The effect of attentional bias toward shape- and weight-related information on body dissatisfaction

Attentional Bias Modification Training Based on Virtual Reality and Eye Tracking in Anorexia Nervosa Patients

Anorexia nervosa (AN) patients exhibit attentional bias (AB) related to the body, which is the tendency to pay greater attention to weight-related body areas compared to non-weight-related ones. This phenomenon has been linked to elevated levels of body dissatisfaction (BD) and may potentially reduce the effectiveness of body exposure therapy. The purpose of this pilot study is to assess the efficacy of a single session of a new body-related AB modification task (ABMT) that combines virtual reality with eye tracking in patients with AN. The goals of the ABMT are to reduce body-related AB by balancing attention between weight and non-weight-related body areas and to reduce BD levels. Twenty-three adolescent patients with AN were embodied in a virtual avatar and immersed in a virtual environment where they completed the ABMT. Body-related AB measures and BD levels were assessed before and after the training. A paired samples t-test showed statistically significant differences between pre-assessment and post-assessment; the complete fixation time on weight-related body parts was reduced and BD levels decreased. The initial evidence of the efficacy of this ABMT has important clinical implications, since AB and BD are considered risk factors for developing and maintaining eating disorder symptomatology among patients with AN.

Sensor technology in eating disorders research: A systematic review

OBJECTIVE

Sensor technologies offer exciting potential to objectively measure psychopathological correlates of eating pathology and eating disorder (ED) research utilizing sensors has rapidly proliferated in the past several years. The aims of the present review are: (1) characterize the types of sensors that have been utilized in ED research, (2) identify the psychopathological factors relevant to EDs that have been assessed using sensors, (3) describe the data supporting the validity and reliability of these sensors, (4) discuss limitations associated with these sensors, and (5) identify gaps that persist within the ED literature with regard to use of sensor technologies.

METHOD

A systematic search was conducted of PubMed, PsycINFO, Web of Science, ProQuest, and "gray" literature sources. Eligible publications were empirical studies that utilized sensors to measure at least one psychological variable among clinical ED populations.

RESULTS

Sensors have been utilized with ED samples to measure eating behaviors, physical activity, sleep, autonomic nervous system activity, eyeblink startle response, visual attention, and visual-haptic object integration. The reliability and validity of these sensors varies widely and there are a number of significant gaps that remain in the literature with regard to the types of sensors utilized, context in which sensors have been used, and populations studied.

DISCUSSION

The existing literature utilizing sensors within ED research largely support the feasibility and acceptability of these tools. Sensors should continue to be utilized within the field, with a specific focus on examining the reliability and validity of these tools within ED samples and increasing the diversity of samples studied.

PUBLIC SIGNIFICANCE STATEMENT

Sensor technologies, such as those included in modern smartwatches, offer new opportunities to measure factors that may maintain or contribute to symptoms of eating disorders. This article describes the types of sensors that have been used in eating disorders research, challenges that may arise in using these sensors, and discusses new applications of these sensors that may be pursued in future research.

Blinded by bodies: Elevated eating disorder symptomatology is associated with increased attentional priority for thin bodies

Selective processing of female thin-ideal body imagery is associated with greater body dissatisfaction, and eating disorder-specific rumination has been shown to mediate this relationship. Across two studies, we employed a modified rapid serial visual presentation task (similar to that used within the emotion-induced blindness literature), such that participants searched for a task-relevant target that was sometimes preceded by a thin body, non-thin body, or neutral task-irrelevant distractor. Our first experiment (N = 372) revealed a "body-induced blindness" in an unselected female sample, such that bodies in general distracted attention more than neutral images, and non-thin bodies distracted more than thin-ideal bodies. In our second experiment, female participants were selected based on eating disorder symptomatology (N = 114). Females that exhibited elevated eating disorder symptoms were distracted more by thin bodies compared to those low in symptomatology, greater distraction from thin bodies was associated with greater body dissatisfaction, and this relationship was mediated by eating disorder-specific rumination. Altogether, our findings illustrate the persistent nature of attentional distortions that occur early in cognitive processing and across time for those high in eating disorder symptomatology.

Attentional bias in eating disorders: A meta-review

OBJECTIVE

This meta-review summarizes and synthesizes the most reliable findings regarding attentional bias in eating disorders across paradigms and stimulus types and considers implications for theory and future research.

