Abstract
The development of eating disorders is associated with a body-related attentional bias. Although eating disorders are especially prevalent in adolescence, so far, no study has analyzed gaze patterns and state body image in response to viewing one’s own body in youth. To fill this gap, the present study aimed to examine a body-related attentional bias and state body satisfaction in adolescents with various forms of eating disorders. Girls with anorexia nervosa, restrictive type (AN-R; n = 30), anorexia nervosa, binge eating/purging type (AN-BP; n = 26), bulimia nervosa (BN; n = 22), clinical controls with anxiety disorders (n = 20) and healthy controls (n = 43) looked at photographs of their own and a peer’s body, while their spontaneous eye movements were recorded. After stimulus presentation, state body satisfaction and individual attractiveness ratings for areas of the presented stimuli were assessed. An analysis of variance revealed that participants of all subgroups showed an attentive preference for unattractive areas of one’s own body. Girls with AN-R attended significantly longer to unattractive body areas than both control groups and significantly shorter to attractive body areas than healthy controls. State body dissatisfaction was more prominent in all eating disorder subgroups, with significantly lower scores in BN compared to AN-R. In general, the higher the state body dissatisfaction, the stronger was the deficit orientation on one’s own body. The attentional bias towards unattractive body areas, which is most pronounced in AN-R, indicates that interventions aiming to modify distorted attention might be promising in the prevention and treatment of eating disorders in adolescence.
Similar content being viewed by others
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Publishing.
Andrist, L. C. (2003). Media images, body dissatisfaction, and disordered eating in adolescent women. The American Journal of Maternal/Child Nursing, 28, 119–123.
Aspen, V., Darcy, A. M., & Lock, J. (2013). A review of attention biases in women with eating disorders. Cognition and Emotion, 27, 820–838.
Ben‐Tovim, D. I., & Walker, M. K. (1991). Further evidence for the stroop test as a quantitative measure of psychopathology in eating disorders. International Journal of Eating Disorders, 10, 609–613.
Blatter-Meunier, J. C., Lavallee, K. L., & Schneider, S. (2013). Patterns of family identification and self-congruence in childhood separation anxiety disorder. Psychopathology, 47, 57–64.
Blechert, J., Nickert, T., Caffier, D., & Tuschen-Caffier, B. (2009). Social comparison and its relation to body dissatisfaction in bulimia nervosa: evidence from eye movements. Psychosomatic Medicine, 71, 907–912.
Blechert, J., Ansorge, U., & Tuschen-Caffier, B. (2010). A body-related dot-probe task reveals distinct attentional patterns for bulimia nervosa and anorexia nervosa. Journal of Abnormal Psychology, 119, 575.
Borzekowski, D. L., Schenk, S., Wilson, J. L., & Peebles, R. (2010). e-Ana and e-Mia: a content analysis of pro-eating disorder web sites. American Journal of Public Health, 100, 1526–1534.
Bounoua, L., Cury, F., Regner, I., Huguet, P., Barron, K. E., & Elliot, A. J. (2012). Motivated use of information about others: linking the 2× 2 achievement goal model to social comparison propensities and processes. British Journal of Social Psychology, 51, 626–641.
Bourn, R., Prichard, I., Hutchinson, A. D., & Wilson, C. (2015). Watching reality weight loss TV. The effects on body satisfaction, mood, and snack food consumption. Appetite, 91, 351–356.
Bucchianeri, M. M., Arikian, A. J., Hannan, P. J., Eisenberg, M. E., & Neumark-Sztainer, D. (2013). Body dissatisfaction from adolescence to young adulthood: findings from a 10-year longitudinal study. Body Image, 10, 1–7.
Cantwell, D. P., Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1997). Correspondence between adolescent report and parent report of psychiatric diagnostic data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 610–619.
Cash, T. F., & Deagle, E. A. (1997). The nature and extent of body‐image disturbances in anorexia nervosa and bulimia nervosa: a meta‐analysis. International Journal of Eating Disorders, 22, 107–126.
Cash, T. F., Fleming, E. C., Alindogan, J., Steadman, L., & Whitehead, A. (2002). Beyond body image as a trait: the development and validation of the body image states scale. Eating Disorders, 10, 103–113.
Cohen, J. (1988). Statistical power analysis for the behavior science. New York: Routledge Academic.
Cordes, M., Vocks, S., Düsing, R., Bauer, A., & Waldorf, M. (2016). Male body image and visual attention towards oneself and other men. Psychology of Men and Masculinity, 17, 243–254.
Cundall, A., & Guo, K. (2015). Women gaze behaviour in assessing female bodies: The effects of clothing, body size, own body composition and body satisfaction. Psychological Research, 1–12.
Delinsky, S. S., & Wilson, G. T. (2006). Mirror exposure for the treatment of body image disturbance. International Journal of Eating Disorders, 39, 108–116.
