Attention Biases for Eating Disorder-Related Stimuli Versus Social Stimuli in Adolescents with Anorexia Nervosa – An Eye-Tracking Study

Abstract

Anorexia nervosa (AN) is characterized by attention biases for eating disorder-related information as well as altered attentional processing of social information. However, little is known about the interplay between the altered attentional processing of these two types of information. The present study investigates attention biases for eating disorder-related information (pictures of bodies) versus social information (pictures of faces), in adolescents with AN. Attention biases were assessed via eye-tracking during a passive-viewing task in which female bodies and faces were presented simultaneously and thus competed directly for attention. Female adolescents (13–18 years) with AN (n = 28) were compared to a clinical comparison group (adolescents with major depression; n = 20) and a comparison group of adolescents with no mental illness (n = 24). All groups looked longer at bodies than at faces, i.e., showed attention biases for bodies in maintenance of attention. These biases were more pronounced in adolescents with AN than in both comparison groups, particularly for underweight bodies, at the expense of looking less at social stimuli. The results indicate “dual” attention biases in adolescents with AN (i.e., towards bodies and away from emotional faces) which could have a twofold negative impact on eating disorder psychopathology: increased attention to eating disorder-related information might directly influence eating disorder symptoms while less attention to social information might have an indirect influence through the amplification of interpersonal difficulties.

Look me in the eyes! A preliminary study on eye‐contact in adolescents with anorexia nervosa

“…The absence of reduced eye‐contact in adolescents with AN suggests that impairments in this social skill are not present at a relatively early stage of the disorder (illness duration in the current sample: median = 13 months, M = 19.82 months, SD = 17.18) but may only develop as the illness progresses and symptoms persist, similar to what has been suggested for facial emotion recognition abilities (Sfärlea et al., 2018). Interestingly, our results contrast those of a previous study (Sfärlea et al., 2023) that found reduced attention to faces in adolescents with AN. However, in that study, pictures of faces were presented alongside pictures of bodies, that is, disorder‐related information.…”

“…Thus, impairments in socio‐emotional skills during this period could have particularly detrimental consequences. In addition, while some alterations in socio‐emotional processing, such as reduced attention to faces, have been found in both adults (Kerr‐Gaffney et al., 2021; Watson et al., 2010) and adolescents (Pinhas et al., 2014; Sfärlea et al., 2023), others, such as deficits in facial emotion recognition, have been found to characterise only adults (Caglar‐Nazali et al., 2014) but not adolescents with AN (Laghi et al., 2015; Sfärlea et al., 2018) and have been suggested to develop with the longer course of the illness. This emphasises the need to examine adolescents with AN separately regarding their socio‐emotional skills, and in particular eye‐contact, in order to find out whether difficulties in eye‐contact are already present at an early stage of the disorder or develop as the disorder progresses.…”

“…No predictions were made for the CC group due to heterogeneous results regarding the direction of their eye‐contact alterations and the lack of previous studies comparing AN and CC groups. Furthermore, we explored whether differences in eye‐contact were modulated by facial emotion, as individuals with AN have been found to avoid certain emotional expressions (e.g., angry faces; Sfärlea et al., 2023).…”

Watch out! A path from anxiety to anorexia nervosa through biased attention?

“…We found a main effect of stimulus type, suggesting that all groups showed an AB towards body-related information (pictures of overweight as well as underweight bodies). In particular, this result is in line with results from another task in an overlapping sample (Sfärlea et al, 2023) and other studies finding attention biases for stimuli related to body shape in female adolescents (Green & McKenna, 1993). It might reflect that body and shape is highly important for many adolescent girls (Wadden et al, 1991;Wertheim & Paxton, 2011).…”

“…It might reflect that body and shape is highly important for many adolescent girls (Wadden et al, 1991;Wertheim & Paxton, 2011). The AB was particularly pronounced for underweight bodies, which also corresponds results obtained in an overlapping sample but a different task (Sfärlea et al, 2023). It is also in line with other studies finding more pronounced ABs for underweight compared to overweight bodies in young women (Glauert et al, 2010;Joseph et al, 2016).…”