METHOD

Four databases were systematically searched, along with reference lists of included reviews, yielding 15 systematic reviews (four of which were also meta-analyses). The quality of each review was appraised using the AMSTAR-2.

RESULTS

Key findings from systematic reviews are summarized, organized by paradigm and stimulus type.

DISCUSSION

The authors synthesize evidence from the highest-quality studies. There is evidence for attentional avoidance and vigilance in eating disorders depending on stimulus properties (low vs. high-calorie food; high-body mass vs. low-body mass index photos of others) and attentional avoidance of food stimuli in those with anorexia nervosa. Sad mood induction may generate attentional bias for food in those with binge-eating disorder. There may also be attentional bias to general threat in eating disorder samples. This meta-review concludes that most systematic reviews in this field are low in quality and summarizes the main areas that could be improved upon in future reviews. Implications of this study's findings for theory and intervention research are also discussed.

Body-related attentional bias as mediator of the relationship between body mass index and body dissatisfaction

Body image disturbance, consisting of an affective (body dissatisfaction) and perceptual (body distortion) component, is not only found in eating disorders, but is also present in healthy individuals, affecting their psychological well-being and everyday life. A higher body mass index is associated with higher body dissatisfaction, whereas results in relation to body distortion are mixed. Furthermore, body dissatisfaction is associated with a weight-related attentional bias. This study aimed to investigate the mediating role of a weight-related attentional bias in the relationship between body mass index and body image disturbance. Forty-one college women took part in a virtual reality and eye tracking procedure, in which the illusion of owning a virtual avatar with their body measurements was induced. During this procedure, body-related attentional bias was measured and afterwards body image disturbance was assessed. Mediation analysis revealed that weight-related attentional bias mediated the relationship between body mass index and body dissatisfaction (but not distortion). These findings suggest that modifying weight-related attentional bias would be a useful treatment target for improving body dissatisfaction. In addition, virtual reality technology could serve as an innovative method for modifying attentional bias in an ecologically valid way. HIGHLIGHTS: This Virtual Reality and Eye-Tracking study expands our knowledge about the relation between body mass index, body-related attention and body image disturbances. The results suggest that attentional bias towards weight-related body parts mediates the relation between BMI and body dissatisfaction. On the contrary, the relation between BMI and body distortion was not significant.

Is It Possible to Train the Focus on Positive and Negative Parts of One's Own Body? A Pilot Randomized Controlled Study on Attentional Bias Modification Training

Dysfunctional body- and shape-related attentional biases are involved in the etiology and maintenance of eating disorders (ED). Various studies suggest that women, particularly those with ED diagnoses, focus on negatively evaluated parts of their own body, which leads to an increase in body dissatisfaction. The present study aims to empirically test the hypothesis that non-ED women show an attentional bias toward negative body parts and that the focus on positive and negative parts of one’s own body can be modified by attentional bias modification training based on a dot-probe task. Although several studies have measured body-related attentional biases by using pictures of participants’ own bodies, the approach of investigating attentional bias via a dot-probe task while presenting pictures of the participants’ own body parts and modifying the biased attention using such pictures is novel. Women (n = 60) rank-ordered 10 parts of their own body regarding their attractiveness. To examine and modify the attentional focus, pictures of the self-defined positive and negative parts of one’s own body were presented by means of a dot-probe task. A paired-sample t-test revealed no difference between reaction times to negative compared to positive body parts, indicating no attentional bias toward negative parts of one’s own body. A two-way ANOVA revealed a main effect of time for pictures of positive and negative parts of one’s own body, with a decrease in reaction times from pre- to post-training. However, there was no significant interaction between time and training condition concerning reaction times to positive and negative body parts. Our findings replicate previous evidence of a balanced attentional pattern regarding one’s own body in women without ED diagnoses. However, the dot-probe task failed to modify the attentional focus. As the modifiability of state body image increases with more pronounced body dissatisfaction, the next step would be to test this approach in clinical samples of women with ED diagnoses.

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

OBJECTIVE

The 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.

METHOD

Three 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.

RESULTS

Forty-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.

CONCLUSIONS

Further 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.

