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Implicit attitudes toward dieting and thinness distinguish fat‐phobic and non‐fat‐phobic anorexia nervosa from avoidant/restrictive food intake disorder in adolescents
Author(s) -
Izquierdo Alyssa,
Plessow Franziska,
Becker Kendra R.,
Mancuso Christopher J.,
Slattery Meghan,
Murray Helen B.,
Hartmann Andrea S.,
Misra Madhusmita,
Lawson Elizabeth A.,
Eddy Kamryn T.,
Thomas Jennifer J.
Publication year - 2019
Publication title -
international journal of eating disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 138
eISSN - 1098-108X
pISSN - 0276-3478
DOI - 10.1002/eat.22981
Subject(s) - dieting , psychology , anorexia nervosa , association (psychology) , eating disorders , clinical psychology , underweight , developmental psychology , weight loss , body mass index , obesity , overweight , psychotherapist , medicine , pathology
Abstract 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.