Same, same but different: Attention bias for food cues in adults and adolescents with anorexia nervosa

Abstract

Objective: Attention processing for food may be biased in people with Anorexia Nervosa (AN). However, previous studies have had inconsistent results. This is likely to be due to indirect assessment of attention, which does not inform on the underlying attention processes, and/or the heterogeneity of participants across studies, testing either adults or adolescents with AN, that is, people at very different developmental and illness stages.Method: Eye-tracking was employed as a direct assessment of attention during a visual probe task with food versus non-food pictures. Attention bias for food was measured in 39 adults and 34 adolescents with AN and in 53 adults and 31 adolescents without AN.Results: All participants had a direction bias for food, specifically for high-calorie food.However, adults with AN subsequently avoided maintaining attention on food versus non-food cues, compared to adults without AN. Adolescents with or without AN demonstrated increased attention maintenance on food versus non-food cues, and, contrary to our hypothesis, did not differ in their attention bias for food cues. Accordingly, adults with AN differed significantly from adolescents with AN in attention maintenance for food cues: while adolescents with AN showed significantly increased attention maintenance on food stimuli, adults avoided maintaining attention on food cues.Discussion: Adults with AN may apply attention strategies to facilitate restrictive eating. This strategy is absent in adolescents with AN. This difference in food-related attention bias between adolescents and adults with AN suggests that attention biases develop over time as the illness progresses. K E Y W O R D Sanorexia nervosa, attention bias, eye-tracking, food, visual probe

Food related attention bias modification training for anorexia nervosa and its potential underpinning mechanisms

“…Eyetracking data showed that while initial AB to food cues in people with AN was comparable to healthy controls, those with AN did not maintain attention on the food cues [2,3]. Rather, they present attentional avoidance [2,3]. This attentional avoidance pattern was more evident when they were presented with high caloric food cues, in contrast to low caloric food cues [3].…”

“…In support of this, a meta-analysis found AB to food pictures with a medium effect size in a mixed sample of eating disorder (ED) patients [1]. Eyetracking data showed that while initial AB to food cues in people with AN was comparable to healthy controls, those with AN did not maintain attention on the food cues [2,3]. Rather, they present attentional avoidance [2,3].…”

“…Rather, they present attentional avoidance [2,3]. This attentional avoidance pattern was more evident when they were presented with high caloric food cues, in contrast to low caloric food cues [3]. As research in healthy individuals indicates that duration of attentional gaze on food is related to subsequent craving and to food intake [6], it has been proposed that attentional avoidance of, rather than increased initial engagement with high caloric food cues, could be a strategy used to reinforce food restriction [7].…”

“…The involvement of cognitive mechanisms related to food processing, including food -related attention bias (AB) in the aetiology and maintenance of anorexia nervosa (AN) is well documented [1][2][3]. We propose that attention bias modification training (ABMT), a novel treatment approach, holds clinical potential for AN by modifying maladaptive AB for food.…”

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

“…These include cognitive remediation approaches that focus on cultivating a flexible, big picture style of thinking [73], cognitive skills training for social avoidance [74], and go/no-go inhibition training [75], which may be of value for the binge-purge form of the illness. Food-related attention bias modification training is also being investigated as an add-on intervention for AN, following directions from anxiety disorder research [76,77].…”