Body Dissatisfaction Enhances Awareness and Facilitates the Consolidation of Body-Related Words During Rapid Serial Visual Presentation

Attentional biases have received considerable focus in research on cognitive biases and body dissatisfaction (BD). However, most work has focused on spatial allocation of attention. The current two experiments employed a rapid serial visual presentation (RSVP) task to investigate attention bias to body-related words in the temporal domain among young females with high and low BD. During this task, there were two targets presented in the same stimulus stream. The first target was defined as target one (T1) and the second was defined as target 2 (T2). Participants were asked to identify T2 while ignoring T1 in single task mode or identify both targets in the dual task mode. In the current study, Experiment 1 assessed the stimulus-driven attention of body-related stimuli. Participants were required to identify a target of neutral word (T2) as quickly and accurately as possible while ignoring the preceding target (T1) of neutral, fat-, or thin-related words. As expected, we observed spontaneous attentional blink (AB) effects elicited by both fat- and thin-related T1s among participants with high BD, suggesting enhanced awareness of body-related stimuli even when this information does not have to be identified. Such effects did not emerge among participants without BD. Experimental 2 investigated the goal-directed attention of body-related stimuli, during which participants needed to identify both the T1 and neutral T2. Participants with BD showed reduced AB effects after both fat- and thin-related T1, suggesting facilitated consolidation of body-related information in goal-directed attention among participants with BD. These findings have important clinical implications that it provided insight for creating more accurate attention bias modification (ABM) task aiming at reducing and preventing BD among young females.

Reactions to ideal body shapes

Difficult-to-attain beauty standards that are promulgated by the media could contribute to body dissatisfaction, but their potential impact upon body image remains unclear. The present study examined reactions to thin-ideal and muscular-ideal images, and examined the effects of ideal image exposure on preferred body shape and time spent deliberating about ideal shape. In a 2 × 2 experimental design, 200 Internet users completed the Kessler psychological distress scale (K10) and were randomly assigned to view idealistic body images or houses (and rated them on semantic differential dimensions). Females viewed thin ideal images and males viewed muscular ideal images, while the control groups viewed images of houses. Between group measures analysis of variance revealed women reacted negatively to thinspirational images. Women were more driven for thinness and idealized a thinner shape for the female body than men. Psychologically distressed participants had a stronger drive for thinness and greater body dissatisfaction compared to low-distress participants. In addition, although beauty ideal imagery had no significant impact on males, females spent more time in choosing ideal body figure. Viewing thin bodies for females created a trend toward desiring a slimmer figure, as well as increased preoccupation with size as they spent more time deliberating over a photorealistic figure rating scale. Therefore, exposure to thinspiration promotes dissatisfaction with self and leads women to dwell more upon their body image.

Eye-tracking research in eating disorders: A systematic review

OBJECTIVE

Those with eating disorders (EDs) show attentional biases to disorder-relevant stimuli, such as food and body shape information. However, attentional bias research in EDs largely relies on reaction time based measures, which are limited in their ability to assess different components and the time course of attention. Eye-tracking paradigms have therefore been utilized to provide greater ecological validity, and directly capture the detailed sequence of processes in perception and attention. While numerous studies have examined eye movements in the mood, anxiety, and psychotic disorders, there has been a lack of studies in EDs. The purpose of this qualitative review is to provide a summary of eye-tracking studies in clinical ED populations.

METHOD

The review was conducted using the PRISMA guidelines. Electronic databases were systematically searched to identify studies examining gaze parameters in ED compared to healthy controls (HCs). Thirty-one studies met inclusion criteria.

RESULTS

Across ED diagnoses, there was evidence of attentional biases towards food and body stimuli. In addition, differential patterns of attention to social information, and differences in smooth pursuit and saccadic eye movements were found in anorexia nervosa (AN).

DISCUSSION

Findings are discussed in relation to research in other psychiatric disorders, and recommendations for future studies using eye-tracking in EDs are given. The findings add to the wider literature on attentional biases in EDs, and provide potential avenues for treatment. IJED-18-0331.R1. Investigación de seguimiento ocular en trastornos de la conducta alimentaria: una revisión sistemática.

Attention bias for appearance words can be reduced in women: Results from a single-session attention bias modification task

BACKGROUND AND OBJECTIVES

We tested whether a single-session of attention bias modification (ABM) could change bias towards appearance-related words and improve body satisfaction.