Dobson, K. S., & Dozois, D. J. (2004). Attentional biases in eating disorders: a meta-analytic review of stroop performance. Clinical Psychology Review, 23, 1001–1022.
Durkin, S. J., & Paxton, S. J. (2002). Predictors of vulnerability to reduced body image satisfaction and psychological wellbeing in response to exposure to idealized female media images in adolescent girls. Journal of Psychosomatic Research, 53, 995–1005.
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: interview or self‐report questionnaire? International Journal of Eating Disorders, 16, 363–370.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.
Fardouly, J., Diedrichs, P. C., Vartanian, L. R., & Halliwell, E. (2015). Social comparisons on social media: the impact of Facebook on young women’s body image concerns and mood. Body Image, 13, 38–45.
Fassino, S., Pierò, A., Gramaglia, C., & Abbate-Daga, G. (2004). Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity. Psychopathology, 37, 168–174.
Fichter, M. M., & Quadflieg, N. (2007). Long‐term stability of eating disorder diagnoses. International Journal of Eating Disorders, 40, S61–S66.
Field, M., Munafò, M. R., & Franken, I. H. (2009). A meta-analytic investigation of the relationship between attentional bias and subjective craving in substance abuse. Psychological Bulletin, 135, 589–607.
Freeman, R., Touyz, S., Sara, G., Rennie, C., Gordon, E., & Beumont, P. (1991). In the eye of the beholder: processing body shape information in anorexic and bulimic patients. International Journal of Eating Disorders, 10, 709–714.
Garner, D. M. (1991). Eating Disorder Inventory-2. Professional Manuals. Odessa: Psychological Assessment Resources.
Glass, G. V., Peckham, P. D., & Sanders, J. R. (1972). Consequences of failure to meet assumptions underlying the fixed effects analyses of variance and covariance. Review of Educational Research, 42, 237–288.
Green, M. W., & McKenna, F. P. (1993). Developmental onset of eating related color‐naming interference. International Journal of Eating Disorders, 13, 391–397.
Grills, A. E., & Ollendick, T. H. (2002). Issues in parent–child agreement: the case of structured diagnostic interviews. Clinical Child and Family Psychology Review, 5, 57–83.
Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., … & Pine, D. S. (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982–990.
Hargreaves, D. A., & Tiggemann, M. (2004). Idealized media images and adolescent body image: “Comparing” boys and girls. Body Image, 1, 351–361.
Hayes, J. F., D’Anci, K. E., & Kanarek, R. B. (2011). Foods that are perceived as healthy or unhealthy differentially alter young women’s state body image. Appetite, 57, 384–387.
Hilbert, A., & Tuschen-Caffier, B. (2006). Eating Disorder Examination-Questionnaire: Deutschsprachige Übersetzung (Bd. 02) [Eating Disorder Examination-Questionnaire: German Translation]. Münster: Verlag für Psychotherapie.
Hilbert, A., Tuschen-Caffier, B., Karwautz, A., Niederhofer, H., & Munsch, S. (2007). Eating disorder examination-questionnaire. Diagnostica, 53, 144–154.
Hildebrandt, T., Loeb, K., Troupe, S., & Delinsky, S. (2012). Adjunctive mirror exposure for eating disorders: a randomized controlled pilot study. Behaviour Research and Therapy, 50, 797–804.
Holmqvist, K., Nyström, M., Andersson, R., Dewhurst, R., Jarodzka, H., & Van de Weijer, J. (2011). Eye tracking: A comprehensive guide to methods and measures. Oxford: Oxford University Press.
Horndasch, S., Kratz, O., Holczinger, A., Heinrich, H., Hönig, F., Nöth, E., & Moll, G. H. (2012). “Looks do matter” – visual attentional biases in adolescent girls with eating disorders viewing body images. Psychiatry Research, 198, 321–323.
Hüttermann, S., & Memmert, D. (2015). The influence of motivational and mood states on visual attention: a quantification of systematic differences and casual changes in subjects’ focus of attention. Cognition and Emotion, 29, 471–483.
In-Albon, T., Kossowsky, J., & Schneider, S. (2010). Vigilance and avoidance of threat in the eye movements of children with separation anxiety disorder. Journal of Abnormal Child Psychology, 38, 225–235.
Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin, 130, 19–65.
Janelle, C. M., Hausenblas, H. A., Ellis, R., Coombes, S. A., & Duley, A. R. (2009). The time course of attentional allocation while women high and low in body dissatisfaction view self and model physiques. Psychology and Health, 24, 351–366.
Jansen, A., Nederkoorn, C., & Mulkens, S. (2005). Selective visual attention for ugly and beautiful body parts in eating disorders. Behaviour Research and Therapy, 43, 183–196.
