Biases in attention and memory for body shape images in eating disorders

  • Ashleigh A. PonaEmail author
  • Angela C. Jones
  • Tracy L. Masterson
  • Denise D. Ben-Porath
Original Article



To investigate attentional and memorial biases towards body shape pictures among female patients with clinical eating disorders and healthy female controls.


A visual dot-probe task was used to assess attention towards pictures reflecting either a thin, normal, or obese female body shape. Pictures were presented in pairs; each pair depicted two different body shapes and were presented twice. Participant responses were compared across time and population.


Overall, the eating disorder patients responded more slowly than controls, F(1,63) = 20.32, p < .001. Both groups showed an attentional bias towards the larger of two body shapes, F(1,63) = 4.30, p = .04, and responded more quickly the second time they viewed the picture pairs, F(1,63) = 33.80, p < .001. Upon second viewing of picture pairs, the eating disorder patients had a larger decrease in reaction time (86 ms) than the control sample (33 ms) only when both pictures included extreme body shapes (thin and obese); the decrease in reaction time when one of the pictures included a normal body shape was the same across groups upon second viewing (eating disorder: 37 ms; control: 32 ms), F(1,63) = 9.32, p = .003.


These findings suggest that individuals with eating disorders may be biased towards recall of dichotomous and/or extreme body shape images. While it remains unclear whether attentional and/or memorial bias is a risk, maintenance, or causal factor in eating disorders, future studies should employ longitudinal, prospective research designs to address these questions.

Level of Evidence

Level II, comparative study.


