Abstract
Background
This research proposes that cognitive biases involving the categorisation of food in terms of calorie content may contribute to restrictive eating in anorexia nervosa (AN). The current study sought to discriminate the validity of two novel hypotheses: (1) People with AN more readily categorise food in terms of calorie content rather than in terms of alternative dimensions (e.g., tastiness), and (2) people with AN have difficulty reclassifying food initially categorised in terms of calorie content, in terms of alternative dimensions.
Methods
To test these hypotheses, a novel food categorisation task was developed and delivered to people with a self-reported lifetime diagnosis of AN (N = 48) and to people with no history of an eating disorder (N = 133). Participants categorised food in terms of calorie content or tastiness.
Results
Results revealed that the AN group, relative to the comparison group, was faster to categorise food in terms of calorie content and slower to reclassify food initially categorised in terms of calorie content.
Conclusions
These findings suggest that AN is characterised by both an inflated tendency to categorise food in terms of calorie content and to become subsequently stuck on this categorisation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Additionally, a post-hoc decision was made to exclude people who identified as male (N = 42) or non-binary (N = 2) in an effort to more closely match the two groups.
Using the 175 kcal/100 g cut-off to classify food items as high vs. low calorie was in accordance with prior research (Jensen et al., 2016). On the basis of this criteria, the AN group did not differ from the comparison group in terms of accuracy in correctly classifying food items as high vs. low calorie (M = 86.80, SD = 26.33 vs. M = 85.63, SD = 14.02; t(56.90) = 0.29, p = .770).
To establish a lifetime diagnosis of AN, participants were required to self-report whether they had ever received a diagnosis of AN. Participants were also required to self-report current or past diagnoses of any other eating disorder or psychiatric illness (e.g., depression, anxiety). While several participants in the comparison group self-reported a history of other psychiatric illnesses, their exclusion from analyses did not change the observed pattern of results.
There were no differences in readiness to categorise food in terms of calorie content versus tastiness between individuals with a self-reported current AN diagnosis and individuals with a self-reported past AN diagnosis.
There were no differences in readiness to reclassify food initially categorised in terms of calorie content, in terms of tastiness, between individuals with a self-reported current AN diagnosis and individuals with a self-reported past AN diagnosis.
References
Berends, T., Boonstra, N., & van Elburg, A. (2018). Relapse in Anorexia Nervosa. Current Opinion in Psychiatry, 31(6), 445–455. https://doi.org/10.1097/YCO.0000000000000453.
Blechert, J., Lender, A., Polk, S., Busch, N. A., & Ohla, K. (2019). Food-Pics _ extended — an image database for Experimental Research on Eating and Appetite: Additional images, normative ratings and an updated review. 10, March, 1–9. https://doi.org/10.3389/fpsyg.2019.00307.
Brooks, S., Prince, A., Stahl, D., Campbell, I. C., & Treasure, J. (2011). A systematic review and meta-analysis of cognitive bias to food stimuli in people with disordered eating behaviour. Clinical Psychology Review, 31(1), 37–51. https://doi.org/10.1016/j.cpr.2010.09.006.
Dalton, B., Foerde, K., Bartholdy, S., McClelland, J., Kekic, M., Grycuk, L., Campbell, I. C., Schmidt, U., & Steinglass, J. E. (2020). The effect of repetitive transcranial magnetic stimulation on food choice-related self‐control in patients with severe, enduring Anorexia Nervosa. International Journal of Eating Disorders, 53(8), 1326–1336. https://doi.org/10.1002/eat.23267.
Dietel, F. A., Jacobs, L., Onken, R., Buhlmann, U., MacLeod, C., & Dondzilo, L. (2023). Association between Judgment biases during Facial Processing and Body Dysmorphic Symptomatology. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-023-10399-0.
Dondzilo, L., Dietel, F. A., Buhlmann, U., & MacLeod, C. (2021). The role of biases in the judgement processing of (un)attractive faces in body dysmorphic symptomatology. Behaviour Research and Therapy, 144, 103919. https://doi.org/10.1016/j.brat.2021.103919.
