Attention bias in adults with anorexia nervosa, obsessive-compulsive disorder, and social anxiety disorder

Abstract

Background Attention bias to threat (selective attention toward threatening stimuli) has been frequently found in anxiety disorder samples, but its distribution both within and beyond this category is unclear. Attention bias has been studied extensively in social anxiety disorder (SAD) but relatively little in obsessive compulsive disorder (OCD), historically considered an anxiety disorder, or anorexia nervosa (AN), which is often characterized by interpersonal as well as body image/eating fears. Methods Medication-free adults with SAD (n=43), OCD (n=50), or AN (n=30), and healthy control volunteers (HC, n=74) were evaluated for attention bias with an established dot probe task presenting images of angry and neutral faces. Additional outcomes included attention bias variability (ABV), which summarizes fluctuation in attention between vigilance and avoidance, and has been reported to have superior reliability. We hypothesized that attention bias would be elevated in SAD and associated with SAD severity. Results Attention bias in each disorder did not differ from HC, but within the SAD group attention bias correlated significantly with severity of social avoidance. ABV was significantly lower in OCD versus HC, and it correlated positively with severity of OCD symptoms within the OCD group. Conclusions Findings do not support differences from HC in attention bias to threat faces for SAD, OCD, or AN. Within the SAD sample, the association of attention bias with severity of social avoidance is consistent with evidence that attention bias moderates development of social withdrawal. The association of ABV with OCD diagnosis and severity is novel and deserves further study.

Threat‐Detection and Attentional Bias to Threat in Women Recovered from Anorexia Nervosa: Neural Alterations in Extrastriate and Medial Prefrontal Cortices

“…Such compensatory processes may be at play in AN. Similar nullcorrelations between measures of anxiety and attentional bias to threat have previously been reported in AN (Schneier et al, 2016;Schober et al, 2014), underscoring the cross-study variability of findings. This could account for the partly discrepant findings from behavioral studies of attentional bias to threat in AN.…”

“…However, unlike some previous studies (Cardi et al, 2013;Telzer et al, 2008), and in contrast to our hypothesis, we did not detect a significant correlation between anxiety and attentional bias to threat. Similar nullcorrelations between measures of anxiety and attentional bias to threat have previously been reported in AN (Schneier et al, 2016;Schober et al, 2014), underscoring the cross-study variability of findings.…”

“…These findings are inconsistent with some previous studies. Using a pictorial dot-probe task similar to ours, Schneier et al (2016) found no evidence of an attentional bias to angry faces in patients with AN. words and faces) and task paradigms (Cardi et al, 2013;Cardi et al, 2015;Harrison et al, 2010).…”

“…a = two-sample t-test, p < .001. b = one-sample t-test, p = .005. c = one-sample t-test, p = .001. d = one-sample t-test, p = .010. e = one-sample t-test, p < .001 [Colour figure can be viewed at wileyonlinelibrary.com] Attentional Bias to Threat in AN L. Bang et al similar biases to general threat stimuli in AN, supporting the behavioral findings in our study. Using a pictorial dot-probe task similar to ours, Schneier et al (2016) found no evidence of an attentional bias to angry faces in patients with AN. Another study (Schober et al, 2014) investigated attentional bias to negatively valenced words (including social threat words) using a dot-probe task, and did not find an attentional bias to such stimuli in patients with AN.…”

A systematic review of studies probing longitudinal associations between anxiety and anorexia nervosa

“…Trait anxiety is greater in anorexia nervosa as compared to HC (e.g. (Schneier et al, 2016;Schulze, Calame, Keller, & Mehler-Wex, 2009)). Anxiety disorder pathology and the prevalence of anxiety disorder diagnoses are also elevated amongst anorexia nervosa as compared to HC (Kerr-Gaffney, Harrison, & Tchanturia, 2018;Sternheim, Startup, & Schmidt, 2015;Swinbourne & Touyz, 2007).…”