With the introduction of new diagnostic criteria in DSM-5, fear of weight gain no longer represents a sine qua non-criterion for the diagnosis of anorexia nervosa (AN). This is of relevance as a subgroup of individuals with AN denies fear of weight gain as the reason for restrictive eating but still remain at a very low weight. As self-reports are susceptible to bias, other methods are needed to confirm the existence of the subtype in order to provide adapted treatment. Therefore, we aimed to measure fear of weight gain using a novel method in clinical psychology, the conjoint analysis (CA). Relative importance and preference scores for various life aspects, including appearance/shape and weight were assessed in women with fat-phobic AN (FP-AN, n = 30), NFP-AN (n = 7), and healthy controls (n = 29). Individuals with FP-AN showed a significant lower preference for weight gain versus weight maintenance than HC (p = 0.011, η 2 p = 0.107). Correlation between explicitly assessed drive for thinness and CA score was low. As expected, in FP-AN the explicitly endorsed fear of weight gain was confirmed by the marked preference for weight maintenance compared to HC, while for NFP-AN explicit and implicit measures diverged, indicating that against their self-report they may experience at least some fear of weight gain. The utility of CA as a tool to measure fear of weight gain -and potentially other psychopathological constructs -requires further confirmation.

Objective Cognitive biases, such as memory, attention, and interpretation bias, are thought to play a central role in the development and maintenance of eating disorders (EDs). The aim of the present study was to investigate whether the interpretation bias is ED‐specific or can be generalized to comorbid disorder‐related threats in women with high levels of ED symptoms. Method In an online study, we measured interpretation bias using the modified Sentence Word Association Paradigm (SWAP), comparing women with (n = 39) and without (sub)threshold eating disorders (n = 56). We assessed endorsement and rejection rates as well as reaction times in response to a positive/neutral or a negative ED‐specific, social anxiety‐specific (SAD), or generalized anxiety‐specific (GAD) interpretive word following an ambiguous sentence. Results In ambiguous situations, women with high ED symptoms selected more negative (p < .001) and fewer positive/neutral ED‐related interpretations (p < .001). Negative interpretations were endorsed significantly faster (p < .001), while positive interpretations were rejected faster in this group (p < .001). These women also manifested negative SAD‐specific interpretation bias patterns in reaction time measures. Nevertheless, ED severity was best predicted by the endorsement of negative ED‐specific stimuli, whereas ED and SAD reaction time measures seemed to have a negligible effect. Discussion The results indicate that the interpretation bias might be ED‐specific. The SWAP can be a useful tool for the further investigation of the etiological relevance of the interpretation bias as well as for the development of modification training interventions.

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Metacognitive Therapy (MCT) developed by A. Wells is one of the new developments of Behavior Therapy. It assumes that not the content of cognition is important for the treatment of psychological disorders. Instead of this from a metacognitive perspective persistent and unflexible patterns of thinking and focusing attention and therewith associated dysfunctional coping behaviors play a crucial role for their development and maintenance. These patterns are called Cog-nitive Attentional Syndrome (CAS). In depres-sion the CAS consists of excessive rumination and worry, focusing attention on potential danger (threat monitoring) and maladaptive coping strategies, e. g. avoidance of social contact or substance abuse. The reason for the use of these strategies is the existence of positive metacognitions which highlight its benefit for the patient (e. g. "Rumination helps me to find a solution for my problems!"). Over time however negative metacognitive beliefs develop about the uncontrollability and danger of these processes (e. g., "Rumination is uncontrollable!"). They account for the continued use of these strategies and of further coping behaviors that backfire. The aim of MCT is to improve the metacognitive awareness of the patients and to regain flexible control over processes of thinking and focusing attention. The CAS is reduced, the underlying metacognitive beliefs are changed and alternative plans of cognitive processing are generated. The existing data suggest that regarding treatment outcome MCT is possibly superior to Cognitive Behavior Therapy.