Dondzilo, L., Spring, S., & MacLeod, C. (2022). Effect of manipulating facial attractiveness judgements on the experience of intrusive thoughts in high facial appearance concern individuals. Behaviour Research and Therapy, 158(April), 104184. https://doi.org/10.1016/j.brat.2022.104184.
Fairburn, C. G., & Beglin, S. J. (2008). Eating disorder examination questionnaire (EDEQ 6.0). In C. G. Fairburn (Ed.), Cognitive behavior therapy and eating disorders (pp. 309–314). Guilford Press.
Foerde, K., Schebendach, J. E., Davis, L., Daw, N., Walsh, B. T., Shohamy, D., & Steinglass, J. E. (2022). Restrictive eating across a spectrum from healthy to unhealthy: Behavioral and neural mechanisms. Psychological Medicine, 52(9), 1755–1764. https://doi.org/10.1017/S0033291720003542.
Hadigan, C. M., Anderson, E. J., Miller, K. K., Hubbard, J. L., Herzog, D. B., Klibanski, A., & Grinspoon, S. K. (2000). Assessment of macronutrient and micronutrient intake in women with Anorexia Nervosa. International Journal of Eating Disorders, 28(3), 284–292. https://doi.org/10.1002/1098-108X(200011)28:3<284::AID-EAT5>3.0.CO;2-G.
Harrison, A., Tchanturia, K., & Treasure, J. (2010). Attentional Bias, emotion recognition, and emotion regulation in Anorexia: State or trait? Biological Psychiatry, 68(8), 755–761. https://doi.org/10.1016/j.biopsych.2010.04.037.
Jensen, C. D., Duraccio, K. M., Barnett, K. A., & Stevens, K. S. (2016). Appropriateness of the food-pics image database for experimental eating and appetite research with adolescents. Eating Behaviors, 23, 195–199. https://doi.org/10.1016/j.eatbeh.2016.10.007.
Jones, E. B., & Sharpe, L. (2017). Cognitive bias modification: A review of meta-analyses. Journal of Affective Disorders, 223, 175–183. https://doi.org/10.1016/j.jad.2017.07.034.
Jonker, N. C., Glashouwer, K. A., Hoekzema, A., Ostafin, B. D., & de Jong, P. J. (2019). Attentional engagement with and disengagement from food cues in Anorexia Nervosa. Behaviour Research and Therapy, 114(December 2018), 15–24. https://doi.org/10.1016/j.brat.2019.01.003.
Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D., & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in Anorexia Nervosa. Journal of Eating Disorders, 5(1), 20. https://doi.org/10.1186/s40337-017-0145-3.
Matheson, E., Wade, T. D., & Yiend, J. (2019). Utilising cognitive bias modification to remedy appearance and self-worth biases in eating disorder psychopathology: A systematic review. Journal of Behavior Therapy and Experimental Psychiatry, 65, 101482. https://doi.org/10.1016/j.jbtep.2019.101482.
Mergelsberg, E. L. P., MacLeod, C., Mullan, B., Rudaizky, D., Allom, V., Houben, K., & Lipp, O. V. (2019). Food healthiness versus tastiness: Contrasting their impact on more and less successful healthy shoppers within a virtual food shopping task. Appetite, 133(October 2018), 405–413. https://doi.org/10.1016/j.appet.2018.11.029.
Miles, S., Gnatt, I., Phillipou, A., & Nedeljkovic, M. (2020). Cognitive flexibility in acute Anorexia Nervosa and after recovery: A systematic review. Clinical Psychology Review, 81, 101905. https://doi.org/10.1016/j.cpr.2020.101905.
Neimeijer, R. A. M., Roefs, A., Glashouwer, K. A., Jonker, N., & de Jong, P. J. (2019). Reduced automatic approach tendencies towards task-relevant and task-irrelevant food pictures in Anorexia Nervosa. Journal of Behavior Therapy and Experimental Psychiatry, 101496. https://doi.org/10.1016/j.jbtep.2019.101496.