METHODS

Females (N = 102; M_age = 33 years) completed an ABM session where attention was trained towards positive appearance-related information (n = 31), away from negative appearance-related information (n = 37), or a non-training session (n = 34). Importance of appearance and shape concern were examined as moderators.

RESULTS

ABM was effective in women high on appearance importance, trained to direct attention away from negative appearance words.

LIMITATIONS

No long-term follow up of attention biases or body image challenge were conducted.

CONCLUSIONS

These findings suggest that certain types of attention biases are amenable to change within a single session.

The causal role of selective attention for thin-ideal images on negative affect and rumination

BACKGROUND AND OBJECTIVES

Attentional bias towards thin-ideal body images has been implicated as a vulnerability factor for eating disorder symptomatology. However, the nature and causal basis of its relationship with other cognitive vulnerability factors, namely, eating disorder-specific rumination and negative mood, remains unclear. Accordingly, the current study investigated the causal influence of attentional bias towards thin-ideal images on emotional and ruminative vulnerability, in response to a body image-related stressor.

METHODS

An established attentional bias modification (ABM) procedure, the modified dot probe task, was used for the assessment and manipulation of attentional bias. Female undergraduate students (N = 110) aged between 17 and 24 years were randomly assigned to either 'attend' towards or 'avoid' thin-ideal images. Pre- and post-attentional training, participants completed the dot probe task, as well as state measures of rumination and negative mood. Additionally, following post-ABM assessment of attentional bias, participants were given a body image-related stressor.

RESULTS

Results showed that participants trained to attend to thin bodies reported heightened negative mood, in response to the stressor, compared with participants trained to avoid thin bodies. On the other hand, groups did not demonstrate a differential increase in eating disorder-specific rumination in response to the stressor.

LIMITATIONS

The current findings will require replication with clinical samples. Additionally, state rumination and negative mood were assessed via single items.

CONCLUSIONS

These results provide the first causal evidence for the role of attentional bias towards thin-ideal images in negative emotional vulnerability. Importantly, these results suggest attentional bias may serve as a risk factor for mood reactivity and a potential target for strategies designed to enhance emotional resilience.

Body image perceptions and symptoms of disturbed eating behavior among children and adolescents in Germany

THEORETICAL BACKGROUND

Body image distortions such as perception biases are assumed to be precursors of eating disorders (ED). This study aims to investigate body image perceptions and symptoms of disturbed eating behavior among a sample of 11-17 year-old students in Germany.

METHODS

A cross-sectional survey study was carried out among 1524 students of twelve secondary schools from all school types in North Rhine-Westphalia (Germany). A naturalistic photograph-rating consisting of photographs of young women's bodies was used to examine children's perceptions of female bodies (i.e., perceived average body size and perceived ideal body size of young women). Also, symptoms of disturbed eating behavior were examined.

RESULTS

Compared to statistical data, children and adolescents underestimated the average body size of young women by more than two BMI-points (estimated average BMI = 20), with no differences between boys and girls. Also, girls and boys generally held a slim female thin-ideal (perceived ideal BMI = 19.5), which is nearly three BMI-points below the average body size in the young female population. Girls showed a slightly stronger female thin-ideal than boys. Among all subgroups, early-adolescent girls (13-14 years) displayed the strongest thin-ideal internalization. Nearly one-third of this group perceived a BMI below 18 as ideal female body size. Symptoms of disturbed eating behavior were common among youth and most frequent among adolescent girls (15-17 years). Girls who displayed a bias towards underestimation of female body size and girls who displayed an underweight female thin-ideal were more likely to report harmful dieting behaviors and psychological distress associated with eating, body, and weight.

CONCLUSIONS

This study found that 11-17 year-old girls and boys do not show accurate judgements regarding the average body size of young women. Instead, there is systematic and significant underestimation, indicating considerable perception biases, which may constitute a risk factor for the development and maintenance of ED. Symptoms of disturbed eating behavior were common, especially among girls, and associated with body-related perceptions. Future research will need to clarify the severity and course of these symptoms.

