Implicit attitudes toward dieting and thinness distinguish fat-phobic and non-fat-phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents

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2019
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Izquierdo, Alyssa
Plessow, Franziska
Becker, Kendra R.
Mancuso, Christopher J.
Slattery, Meghan
Murray, Helen B.
Misra, Madhusmita
Lawson, Elizabeth A.
Thomas, Jennifer J.
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Zusammenfassung

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.

Zusammenfassung in einer weiteren Sprache
Fachgebiet (DDC)
150 Psychologie
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anorexia nervosa, ARFID, avoidant/restrictive food intake disorder, dieting, drive for thinness, IAT, implicit association test
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ISO 690IZQUIERDO, Alyssa, Franziska PLESSOW, Kendra R. BECKER, Christopher J. MANCUSO, Meghan SLATTERY, Helen B. MURRAY, Andrea S. HARTMANN, Madhusmita MISRA, Elizabeth A. LAWSON, Jennifer J. THOMAS, 2019. Implicit attitudes toward dieting and thinness distinguish fat-phobic and non-fat-phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents. In: International Journal of Eating Disorders. Wiley. 2019, 52(4), pp. 419-427. ISSN 0276-3478. eISSN 1098-108X. Available under: doi: 10.1002/eat.22981
BibTex
@article{Izquierdo2019Impli-55231,
  year={2019},
  doi={10.1002/eat.22981},
  title={Implicit attitudes toward dieting and thinness distinguish fat-phobic and non-fat-phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents},
  number={4},
  volume={52},
  issn={0276-3478},
  journal={International Journal of Eating Disorders},
  pages={419--427},
  author={Izquierdo, Alyssa and Plessow, Franziska and Becker, Kendra R. and Mancuso, Christopher J. and Slattery, Meghan and Murray, Helen B. and Hartmann, Andrea S. and Misra, Madhusmita and Lawson, Elizabeth A. and Thomas, Jennifer J.}
}
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    <dcterms:abstract xml:lang="eng">Objective:&lt;br /&gt;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.&lt;br /&gt;&lt;br /&gt;Method:&lt;br /&gt;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.&lt;br /&gt;&lt;br /&gt;Results:&lt;br /&gt;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.&lt;br /&gt;&lt;br /&gt;Discussion:&lt;br /&gt;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.</dcterms:abstract>
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