Perpiñá, C., Segura, M., & Sánchez-Reales, S. (2017). Cognitive flexibility and decision-making in eating disorders and obesity. Eating and Weight disorders - studies on Anorexia. Bulimia and Obesity, 22(3), 435–444. https://doi.org/10.1007/s40519-016-0331-3.
Ralph-Nearman, C., Achee, M., Lapidus, R., Stewart, J. L., & Filik, R. (2019). A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism. Brain and Behavior, 9(12). https://doi.org/10.1002/brb3.1458.
Rudaizky, D., Rinck, M., Becker, E., & MacLeod, C. (2020). Are avoidance biases in social anxiety due to biases in stimulus coding or in post-coding behavioral tendencies? Behaviour Research and Therapy, 132, 103656. https://doi.org/10.1016/j.brat.2020.103656.
Schebendach, J. E., Mayer, L. E., Devlin, M. J., Attia, E., Contento, I. R., Wolf, R. L., & Walsh, B. T. (2008). Dietary energy density and diet variety as predictors of outcome in Anorexia Nervosa. The American Journal of Clinical Nutrition, 87(4), 810–816. https://doi.org/10.1093/ajcn/87.4.810.
Shao, R., Krug, I., & Dondzilo, L. (2023). The Indirect Effect of Biased Judgment Processing of bodies on eating Disorder Symptomatology through eating disorder-specific reflection. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-023-10439-9.
Steinglass, J. E., Walsh, B. T., & Stern, Y. (2006). Set shifting deficit in Anorexia Nervosa. Journal of the International Neuropsychological Society, 12(03). https://doi.org/10.1017/S1355617706060528.
Steinglass, J., Foerde, K., Kostro, K., Shohamy, D., & Walsh, B. T. (2015). Restrictive food intake as a choice-A paradigm for study. International Journal of Eating Disorders, 48(1), 59–66. https://doi.org/10.1002/eat.22345.
Sysko, R., Walsh, B. T., Schebendach, J., & Wilson, G. T. (2005). Eating behavior among women with Anorexia Nervosa. The American Journal of Clinical Nutrition, 82(2), 296–301. https://doi.org/10.1093/ajcn/82.2.296.
Tchanturia, K., Davies, H., Roberts, M., Harrison, A., Nakazato, M., Schmidt, U., Treasure, J., & Morris, R. (2012). Poor cognitive flexibility in eating disorders: Examining the evidence using the Wisconsin Card sorting Task. Plos One, 7(1), e28331. https://doi.org/10.1371/journal.pone.0028331.
Veenstra, E. M., & de Jong, P. J. (2011). Reduced automatic motivational orientation towards food in restricting Anorexia Nervosa. Journal of Abnormal Psychology, 120(3), 708–718. https://doi.org/10.1037/a0023926.
Williamson, D. A., Muller, S. L., Reas, D. L., & Thaw, J. M. (1999). Cognitive Bias in Eating disorders. Behavior Modification, 23(4), 556–577. https://doi.org/10.1177/0145445599234003.
Williamson, D. A., White, M. A., York-Crowe, E., & Stewart, T. M. (2004). Cognitive-behavioral theories of eating disorders. Behavior Modification, 28(6), 711–738. https://doi.org/10.1177/0145445503259853.
Funding
This work was supported by the Australian Research Council (FL170100167) and a Research Collaboration Award from the University of Western Australia.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Research Involving Human Participants and/or Animals
No animal studies were carried out by the authors for this article.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Dondzilo, L., Phillipou, A., Miles, S. et al. Cognitive biases involving readiness to categorise food in terms of calorie content in anorexia nervosa. Cogn Ther Res 48, 327–336 (2024). https://doi.org/10.1007/s10608-023-10462-w
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-023-10462-w