The effects of priming in a cued dot-probe task on appearance-related attentional biases in women

The dot-probe task (DPT) is a reaction time measure of attentional bias. Research using this task has found inconsistent patterns of appearance-related attentional biases in women. This study examined the effects of a novel priming variation of the DPT, which incorporated additional cues into each trial of the task, on measurement of such biases. The study also examined associations between these biases and body image, a component of eating disorder symptomatology. A convenience sample of women from the general community (N = 103) completed body image measures online and attended a laboratory session to complete one of four DPTs: (1) an appearance-cued DPT containing images of thin-ideal models between each trial; (2) neutral-cued DPT containing images of forests; (3) time-delayed DPT controlling for time in place of an image; or (4) typical DPT containing only word stimuli. Women who completed the appearance-cued DPT demonstrated a stronger attentional bias for positive, but not negative, appearance words than women who completed the other DPT versions. Furthermore, for the appearance-cued and time-delayed DPTs, this bias correlated with poorer body image across several indicators (appearance evaluation, body dissatisfaction, self-evaluative salience of appearance, and state body satisfaction). Although it was unexpected that no attentional bias for negative-appearance words was found, the attentional bias for positive-appearance words may suggest that effects were driven by the ego-threat of positive-appearance words. Further research is warranted to determine whether such biases contribute to and maintain body image disturbance and disordered eating.

The mediating role of rumination in the relation between attentional bias towards thin female bodies and eating disorder symptomatology

The present study sought to investigate the association between selective attentional processing of body images, rumination, and eating disorder symptoms in young women. Seventy-three undergraduate female students (ages 17–24) completed a modified dot-probe task to assess whether young women showed a differential attentional bias pattern towards thin and non-thin female bodies. Participants also completed self-report measures of eating disorder pathology. It was found that increased reports of dietary restraint and body dissatisfaction were associated with both greater attentional bias towards thin bodies and avoidance of non-thin bodies (as compared to neutral images), although the former relationship was stronger than the latter. The results suggest attentional vigilance to thin-ideal images plays a greater role in the potential development and/or maintenance of eating disorder symptoms, at least in a university sample of young women. Results also revealed that eating disorder-specific rumination mediated the relationship between attentional bias to thin ideal images and eating disorder symptoms. These findings build on existing research and theories, for example the impaired disengagement model of rumination, and have potential clinical applications such as specifically targeting ruminative and/or attentional processes in the prevention and/or treatment of eating disorder symptoms.

Time course of attentional biases toward body shapes: The impact of body dissatisfaction

Using a dot-probe discrimination task and a between-subjects design, we examined the time course of attentional biases (facilitated attention, delayed disengagement, and avoidance) toward thin versus fat bodies and explored the influence of body dissatisfaction (BD) on attention allocation among a sample of 163 women from the general population. Three stimulus presentation times were used: 100ms, 500ms, and 1500ms. We also used neutral body-shape-related stimuli as neutral stimuli related to the concept of interest to overcome the limitations of previous studies. At 500ms, the results highlighted delayed disengagement from very thin and negatively assessed bodies among women with high BD. This mechanism, which leads to attentional focalization on bodies that are difficult to achieve, might be considered dysfunctional because it may maintain or reinforce BD. Results at 100ms and 1500ms, as well as results for fat bodies, were not conclusive.

An attentional bias for thin bodies and its relation to body dissatisfaction

Research suggests that humans have an attentional bias for the rapid detection of emotionally valenced stimuli, and that such a bias might be shaped by clinical psychological states. The current research extends this work to examine the relation between body dissatisfaction and an attentional bias for thin/idealized body shapes. Across two experiments, undergraduates completed a gender-consistent body dissatisfaction measure, and a dot-probe paradigm to measure attentional biases for thin versus heavy bodies. Results indicated that men (n=21) and women (n=18) show an attentional bias for bodies that correspond to their own gender (Experiment 1), and that high body dissatisfaction among men (n=69) and women (n=89) predicts an attentional bias for thin same-gender bodies after controlling for body mass index (BMI) (Experiment 2). This research provides a new direction for studying the attentional and cognitive underpinnings of the relation between body dissatisfaction and eating disorders.

The role of memory in the relationship between attention toward thin-ideal media and body dissatisfaction

PURPOSE

This study examined the causal relationship between attention and memory bias toward thin-body images, and the indirect effect of attending to thin-body images on women's body dissatisfaction via memory.

METHOD

In a 2 (restrained vs. unrestrained eaters) × 2 (long vs. short exposure) quasi-experimental design, female participants (n = 90) were shown images of thin models for either 7 s or 150 ms, and then completed a measure of body dissatisfaction and a recognition test to assess their memory for the images.

