Abstract
With the introduction of new diagnostic criteria in DSM-5, fear of weight gain no longer represents a sine qua non-criterion for the diagnosis of anorexia nervosa (AN). This is of relevance as a subgroup of individuals with AN denies fear of weight gain as the reason for restrictive eating but still remain at a very low weight. As self-reports are susceptible to bias, other methods are needed to confirm the existence of the subtype in order to provide adapted treatment. Therefore, we aimed to measure fear of weight gain using a novel method in clinical psychology, the conjoint analysis (CA). Relative importance and preference scores for various life aspects, including appearance/shape and weight were assessed in women with fat-phobic AN (FP-AN, n = 30), NFP-AN (n = 7), and healthy controls (n = 29). Individuals with FP-AN showed a significant lower preference for weight gain versus weight maintenance than HC (p = 0.011, = 0.107). Correlation between explicitly assessed drive for thinness and CA score was low. As expected, in FP-AN the explicitly endorsed fear of weight gain was confirmed by the marked preference for weight maintenance compared to HC, while for NFP-AN explicit and implicit measures diverged, indicating that against their self-report they may experience at least some fear of weight gain. The utility of CA as a tool to measure fear of weight gain — and potentially other psychopathological constructs —requires further confirmation.
Highlights
Individuals with anorexia nervosa (AN) who do not report fear of gaining weight or becoming fat, so called non-fat phobic anorexia nervosa (NFP-AN; Lee et al, 1993), seem to occur with a wide geographic distribution in both western and non-western populations and exhibit a consistent profile of low scores on measures of eating disorder pathology (Dalle Grave et al, 2008; Becker et al, 2009; Wildes et al, 2013)
The aim of this study was to test a novel implicit measure of fear of weight gain in participants with AN and healthy controls (HC), by measuring the relative importance of appearance and preference for attributes related to fear of weight gain when making choices between various life profiles with the help of a choice-based conjoint (CBC) analysis
Our second hypothesis was confirmed since participants with FP-AN showed a significantly lower preference for weight gain versus weight maintenance compared to HC
Summary
Individuals with anorexia nervosa (AN) who do not report fear of gaining weight or becoming fat, so called non-fat phobic anorexia nervosa (NFP-AN; Lee et al, 1993), seem to occur with a wide geographic distribution in both western and non-western populations and exhibit a consistent profile of low scores on measures of eating disorder pathology (Dalle Grave et al, 2008; Becker et al, 2009; Wildes et al, 2013). The latter could be one possible explanation for their denial of fear of weight gain, besides having divergent rationales for food restriction (Becker et al, 2009; Lee et al, 2012) and minimizing or denying shape and weight concerns (Izquierdo et al, 2019). Results revealed that adolescents with and without reported fear of weight gain showed similar implicit biases toward dieting and thinness, but those with NFP-AN scored significantly lower on the explicit EDI-3 Drive for Thinness subscale than individuals with FP-AN. A dimensional approach to examine the association of implicit and explicit measures of fear of weight gain and eating psychopathology is lacking. This study highlights the novel information that can be gained by investigating both implicit and explicit measures in this group
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