“Glass fairies” and “bone children”: Adolescents and young adults with anorexia nervosa show positive reactions towards extremely emaciated body pictures measured by the startle reflex paradigm

Abstract

In this study, we investigated the emotional processing of extremely emaciated body cues in adolescents and young adults with (n = 36) and without (n = 36) anorexia nervosa (AN), introducing a new picture type, which was taken from websites that promote extreme thinness and is targeted specifically at adolescents interested in extreme thinness. A startle reflex paradigm was used for implicit reactions, while a self-assessment instrument was used for subjective responses. We found a significant group difference with a startle inhibition (appetitive response) among the patients and a startle potentiation (aversive response) among the controls, whereas no such difference for subjective measures was found. The results are in contrast to previous studies, which proposed a general failure to activate the appetitive motivational system in AN, but in keeping with findings from other addictions, where the same response pattern has been found. Implications for prevention and therapy are discussed.

Affective Responses in Different Stages of Anorexia Nervosa: Results from a Startle‐reflex Paradigm

“…Bellodi et al (2013) showed lower baseline reactions of startle responses when confronting adult AN participants with blanc screens. In contrast, Reichel et al (2014) showed appetitive startle responses to positive stimuli comparable with healthy controls (HCs) in a sample of adolescents with current AN, and also appetitive responses to body pictures picked from pro-Ana websites (emaciated bodies) only in AN participants. In contrast, Reichel et al (2014) showed appetitive startle responses to positive stimuli comparable with healthy controls (HCs) in a sample of adolescents with current AN, and also appetitive responses to body pictures picked from pro-Ana websites (emaciated bodies) only in AN participants.…”

“…In anorectic patients, results regarding emotion-modulated startle are conflicting (Bellodi, Martoni, Galimberti & Cavallini, 2013;Friederich et al, 2006;Racine et al, 2016;Reichel et al, 2014), and longitudinal data are lacking. In adults with ongoing AN, Racine et al (2016) as well as Friederich et al (2006) observed a lack of startle inhibition to positive cues.…”

Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation

“…However, emerging theories argue against generalized reward deficits in AN (O’Hara et al, 2015, Wierenga et al, 2014). Indeed, recent data indicate that reward processing is enhanced in the presence of illness-compatible cues (e.g., emaciated bodies) and behaviors (e.g., physical activity) in individuals with AN (Giel et al, 2013, O’Hara et al, 2015, Reichel et al, 2014). Enhanced reward processing of certain stimuli, rather than an overall inability to experience reward, suggests that treatments should focus on shifting appetitive reactivity away from illness-compatible cues and towards stimuli associated with positive emotions in the general population.…”

“…We predicted that patients with AN would show: 1) enhanced emotional reactivity, as indicated by a potentiated startle response, to negative and food images (compared to neutral images), and 2) difficulty suppressing emotional responses to negative and food images, as indicated by similar startle responses when receiving suppress and maintain regulation cues. Given inconsistent findings for positive images between the two previous EMSP studies in AN (Friederich et al, 2006, Reichel et al, 2014), we did not have a priori hypotheses regarding within-subject differences for positive images.…”

“…Further, patients with AN had a greater startle response to food images than patients with BN, supporting the premise that food is experienced as aversive among persons with AN (Friederich et al, 2006). More recently, both patients with AN and controls ( N = 36 in each group) exhibited attenuated startle to pleasant images, but differed substantially in their responses to emaciated body pictures (Reichel et al, 2014). Startle findings suggested that patients with AN found emaciated body images pleasant, whereas control participants perceived these images as aversive, despite non-significant group differences for self-reported valence and arousal.…”