Implicit attitudes toward dieting and thinness distinguish fat‐phobic and non‐fat‐phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents. Issue 4 (31st December 2018)

• Record Type: Journal Article
• Authors: Izquierdo, Alyssa; Plessow, Franziska; Becker, Kendra R.; Mancuso, Christopher J.; Slattery, Meghan; Murray, Helen B.; Hartmann, Andrea S.; Misra, Madhusmita; Lawson, Elizabeth A.; Eddy, Kamryn T.; Thomas, Jennifer J.
• Other Names: Eddy Kamryn T. guestEditor.; Thomas Jennifer J. guestEditor.
• Is Part Of: International journal of eating disorders. Volume 52:Issue 4(2019)
• Page Start: 419
• Page End: 427
• Publication Date: 2018-12-31
• Subjects: anorexia nervosa -- ARFID -- avoidant/restrictive food intake disorder -- dieting -- drive for thinness -- IAT -- implicit association test; Appetite disorders -- Periodicals; Ingestion disorders -- Periodicals; Eating disorders -- Periodicals; 616.8526
• DOI: 10.1002/eat.22981
• Languages: English
• ISSNs: 0276-3478

Abstract

Abstract: Objective: The majority of individuals with anorexia nervosa (AN) have a fat‐phobic (FP‐AN) presentation in which they explicitly endorse fear of weight gain, but a minority present as non‐fat‐phobic (NFP‐AN). Diagnostic criteria for avoidant/restrictive food intake disorder (ARFID) specifically exclude fear of weight gain. Differential diagnosis between NFP‐AN and ARFID can be challenging and explicit endorsements do not necessarily match internal beliefs. Method: Ninety‐four adolescent females (39 FP‐AN, 13 NFP‐AN, 10 low‐weight ARFID, 32 healthy controls [HC]) completed implicit association tests (IATs) categorizing statements as pro‐dieting or non‐dieting and true or false (questionnaire‐based IAT), and images of female models as underweight or normal‐weight and words as positive or negative (picture‐based IAT). We used the Eating Disorder Examination to categorize FP‐ versus NFP‐AN presentations. Results: Individuals with FP‐AN and NFP‐AN demonstrated a stronger association between pro‐dieting and true statements, whereas those with ARFID and HCs demonstrated a stronger association between pro‐dieting and false statements. Furthermore, while all groups demonstrated a negative implicit association with underweight models, HC participants had a significantly stronger negative association than individuals with FP‐AN and NFP‐AN. Discussion: Individuals with NFP‐AN exhibited a mixed pattern in which some of their implicit associations were consistent with their explicit endorsements, whereas others were not, possibly reflecting a minimizing response style on explicit measures. In contrast, individuals with ARFID demonstrated implicit associations consistent with explicit endorsements. Replication studies are needed to confirm whether the questionnaire‐based IAT is a promising method of differentiating between restrictive eating disorders that share similar clinical characteristics.