Jansen, A., Voorwinde, V., Hoebink, Y., Rekkers, M., Martijn, C., & Mulkens, S. (2016). Mirror exposure to increase body satisfaction: should we guide the focus of attention towards positively or negatively evaluated body parts? Journal of Behavior Therapy and Experimental Psychiatry, 50, 90–96.
Johnson, F., & Wardle, J. (2005). Dietary restraint, body dissatisfaction, and psychological distress: a prospective analysis. Journal of Abnormal Psychology, 114, 119.
Kraus, N., Lindenberg, J., Zeeck, A., Kosfelder, J., & Vocks, S. (2015). Immediate effects of body checking behaviour on negative and positive emotions in females with eating disorders: an ecological momentary assessment approach. European Eating Disorders Review, 23, 399–407.
Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863.
Legenbauer, T., Thiemann, P., & Vocks, S. (2014). Body image disturbance in children and adolescents with eating disorders. Zeitschrift für Kinder-und Jugendpsychiatrie und Psychotherapie, 42, 51–59.
Littleton, H. L., & Ollendick, T. (2003). Negative body image and disordered eating behavior in children and adolescents: what places youth at risk and how can these problems be prevented? Clinical Child and Family Psychology Review, 6, 51–66.
Melnyk, S. E., Cash, T. F., & Janda, L. H. (2004). Body image ups and downs: prediction of intra-individual level and variability of women’s daily body image experiences. Body Image, 1, 225–235.
Mogg, K., Bradley, B., Miles, F., & Dixon, R. (2004). Brief report time course of attentional bias for threat scenes: testing the vigilance‐avoidance hypothesis. Cognition and Emotion, 18, 689–700.
Mond, J., Mitchison, D., Latner, J., Hay, P., Owen, C., & Rodgers, B. (2013). Quality of life impairment associated with body dissatisfaction in a general population sample of women. BMC Public Health, 13, 920.
Myers, T. A., & Crowther, J. H. (2009). Social comparison as a predictor of body dissatisfaction: a meta-analytic review. Journal of Abnormal Psychology, 118, 683–698.
Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244–251.
Neuschwander, M., In-Albon, T., Adornetto, C., & Schneider, S. (2013). Interrater-Reliabilität des Diagnostischen Interviews bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS) [Interrater reliability of the “Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter”(Kinder-DIPS)]. Zeitschrift für Kinder-und Jugendpsychiatrie und Psychotherapie, 41, 319–334.
Norris, M. L., Boydell, K. M., Pinhas, L., & Katzman, D. K. (2006). Ana and the internet: a review of pro‐anorexia websites. International Journal of Eating Disorders, 39, 443–447.
Owen, R., & Spencer, R. M. (2013). Body ideals in women after viewing images of typical and healthy weight models. Body Image, 10, 489–494.
Paul, T., & Thiel, A. (2005). Eating Disorder Inventory-2 (EDI-2): Deutsche Version [Eating Disorder Inventory-2 (EDI-2): German Version.] Göttingen: Hogrefe.
Pinhas, L., Fok, K. H., Chen, A., Lam, E., Schachter, R., Eizenman, O., … & Eizenman, M. (2014). Attentional biases to body shape images in adolescents with anorexia nervosa: An exploratory eye-tracking study. Psychiatry Research, 220, 519–526.
Renwick, B., Campbell, I. C., & Schmidt, U. (2013). Attention bias modification: a new approach to the treatment of eating disorders? International Journal of Eating Disorders, 46, 496–500.
Rinck, M., & Becker, E. S. (2006). Spider fearful individuals attend to threat, then quickly avoid it: evidence from eye movements. Journal of Abnormal Psychology, 115, 231–238.
Rodgers, R. F., & DuBois, R. H. (2016). Cognitive biases to appearance-related stimuli in body dissatisfaction: a systematic review. Clinical Psychology Review, 46, 1–11.
Roefs, A., Jansen, A., Moresi, S., Willems, P., van Grootel, S., & van der Borgh, A. (2008). Looking good. BMI, attractiveness bias and visual attention. Appetite, 51, 552–555.
Ruuska, J., Kaltiala-Heino, R., Rantanen, P., & Koivisto, A. M. (2005). Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa? Eating and Weight Disorders, 10, 98–106.
Salbach-Andrae, H., Schneider, N., Bürger, A., Pfeiffer, E., Lehmkuhl, U., & Holzhausen, M. (2010). Psychometrische Gütekriterien des Eating Disorder Inventory (EDI-2) bei Jugendlichen [Psychometric properties of the Eating Disorder Inventory (EDI-2) in adolescents]. Zeitschrift für Kinder-und Jugendpsychiatrie und Psychotherapie, 38, 219–228.
Schmider, E., Ziegler, M., Danay, E., Beyer, L., & Bühner, M. (2010). Is it really robust? Reinvestigating the robustness of ANOVA against violations of the normal distribution assumption. Methodology, 6, 147–151.
