Unravelling body image in anorexia nervosa using virtual selves

Investigating specific factors contributing to the development and maintenance
of anorexia nervosa (AN) is important to inform treatment options, especially
because relapse rates are high in this population. So far, prior interventions
targeting food restriction in AN have focused on the reduction of fear of food
intake. We recently developed a theoretical model incorporating key mechanisms
of existing theories and described how body-related self-disgust can play a
central role in the onset and maintenance of AN. Because treatments currently
do not specifically address self-disgust, this could explain why their
effectiveness is often limited on the long term: residual levels of
self-disgust after treatment could make individuals vulnerable to relapse. To
effectively reduce disgust, habituation via prolonged exposure is considered
critical to weaken the intrinsically revolting nature of disgust-eliciting
objects. However, it is only justifiable to start testing such a new
interventional approach, after the validity of the underlying theoretical model
has been thoroughly investigated.

The primary objective of the current study is to investigate whether
self-disgust is heightened in patients with AN. If this indeed is the case,
this would provide important leads to improve existing treatment options for
AN.

This study will use an observational design (case-control study).

In this observational study participants will be asked to fill out seven
questionnaires, engage in a VR free-viewing task during which fEMG responses
are being recorded, and perform two computer tasks. In total, the time
investment will be approximately 105 minutes. The study might elicit negative
affect in the short term in the patient group, due to the brief presentation of
eating disorder relevant stimuli. Because all patients will be in treatment at
the time of the study, any negative effects of the study can be discussed with
their therapists. Since individuals with heightened levels of eating disorder
symptoms are excluded from participation in the comparison group and on basis
of positive experiences with prior studies in which we included adolescent
girls in a comparison group for a study regarding disgust and eating disorder
symptoms, we do not expect that the current study will have any negative effect
on participants in the comparison group, and if so, we expect this to be only
temporary. The study is expected to advance our understanding of the
persistence of food restriction in individuals with AN. Although several
studies so far have linked disgust to AN, it remains entirely unclear what
exactly elicits disgust in individuals with AN. By studying disgust responses
in real-time, the current study will help to get insight into the exact nature
of disgust in AN which will help to determine what might be important targets
for treatment.