A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism

Abstract

ObjectiveThe current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach‐ and/or avoidance‐related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder‐specific ED frameworks; and (c) suggests how research can address perfectionism‐related ED biases.MethodThree databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer‐reviewed studies of 18‐ to 39‐year‐olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included.ResultsForty‐six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease‐specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies.ConclusionsFurther integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge‐eating disorder, or evaluate perfectionism‐relevant stimuli, despite the fact that perfectionism is implicated in models of ED.

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

“…Although there is an increasing number of studies examining implicit biases in ED cohorts, these studies are mostly cross-sectional and methodologically heterogeneous. In contrast to a recently published review that focused only on visual attentional biases in individuals with EDs [ 29 ], our work pursued a broader approach to this field by considering all available indirect assessment methods. We included controlled studies (ED cohorts vs. healthy controls) that applied at least one indirect bias assessment method.…”

Soleymani, Mazidi, Neimeijer, de Jong (2021). Eating disorder-specific rumination moderates the association between attentional bias to high-caloric foods and eating disorder symptoms: Evidence from a reliable free-viewing eye-tracking task.

“…To date, most of the studies that examined AB to food have used Reaction Time (RT)based tasks such as the Emotional Stroop task and the Dot-Probe paradigm (Kerr-Gaffney, Harrison, & Tchanturia, 2018;Ralph-Nearman, Achee, Lapidus, Stewart, & Filik, 2019). These tasks rely on Reaction Time (RT) to infer the allocation of attention to different stimuli.…”

People who overvalue appearance selectively attend to descriptors of the attractiveness ideal: Findings from an emotional Stroop task

“…People with eating disorders have been shown to have an attentional bias for disorder‐related stimuli (e.g., eating, food, body shape, and weight) compared to people without eating disorders (Aspen, Darcy, & Lock, 2013; Brooks et al, 2011; Dobson & Dozois, 2004; Johansson, Ghaderi, & Andersson, 2005; Ralph‐Nearman, Achee, Lapidus, Stewart, & Filik, 2019; Stojek et al, 2018; Van den Eynde et al, 2011). Although there are different methods to assess attentional biases, the most common procedure used in the eating disorders literature has been the emotional Stroop task (Williams, Mathews, & MacLeod, 1996).…”