Schneider, N., Frieler, K., Pfeiffer, E., Lehmkuhl, U., & Salbach‐Andrae, H. (2009a). Comparison of body size estimation in adolescents with different types of eating disorders. European Eating Disorders Review, 17, 468–475.
Schneider, S., Unnewehr, S., & Margraf, J. (2009b). Kinder-DIPS – Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter [Kinder-DIPS – Diagnostic interview for mental disorders in childhood and adolescence].Heidelberg: Springer.
Schneider, S., Weiss, M., Thiel, A., Werner, A., Mayer, J., Hoffmann, H., … & GOAL Study Group. (2013). Body dissatisfaction in female adolescents: Extent and correlates. European Journal of Pediatrics, 172, 373–384.
Seiffge‐Krenke, I., & Kollmar, F. (1998). Discrepancies between mothers’ and fathers’ perceptions of sons’ and daughters’ problem behaviour: a longitudinal analysis of parent‐adolescent agreement on internalising and externalising problem behaviour. Journal of Child Psychology and Psychiatry, 39, 687–697.
Shafran, R., Fairburn, C. G., Robinson, P., & Lask, B. (2004). Body checking and its avoidance in eating disorders. International Journal of Eating Disorders, 35, 93–101.
Simons, M., Schneider, S., & Herpertz-Dahlmann, B. (2006). Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. Psychotherapy and Psychosomatics, 75, 257–264.
Smeets, E., Jansen, A., & Roefs, A. (2011a). Bias for the (un)attractive self: on the role of attention in causing body (dis)satisfaction. Health Psychology, 30, 360–367.
Smeets, E., Tiggemann, M., Kemps, E., Mills, J. S., Hollitt, S., Roefs, A., & Jansen, A. (2011b). Body checking induces an attentional bias for body‐related cues. International Journal of Eating Disorders, 44, 50–57.
Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 14, 406–414.
Smith, E., & Rieger, E. (2009). The effect of attentional training on body dissatisfaction and dietary restriction. European Eating Disorders Review, 17, 169–176.
Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. Journal of Psychosomatic Research, 53, 985–993.
Swami, V., Frederick, D. A., Aavik, T., Alcalay, L., Allik, J., Anderson, D., … & Danel, D. (2010). The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the international body project I. Personality and Social Psychology Bulletin, 36, 309–325.
Tantleff-Dunn, S., Barnes, R. D., & LaRose, J. G. (2011). It’s not just a “woman thing”: the current state of normative discontent. Eating Disorders, 19, 392–402.
Vocks, S., Legenbauer, T., Wächter, M., Wucherer, M., & Kosfelder, J. (2007). What happens in the course of body exposure? Physiological, cognitive and affective reactions to mirror confrontation in eating disorders. Journal of Psychosomatic Research, 62, 231–239.
Vocks, S., Hechler, T., Rohrig, S., & Legenbauer, T. (2009a). Effects of a physical exercise session on state body image: the influence of pre-experimental body dissatisfaction and concerns about weight and shape. Psychology and Health, 24, 713–728.
Vocks, S., Stahn, C., Loenser, K., & Legenbauer, T. (2009b). Eating and body image disturbances in male-to-female and female-to-male transsexuals. Archives of Sexual Behavior, 38, 364–377.
Vocks, S., Schulte, D., Busch, M., Grönemeyer, D., Herpertz, S., & Suchan, B. (2011). Changes in neuronal correlates of body image processing by means of cognitive-behavioural body image therapy for eating disorders: a randomised-controlled fMRI study. Psychological Medicine, 41, 1651–1664.
von Wietersheim, J., Kunzl, F., Hoffmann, H., Glaub, J., Rottler, E., & Traue, H. C. (2012). Selective attention of patients with anorexia nervosa while looking at pictures of their own body and the bodies of others: an exploratory study. Psychosomatic Medicine, 74, 107–113.
Williamson, D. A., White, M. A., York-Crowe, E., & Stewart, T. M. (2004). Cognitive-behavioral theories of eating disorders. Behavior Modification, 28, 711–738.
Acknowledgements
This study was funded by the Swiss Anorexia Nervosa Foundation (project number 08–11) and the Mercator Foundation (project number An-2010-0036) awarded to S. Vocks and S. Schneider. We thank all of the girls who participated in this study, as well as the involved research assistants and graduate students for their support during data collection and data management.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in this study.
Rights and permissions
About this article
Cite this article
Bauer, A., Schneider, S., Waldorf, M. et al. Selective Visual Attention Towards Oneself and Associated State Body Satisfaction: an Eye-Tracking Study in Adolescents with Different Types of Eating Disorders. J Abnorm Child Psychol 45, 1647–1661 (2017). https://doi.org/10.1007/s10802-017-0263-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-017-0263-z