RESULTS

Both restrained and unrestrained eaters in the long exposure condition had better recognition memory for images of thin models than did those in the short exposure condition. Better recognition memory for images of thin models was associated with lower body dissatisfaction. Finally, exposure duration to images of thin models had an indirect effect on body dissatisfaction through recognition memory.

CONCLUSIONS

These findings suggest that memory for body-related information may be more critical in influencing women's body image than merely the exposure itself, and that targeting memory bias might enhance the effectiveness of cognitive bias modification programs.

Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa

Objective

Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG).

Method

Eye movements were recorded in a group of patients with AN (n = 16), BN (n = 16) and a CG (n = 16) in an ecologically valid setting, i.e., during a 3-min mirror exposure.

Results

Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern.

Discussion

The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns.

Attention bias modification produces no changes to appearance-related bias, state or trait body dissatisfaction in nonclinical women

The potential of attention bias modification to reduce appearance-related attentional biases and female body dissatisfaction has not been investigated. Immediate and short-term effects were therefore examined across attentional biases, state and trait body dissatisfaction in a randomised controlled trial consisting of 62 female participants aged 18–35 years. The results show no changes to attentional bias across either the experimental or control condition and no significant changes in body dissatisfaction immediately post-training or at 1–2 weeks follow-up. Single-session attention bias modification protocols may therefore not be sufficient in modifying appearance-based biases and associated disordered body schemas within a nonclinical sample.

Cognitive biases in response to visual body-related stimuli in eating disorders: study protocol for a systematic review and meta-analysis

BACKGROUND

Biased processing of body-related information may be linked to the development and maintenance of eating disorders (ED). The objective of this systematic review will be to examine the occurrence and the extent of cognitive biases in response to visual body-related stimuli in individuals with ED and individuals with an increased risk to develop ED.

METHODS

Studies will be identified by searching MEDLINE and PsycINFO. We will include observational and experimental studies that examine the association between cognitive biases (information processing biases) in response to visual body-related stimuli and eating-related pathology in clinical and non-clinical adult samples. In addition to database searches, citation tracking will be used. Two reviewers will first screen titles and abstracts independently and will then review full texts for eligibility. Data extraction will be done independently by two reviewers. Conflicts at all levels of screening and extraction will be resolved through discussion. Studies will be included if they 1) assess cognitive biases (i.e., attentional biases, memory biases, judgment biases, response biases, and interpretation biases) in response to visual body-related stimuli (i.e., pictures or photographs of a human body or a human body shape), 2) if they report associations between biases and eating-related pathology, 3) if study participants are at least 16 years or older, and 4) if no priming task was administered prior to the assessment. Descriptive data of studies will also be collected. Risk of bias assessment will be undertaken by two independent reviewers. Data will be analyzed using random-effects meta-analysis.

DISCUSSION

This systematic review will synthesize the evidence for cognitive bias in response to visual body-related stimuli in individuals with ED and individuals with an increased risk of developing an ED. The findings may help to better understand information processing in eating-related psychopathology.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015019165.

Eyes on the bodies: an eye tracking study on deployment of visual attention among females with body dissatisfaction

Visual attentional bias has important functions during the appearance social comparisons. However, for the limitations of experimental paradigms or analysis methods in previous studies, the time course of attentional bias to thin and fat body images among women with body dissatisfaction (BD) has still been unclear. In using free reviewing task combined with eye movement tracking, and based on event-related analyses of the critical first eye movement events, as well as epoch-related analyses of gaze durations, the current study investigated different attentional bias components to body shape/part images during 15s presentation time among 34 high BD and 34 non-BD young women. In comparison to the controls, women with BD showed sustained maintenance biases on thin and fat body images during both early automatic and late strategic processing stages. This study highlights a clear need for research on the dynamics of attentional biases related to body image and eating disturbances.

