7 - (IOP 35) Eating Anxiety and Avoidance Tendencies in Adolescents and Young Adults with Restrictive Eating Disorders

Background: Evidence suggests that anxiety related to food, eating, and weight gain maintains restrictive eating disorders such as anorexia nervosa (AN) and contributes to food avoidance. The approach-avoidance task, a behavioral measure of avoidance tendencies, consistently demonstrates avoidance bias to threat-related stimuli in individuals with anxiety disorders. However, prior studies using this task with participants with AN have not found an avoidance bias to high-calorie foods. These null findings may stem from a methodological limitation: measuring responses to food images without the expectations of actually eating these foods. We hypothesized that connecting food images to the real-world consequence of eating would more effectively elicit anxiety and avoidance behavior in individuals with restrictive eating disorders.

Methods: Participants consisted of adolescents and young adults (14–24 years, mean age 17.3 years, 95.7% female, 6.5% Hispanic, 2.2% Black, 2.2% Native Hawaiian/Pacific Islander, 91.3% White, 6.5% Other) with restricting type AN (n=31) and atypical AN (n=15). After eating lunch in a partial hospitalization program, participants completed an approach-avoidance task with images of high-calorie foods. Participants experienced two counterbalanced conditions one week apart: (1) an Eating Anticipation condition, where they were expected to eat one randomly-selected food; and (2) a No Eating condition, where they were not expected to eat any of the foods viewed.

Results: In the Eating Anticipation condition, participants reported significantly greater increases in distress ratings, F(3, 132)=37.60, p<.001, ɳp2=.46, and state anxiety scores, F(3, 135)=11.55, p<.001, ɳp2=.20, compared to the No Eating condition. Repeated-measures ANOVA found main effects when comparing reaction time toward images of foods versus objects, suggesting that participants were significantly faster at both avoiding, F(1, 42)=7.43, p=.009, ɳp2=.15, and approaching, F(1, 42)=9.70, p=.003, ɳp2=.19, foods relative to objects. No main effect was found when comparing reaction time approaching versus avoiding foods, F(1, 42)=0.001, p=.972, suggesting that participants approached and avoided foods at a similar rate. Repeated-measures ANOVA did not find significant interaction effects, suggesting that participants in both the Eating Anticipation and No Eating conditions avoided foods relative to objects at a similar rate, F(1, 42)=1.22, p=.275, and avoided and approached foods at a similar rate, F(1, 42)=0.35, p=.555, across conditions.

Conclusion: Passively viewing food images may not reliably elicit anxiety in adolescents and young adults with AN and atypical AN. These findings may explain the limited effectiveness of exposure interventions using food images to target food-related anxiety. The approach-avoidance task’s reliability for measuring eating-related avoidance behavior in people with eating disorders requires further investigation.