A systematic review of attentional biases in disorders involving binge eating

Abstract

Objective Attentional bias (AB) may be one mechanism contributing to the development and/or maintenance of disordered eating. AB has traditionally been measured using reaction time in response to a stimulus. Novel methods for AB measurement include eye tracking to measure visual fixation on a stimulus, and electroencephalography to measure brain activation in response to a stimulus. This systematic review summarizes, critiques, and integrates data on AB gathered using the above-mentioned methods in those with binge eating behaviors, including binge eating, loss of control eating, and bulimia nervosa. Method Literature searches on PubMed and PsycInfo were conducted using combinations of terms related to binge eating and biobehavioral AB paradigms. Studies using AB paradigms with three categories of stimuli were included: food, weight/shape, and threat. For studies reporting means and standard deviations of group bias scores, Hedges’ g effect sizes for group differences in AB were calculated. Results Fifty articles met inclusion criteria and were reviewed. Individuals who binge eat in the absence of compensatory behaviors show an increased AB to food cues, but few studies have examined such individuals’ AB toward weight/shape and threatening stimuli. Individuals with bulimia nervosa consistently show an increased AB to shape/weight cues and socially threatening stimuli, but findings for AB to food cues are mixed. Discussion While there are important research gaps, preliminary evidence suggests that the combination of AB to disorder-specific cues (i.e., food and weight/shape) and AB toward threat may be a potent contributor to binge eating. This conclusion underscores previous findings on the interaction between negative affect and AB to disorder-specific cues. Recommendations for future research are provided.

A systematic review of reviews of neurocognitive functioning in eating disorders: The state‐of‐the‐literature and future directions

“…2018) found consistent evidence of biases toward food stimuli in binge-type EDs without compensatory behaviors, though more inconsistent evidence in BN (Stojek et al, 2018; for similar mixed results, see Van den Eynde et al, 2011). However, a more consistent pattern in BN was found for Stroop studies using weight/shape and threat stimuli, which reported a larger attention bias in BN versus controls (Stojek et al, 2018).…”

“…2018) found consistent evidence of biases toward food stimuli in binge-type EDs without compensatory behaviors, though more inconsistent evidence in BN (Stojek et al, 2018; for similar mixed results, see Van den Eynde et al, 2011). However, a more consistent pattern in BN was found for Stroop studies using weight/shape and threat stimuli, which reported a larger attention bias in BN versus controls (Stojek et al, 2018). A meta-analysis of dot-probe task performance (k = 4) revealed a large attention bias toward negative shape-related stimuli (d = .80) and away from positive eating and shape-related stimuli (d = −.83) in AN and BN versus controls (Aspen, Darcy, & Lock, 2013; see also Brooks et al, 2011).…”

Moving beyond self‐report data collection in the natural environment: A review of the past and future directions for ambulatory assessment in eating disorders

“…Results indicated that women with ED psychopathology, on average, had longer reaction times to appearance‐related words than non‐ED controls, which the authors suggest could reflect increased processing and rumination about disorder‐relevant stimuli among those with ED symptoms. While the authors specifically interpreted this task as a measure of schema activation, these findings are also supported by the broader attention bias literature in EDs demonstrating selective attention toward weight and shape stimuli on modified Emotional Stroop paradigms, as indexed by longer reaction times to such stimuli (Aspen et al, ; Stojek et al, ).…”

“…Prominent models of EDs highlight the importance of various cognitive processes in the etiology and maintenance of symptoms (e.g., Fairburn, Cooper, & Shafran, ; Vitousek & Hollon, ; Wonderlich et al, ). For instance, it has been suggested that cognitive schemas of individuals with EDs facilitate processing of appearance‐related information (Vitousek & Hollon, ), that cognitive rumination exacerbates and maintains negative affect in EDs (Smith, Mason, & Lavender, ), and that attentional biases may maintain ED symptoms by directing cognitive resources toward disorder‐salient stimuli, thereby interfering with tasks and distorting interpretations about the environment (Aspen, Darcy, & Lock, ; Stojek et al, ). In recent years, several cognitive processes that are thought to be relevant to EDs have been investigated by measuring individuals' performances on behavioral tasks, though this work has largely been limited to laboratory settings (Smith, Mason, Johnson, Lavender, & Wonderlich, ).…”

“…Stroop paradigms, as indexed by longer reaction times to such stimuli (Aspen et al, 2013;Stojek et al, 2018).…”