German version of the Multidimensional Body-Self Relations Questionnaire - Appearance Scales (MBSRQ-AS): confirmatory factor analysis and validation

The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is a widely used questionnaire that measures body image as a multidimensional construct. The Appearance Scales (AS) of the MBSRQ (Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, Overweight Preoccupation and Self-Classified Weight) are subscales which facilitate a parsimonious assessment of appearance-related aspects of body image. The current study tested the psychometric properties and factor structure of a German translation of the MBSRQ-AS. Participants were n=230 female patients with the SCID diagnosis of an eating disorder and n=293 female healthy controls. In a confirmatory factor analysis, convincing goodness-of-fit indices emerged. The subscales of the questionnaire yielded good reliability and convergent and discriminant validity coefficients, with most items showing excellent characteristics. Like the English version, the German adaptation of the questionnaire can be recommended for a multidimensional assessment of appearance-related aspects of body image in both research and clinical practice.

Predictors of weight variation and weight gain in peri- and post-menopausal women

This research encompasses a community sample of 497 women in peri- and post-menopause and uses structural equation modelling to investigate the structural models of weight variation and weight gain. Variables such as body shape concerns, depression, stress and life events are explored. Weight gain (from pre-menopause to current menopausal status) was observed in 69 per cent of participants. The predictors of weight gain were lower education level ( β = −.146, p = .017), less or no physical exercise ( β = −.111, p = .021), having a recent psychological problem ( β = .191, p < .001), transition from peri- to post-menopause ( β = .147, p = .013) and more frequent body shape concerns ( β = .313, p < .001). Prevention of weight gain in pre-menopause is recommended; risk groups should be targeted considering the predictors of weight increase.

A review of attention biases in women with eating disorders

There is robust evidence that women with eating disorders (EDs) display an attention bias (AB) for disorder-salient stimuli. Emerging data suggest that the presence of these biases may be due, in part, to neurological deficits, such as poor set shifting and weak central coherence. While some have argued that these biases function to predispose and/or act to maintain disordered eating behaviours, evidence supporting this view has rarely been examined. This report summarises and integrates the existing literature on AB in EDs and other related psychiatric disorders to better understand its potential role in the development and maintenance of an ED. The domains reviewed include experimental data using the dot-probe and modified Stroop task and neurobiological findings on AB in women with EDs as well as the role of AB in current theoretical models. We conclude by proposing an integrated model on the role of AB in EDs and discuss treatment approaches aimed at modifying these biases.

Attentional biases among body-dissatisfied young women: an ERP study with rapid serial visual presentation

In the current study, rapid serial visual presentation (RSVP) task combined with event related potentials (ERP) was used to investigate attention biases toward body-related words in a nonclinical sample of body dissatisfied females. Consistent with the hypotheses, the amplitudes of N100, N170 and P3 are sensitive to different body-related words in the RSVP paradigm only among body weight dissatisfied women (WD group), while control group did not show this difference. The early anterior N100 and bi-lateral parietal and occipital N170 amplitudes elicited by fatness-related words were larger than those elicited by thinness-related and neutral words among WD group, a finding which is consistent with the presence of a 'negativity bias'. Also, WD group women showed significantly different amplitudes in response to three categories of stimuli with thin words eliciting the largest P3 amplitudes, followed by fat words and the least neutral words. The current findings indicated that attention biases toward body weight related words were evident during both sensory and cognitive stages of information processing. Findings are also consistent with hypotheses of cognitive-behavioral accounts of body weight dissatisfaction which propose, in part, that individual differences on cognitive tasks reveal underlying psychopathology; attentional biases reflect disordered body schema, not disordered eating, and can therefore be seen in non-clinical samples.

Body checking induces an attentional bias for body-related cues

OBJECTIVE

Theoretical models suggest that body checking is linked to biased cognitive processing. However, this link has not been investigated in any systematic way. The present study examined the influence of body checking on attentional bias for body-related cues by manipulating body checking behaviors in nonclinical participants.

METHOD

66 women were randomly assigned to one of three conditions: body checking, body exposure, or control. A body visual search task was used to measure attentional bias.

RESULTS

Participants in the body checking condition showed speeded detection of body-related information compared to participants in the exposure and control conditions. No evidence was found for increased distraction by body-related information. Furthermore, participants in the body checking condition reported more body dissatisfaction after the manipulation than participants in the body exposure and control conditions.

DISCUSSION

These results are the first to experimentally establish the link between body checking and attentional bias toward body-related cues.

