Fat-Phobic and Non-Fat-Phobic Anorexia Nervosa: A Conjoint Analysis on the Importance of Shape and Weight

Abstract

With the introduction of new diagnostic criteria in DSM-5, fear of weight gain no longer represents a sine qua non-criterion for the diagnosis of anorexia nervosa (AN).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.

Implicit bias to food and body cues in eating disorders: a systematic review

“…Finally, in a recent study using an IAT, Izquierdo et al [ 59 ] found fat-phobic and non-fat-phobic patients with AN, as well as underweight restrictive eaters and healthy controls to all display implicit negative bias towards underweight models [ 59 ]. Korn et al [ 60 ] also examined patients with AN who self-reported fear of gaining weight and patients who denied it, and found a disparity between explicit statements and results in an indirect bias assessment task (implicit conjoint analysis, CA) to be present in non-fat-phobic patients, thus providing evidence that an implicit drive for thinness might as well exist in patients with AN who explicitly deny fat phobia [ 60 ].…”

Overcoming limitations of self-report: an assessment of fear of weight gain in anorexia nervosa and healthy controls using implicit association tests

“…The IATs were conducted as part of a larger research project, which involved the following series of assessments: First, a picture was taken of each participant, which was used within the experimental tasks following the IAT paradigms, and a conjoint analysis was conducted. This paradigm has been described elsewhere [ 42 ]. The two IAT paradigms followed.…”

Faced with one’s fear: Attentional bias in anorexia nervosa and healthy individuals upon confrontation with an obese body stimulus in an eye‐tracking paradigm

“…Subsequently, a picture of the participants was taken, their height and weight were measured using a stable stadiometer seca 217 (seca) and bathroom scales Pino white 63747 (SOEHNLE), whereof body mass index (BMI) was calculated as kg/m 2 . Then, they took part in a Conjoint Analysis (Korn, Vocks, Thomas, Giabbiconi, & Hartmann, 2020)…”

“…Subsequently, a picture of the participants was taken, their height and weight were measured using a stable stadiometer seca 217 (seca) and bathroom scales Pino white 63747 (SOEHNLE), whereof body mass index (BMI) was calculated as kg/m 2 . Then, they took part in a Conjoint Analysis (Korn, Vocks, Thomas, Giabbiconi, & Hartmann, 2020) and an Implicit Association Test (IAT paradigm: T. Borgers, N. Krüger, S. Vocks, J. J. Thomas, F. Plessow, & A. S. Hartmann, unpublished data). After the eye‐tracking session, participants took part in an electroencephalography (EEG paradigm: A. T. Henn, T. Borgers, S. Vocks, C. ‐M.…”

“…Subsequently, a picture of the participants was taken, their height and weight were measured using a stable stadiometer seca 217 (seca) and bathroom scales Pino white 63747 (SOEHNLE), whereof body mass index (BMI) was calculated as kg/m 2 . Then, they took part in a Conjoint Analysis (Korn, Vocks, Thomas, Giabbiconi, & Hartmann, 2020) Hartmann, unpublilshed data) and electromyography paradigm (EMG paradigm: A. S. Hartmann, unpublished data), and completed questionnaires in Unipark (QuestBack GmbH). Finally, the participants attended a debriefing session and received the reimbursement.…”