore at least partly explain why some people do (AN) and others do
not (obesity) succeed in their attempt to restrict their food intake. To get
more insight in temporal attentional bias the so called Rapid Serial Visual
Presentation Task will be administered.
2. Automatic approach / avoidance tendencies. According to recent dual process
models, a relatively strong automatic approach tendency towards food may
contribute to the inability to regulate eating behavior of obese people.
Conversely, the absence of such a tendency could explain the ability of AN
patients to maintain their restrictive food intake. For more insight into the
presumed reciprocal relationship between the absence of automatic approaches
tendencies and eating pathology, this project will not study whether anorexic
patients are characterized by an absent automatic approach tendency and whether
obese persons have in turn a stronger automatic approach tendency, but will
also investigate whether indices of treatment success are associated with an
increase (after 1 and 3 years follow up) in approach tendencies in patients
with anorexia and a decrease in the approach tendencies in obese individuals.
For the same reason will be tested whether the remaining (lack of) tendencies
during one year follow-up are predictive of the return (or persistence) of
eating pathology during the 3-year follow up for both the anorexics and the
obese people. The automatic tendency will be measured with an Affective Simon
Test manikin version (AST-manikin). In this task food is a task irrelevant
feature, what is making the task particularly sensitive to bottom-up activated
approach tendencies. An important question therefore remains whether the
apparent ability of AN to prevent food activating automatic approaches
tendencies is limited to situations where food cues are outside the focus of
attention or also include situations where the decision to approach or avoid
food is central (like during the meal). In order to study the role of the more
top-down activated tendencies also the Stimulus-Response Compatibility Task
(SRC manikin) will be administered in a separate sample. In this task food is a
task relevant feature and the required response (approach or avoidance) is
dependent on the presence or absence of food cues.
3. Implicit self-esteem
Anorexia Patients seem to have a low (implicit) self-esteem that they largely
depend on their appearance and weight. The last line of research focuses on
whether this is particularly the case when they assess themselves through the
eyes of another (observer perspective). The task that will be used is a new
developed variant of the Implicit Associate Task (de Jong et al, 2001) compared
with the traditional IAT (Greenwald et al, 1998), the most widely used measure
of implicit self-esteem. The new developed learning variant of the IAT examines
how easily patients associate themselves with something positive if they think
they are judged by the critical eyes of others. To test the hypothesis that
anorexia patients depend their self-esteem largely on their appearance a
condition is added where participants before the task will be primed on their
appearance.

This study aims to contribute from a cognitive-motivational perspective to a
better understanding of the processes involved in dysfunctional eating behavior
in anorexia nervosa and obesity.

This project is a longitudinal design to study automatic processes in anorexia
and obesity at start of treatment, after 1 year and after 3 year follow up.

There are no risks associated with participation.