Attentional avoidance of high-fat food in unsuccessful dieters

Using the exogenous cueing task, this study examined whether restrained and disinhibited eaters differ in their orientation of attention towards and their difficulty to disengage from high versus low-fat food pictures in a relatively short (500 ms) and a long presentation format (1500 ms). Overall, participants in the 500 ms condition showed a tendency to direct attention away from high-fat food pictures compared to neutral pictures. No differential pattern was evident for the 1500 ms condition. Correlational analysis revealed that reduced engagement with high-fat food was particularly pronounced for disinhibited eaters. Although in the short term this seems an adaptive strategy, it may eventually become counterproductive, as it could hinder habituation and learning to cope with seductive characteristics of high-fat food.

Attentional and interpretative biases in appearance concern: An investigation of biases in appearance-related information processing

The present study examined associations between high levels of appearance concern and information processing biases in interpretation and attention. An opportunity sample (N=79) categorised ambiguous stimuli as related or unrelated to appearance. Participants then responded to the same stimuli in a modified visual dot-probe task assessing attentional bias. Participant responses were assessed in relation to level of appearance concern. The results indicated a valence specific bias towards interpretation of ambiguous stimuli as negative and appearance-related in individuals with higher levels of concern. There was also evidence of attentional bias towards information perceived as appearance-related in participants with higher levels of appearance concern. The study findings suggest that association between appearance-orientated information processing biases and level of appearance concern; this association may lead to mutually reinforcing bias and concern.

An investigation of the effect of body dissatisfaction on selective attention toward negative shape and weight-related information

OBJECTIVE

The aim of the present study was to investigate the effect of inducing body dissatisfaction on selective attention toward negative shape and weight-related information.

METHOD

A total of 54 female undergraduate university students were randomly allocated to one of three induction conditions: body dissatisfaction, negative mood, and neutral. Subsequently, participants' attentional bias toward negative shape/weight words was measured using a dot probe task.

RESULTS

Contrary to the hypotheses, participants in the body dissatisfaction condition did not demonstrate an increase in attention toward negative shape/weight words compared with the negative mood and neutral conditions. Indeed, it was the negative mood induction that resulted in significantly increased attention toward negative shape/weight words relative to the body dissatisfaction condition.

DISCUSSION

The finding that the negative mood (rather than the body dissatisfaction) induction triggered an attentional bias toward shape- and weight-related information is discussed in terms of the anxiety literature given the nature of the mood induction utilized. This finding might help to account for the high comorbidity between eating disorders and anxiety disorders and suggests the possible relevance of attentional training interventions designed for anxiety disorders in the treatment of eating disorders.

Drive for thinness and attention toward specific body parts in a nonclinical sample

OBJECTIVE

To examine the differences between participants scoring high versus low on a drive for thinness construct concerning their visual attention toward specific body parts. We hypothesized that participants scoring high on the drive for thinness subscale would show increased attention to body regions, which are important in the assessment of body weight and thinness like the waist, hips, legs, and arms.

METHOD

We examined eye-gaze behavior of a nonclinical sample of 51 male and female college students with an eye-tracking system as they were looking at pictures of young, attractive males and females. In addition, we used the Eating Disorder Inventory to measure drive for thinness.

RESULTS

Participants with increased scores on the drive for thinness subscale looked longer and more often to the waist, hips, legs, and arms as compared with low scorers. In addition, they showed decreased attention toward the head or face.

CONCLUSION

The results indicate that participants scoring high on drive for thinness show an attentional bias toward body regions that are associated with assessing changes in weight. However, they neglected the face, which is the most important source of social and affective information when looking at others.

Attentional bias in eating disorders

OBJECTIVE

To examine the relationship between eating disorders and attentional biases.

METHOD

The first study comprised 23 female patients with clinical eating disorders, women with high levels of anxiety (n = 19), and three female normal control groups comprising low (n = 31), moderate (n = 21), or high levels of shape concern (n = 23). The second study comprised 82 women with clinical eating disorders and 44 healthy controls. All participants completed measures of eating disorder psychopathology and completed a modified pictorial dot-probe task.

RESULTS

In the first study, biases were found for negative eating and neutral weight pictures, and for positive eating pictures in women with eating disorders; these biases were greater than those found in anxious and normal controls. The second study replicated these findings and biases were also found for negative and neutral shape stimuli.

CONCLUSION

It is concluded that future research should establish whether such biases warrant specific therapeutic interventions.