Information processing biases in eating disorders
Introduction
Recent cognitive accounts of emotional disorders have suggested that biases in attention and memory may act as maintenance factors in their psychopathology. Much of this work has focused on anxiety disorders such as panic disorder (Clark, 1988), social phobia Clark & McManus, 2002, Rapee & Heimberg, 1997, specific phobias (e.g., Thorpe & Salkovskis, 1997), posttraumatic stress disorder (PTSD; McNally, English, & Lipke, 1993), obsessive-compulsive disorder (Rachman, 1997) and depression (Rude, Wenzlaff, Gibbs, Vane, & Whitney, 2002). Comparable biases of attention and memory have also been demonstrated more recently in people with eating disorders Ainsworth et al., 2002, Faunce, 2002, Huon, 1995, Williamson et al., 1999 and these have been suggested to contribute to their maintenance (Vitousek & Hollon, 1990). The purpose of this paper is to present a current review of the existing literature on attentional and memory biases in eating disorders, and to consider in further detail the clinical implications of such biases. While a number of reviews in the field of eating disorders have already been presented (e.g., Ainsworth et al., 2002, Faunce, 2002, Huon, 1995), memory biases have tended to be neglected in general reviews, and the clinical implications of such reviews have not always received sufficient focus. Moreover, this review is particularly timely, with the publication of recent research demonstrating the potential for modification of information processing biases to be used as a therapeutic intervention (MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002). The implications of such a finding are discussed later.
Section snippets
Information processing in eating disorders
Information processing theories are specifically interested in the way in which material, particularly of an emotional and/or threatening kind are processed, and how this may contribute to the emotional disorder (MacLeod, Mathews, & Tata, 1986). One of the earliest accounts of information processing biases in eating disorders suggested that they arose from “maladaptive schemata” associated with food, shape, weight, and self (Vitousek & Hollon, 1990). It was suggested that patients with eating
The emotional Stroop task: some background
The Stroop task (Stroop, 1935) was initially modified in the 1980s to assess attentional bias in emotional disorders such as anxiety and depression. In the original task, participants are required to name the color of the ink of an item while attempting to ignore the item itself, and it is well established that participants take longer to name the color of the item when the items are antagonistic color names than when they are rows of Xs. In this modified Stroop task, participants are asked to
The emotional Stroop in eating disorders: experimental data
The use of the emotional Stroop in eating disorders is almost identical to that in anxiety disorders. Generally, studies have compared reaction times (RTs) for the color naming of eating disorder salient stimuli (e.g., ‘fat’) with either the color-naming of nonwords (e.g., XXXX) or the color naming of control words (e.g., ‘pencil’).
The emotional Stroop in eating disorders: conceptual and methodological issues
A number of concerns have been raised about the use of the Stroop task, and these can generally be divided into conceptual and methodological points, each of which will be highlighted in turn.
Conceptual concerns have focused largely on the appropriateness of the emotional Stroop to measure attentional biases in general. Little attention has been given to accounting for the mechanisms behind the interference effect. For example, there is no clear consensus as to whether the effects seen in
The dot probe task: some background
Given the limitations of the emotional Stroop task, it is not surprising that investigators have turned to other methods to investigate the relationship between attention and psychopathology. One of the most widely used alternative measures of attentional bias is the dot probe task, originally developed by MacLeod et al. (1986). In this task, pairs of stimuli (e.g., a threat word and a neutral word) are briefly presented on a screen and are immediately followed by a dot (the probe) in the
The dot probe in eating disorders
To the best of our knowledge, only one study to date has investigated attentional biases in people with clinical eating disorders using the dot probe method (Reiger et al., 1998). In this study, 35 women with AN or BN demonstrated a tendency to direct their attention away from positive shape words connoting a thin physique and towards negative shape words connoting a large physique. This finding was interpreted as showing that patients with eating disorders attended to information consistent
Memory biases in eating disorders
Few studies have examined memory biases in people with clinical eating disorders. The largest study found that 30 patients with a range of eating disorders recalled more ‘fatness’-related words than control words, and recalled more of these words than women without a clinical eating disorder (Sebastian, Williamson, & Blouin, 1996). However, this study did not control for the valence of the words, hence, it may be the case that the clinical participants were demonstrating a bias for negative
Conclusions and clinical implications
This review has presented an overview of the existing literature relating to biases of attention and memory in eating disorders. More effort has been devoted to the investigation of attentional biases in the literature using the Stroop task and this has been reflected in the review. While there has been some variation in findings, research has generally indicated that people with eating disorders take longer to name the color of eating-, shape-, and weight-related words than other words.
Acknowledgements
This review was supported by a research career development fellowship awarded to RS by The Wellcome Trust (63209).
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