Abstract
ObjectiveThe 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.MethodThree 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.ResultsForty‐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.ConclusionsFurther 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.
Highlights
After articles and search results from the three databases were manu‐ ally combined from three independent reviewers in a systematic fashion, and duplicates were removed (n = 1,922), remaining titles and abstracts were read thoroughly by two of the independent re‐ viewers to ensure that the following review inclusion and eligibility criteria were met: (a) results based upon original research pub‐ lished in peer‐reviewed journals written in English; (b) human par‐ ticipants aged 18–39 with at least one active anorexia nervosa (AN), bulimia nervosa (BN), and/or binge‐eating disorder (BED) group according to DSM‐III, DSM‐IV, or DSM‐V criteria who were compared to healthy individuals without eating disorder (ED) (HC); and (c) article contained implicit methods to investigate information processing strategies involving food, body‐ and/or per‐ fectionism‐related stimuli (n = 1,774 excluded)
The sole Functional magnetic resonance imaging (fMRI) study of this disorder demonstrates that BED show greater activation in anterior cingulate cortex (ACC) to high‐ than low‐calorie food images when compared to obese HC and healthy weight HC groups, suggestive of heightened resources needed to maintain cognitive control in the face of disorder‐salient stimuli that trigger lack of control in BED (Geliebter, Benson, Pantazatos, Hirsch, & Carnell, 2016)
The majority of Stroop studies show that AN and BN both exhibit greater interference to body and shape words than HC, consistent with a transdiagnostic view of ED (Fairburn et al, 2003), Stroop in‐ terference calculations are unable to disentangle whether longer response times to these words reflect approach versus avoidance processes
Summary
The current systematic and methodological review was conducted following PRISMA Guidelines (see Figure 1 PRISMA Flow Chart; Moher, Liberati, Tetzlaff, & Altman, 2009). One such PET study demonstrates that in response to high‐ but not low‐calorie food im‐ ages, AN exhibit greater heart rate, anxiety ratings, and blood flow to temporal and occipital brain regions than HC (Gordon et al, 2001) Since these regions are involved in perceptual and attentional pro‐ cessing of visual stimuli, these results support the notion of a bias as‐ sociated with high‐calorie food, as opposed to food more generally, as reported by ERP study findings (Blechert et al, 2011). The sole fMRI study of this disorder demonstrates that BED show greater activation in ACC to high‐ than low‐calorie food images when compared to obese HC and healthy weight HC groups, suggestive of heightened resources needed to maintain cognitive control in the face of disorder‐salient stimuli that trigger lack of control in BED (Geliebter, Benson, Pantazatos, Hirsch, & Carnell, 2016)
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