Attentional bias Memorial bias Dot probe Eating disorders 


Author contributions

All authors contributed substantially to the concept, design, analysis, and interpretation of the data presented in the manuscript.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional review board (approval number: 2013-008; date: 11/8/2012) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Vitousek KB, Hollon SD (1990) The investigation of schematic content and processing in eating disorders. Cogn Ther Res 14(2):191–214. CrossRefGoogle Scholar
  2. 2.
    Ben-Tovim DI, Walker MK (1991) Further evidence for the Stroop test as a quantitative measure of psychopathology in eating disorders. Int J Eat Disord 10(5):609–613.<609::AID-EAT2260100513>3.0.CO;2-M CrossRefGoogle Scholar
  3. 3.
    Ben-Tovim D, Walker M, Fok D, Yap E (1989) An adaptation of the Stroop test for measuring shape and food concerns in eating disorders: a quantitative measure of psychopathology? Int J Eat Disord 8:681–687.<681::AID-EAT2260080609>3.0.CO;2-#Google Scholar
  4. 4.
    Perpina C, Hemsley O, Treasure J, de Silva P (1993) Is the selective information processing of food and body words specific to patients with eating disorders? Int J Eat Disord 14:359–366.<359::AID-EAT2260140314>3.0.CO;2-G CrossRefPubMedGoogle Scholar
  5. 5.
    Hermans D, Pieters G, Eelen P (1998) Implicit and explicit memory for shape, body weight, and food-related words in patients with anorexia nervosa and nondieting controls. J Abnorm Psychol 107(2):193–202. CrossRefPubMedGoogle Scholar
  6. 6.
    Sebastian S, Williamson D, Blouin D (1996) Memory bias for fatness stimuli in the eating disorders. Cogn Ther Res 20(3):275–286. CrossRefGoogle Scholar
  7. 7.
    Baker J, Williamson D, Sylve C (1995) Body image disturbance, memory bias, and body dysphoria: effects of negative mood induction. Behav Ther 26:747–759. CrossRefGoogle Scholar
  8. 8.
    Faunce G (2002) Eating disorders and attentional bias: a review. Eat Disord 10(2):125–139. CrossRefPubMedGoogle Scholar
  9. 9.
    Macleod C, Mathews A, Tata P (1986) Attentional bias in emotional disorders. J Abnorm Psychol 95(1):15–20. CrossRefPubMedGoogle Scholar
  10. 10.
    Rieger E et al (1998) Attentional biases in eating disorders: a visual probe detection procdure. Int J Eat Disord 23(2):199–205.<199::AID-EAT10>3.0.CO;2-W CrossRefPubMedGoogle Scholar
  11. 11.
    Shafran R, Lee M, Cooper Z, Palmer R, Fairburn C (2007) Attentional bias in eating disorders. Int J Eat Disord 40:369–380. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Shafran R, Lee M, Cooper Z, Palmer RL, Fairburn CG (2008) Effect of psychological treatment on attentional bias in eating disorders. Int J Eat Disord 41(4):348–354. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Stormark K, Torkildsen O (2004) Selective processing of linguistic and pictorial food stimuli in females with anorexia and bulimia nervosa. Eat Behav 5:27–33. CrossRefPubMedGoogle Scholar
  14. 14.
    Blechert J, Ansorge U, Tuschen-Caffier B (2010) A body-related dot-probe task reveals distinct attentional patterns for bulimia nervosa and anorexia nervosa. J Abnorm Psychol 119(3):575–585. CrossRefPubMedGoogle Scholar
  15. 15.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DC.
  16. 16.
    American Psychiatric Association (2006) Treatment of patients with eating disorders, third edition. Am J Psychiatry 163:4–54. CrossRefGoogle Scholar
  17. 17.
    Fairburn C, Beglin S (2008) Eating disorder examination questionnaire (EDE-Q 6.0). In: Fairburn C (ed) Cognitive behavior therapy and eating disorders. Guilford Press, New York, pp 309–313Google Scholar
  18. 18.
    Aardoom JJ, Dingemans AE, Slof Op’t Landt MCT, Van Furth EF (2012) Norms and discriminative validity of the eating disorder examination questionnaire (EDE-Q). Eat Behav 13(4):305–309. CrossRefPubMedGoogle Scholar
  19. 19.
    Glauert R, Rhodes G, Fink B, Grammer K (2010) Body dissatisfaction and attentional bias to thin bodies. Int J Eat Disord 43(1):42–49. CrossRefPubMedGoogle Scholar
  20. 20.
    Salthouse TA (1991) Theoretical perspectives on cognitive aging. Psychology Press, New York.
  21. 21.
    Craik FIM, McDowd JM (1987) Age differences in recall and recognition. J Exp Psychol Learn Mem Cogn 13:474–479. CrossRefGoogle Scholar
  22. 22.
    Dobson KS, Dozois DJA (2004) Attentional biases in eating disorders: a meta-analytic review of Stroop performance. Clin Psychol Rev 23(8):1001–1022. CrossRefPubMedGoogle Scholar
  23. 23.
    Israeli A, Stewart S (2001) Memory bias for forbidden food cues in restrained eaters. Cogn Ther Res 26:53–62. CrossRefGoogle Scholar
  24. 24.
    Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 41(5):509–528. CrossRefGoogle Scholar
  25. 25.
    Lethbridge J, Watson HJ, Egan SJ, Street H, Nathan PR (2011) The role of perfectionism, dichotomous thinking, shape and weight overvaluation, and conditional goal setting in eating disorders. Eat Behav 12(3):200–206. CrossRefPubMedGoogle Scholar
  26. 26.
    Norris M, Boydell K, Pinhas L, Katzman D (2006) Ana and the internet: a review of pro-anorexia websites. Int J Eat Disord 39:443–447. CrossRefPubMedGoogle Scholar
  27. 27.
    Roberts M, Tchanturia K, Stahl D, Southgate L, Treasure J (2007) A systematic meta-analysis of set-shifting ability in eating disorders. Psychol Med 37:1075–1084. CrossRefPubMedGoogle Scholar
  28. 28.
    Bryant-Waugh R, Knibbs J, Fosson A, Kaminski Z, Lask B (1988) Long term follow up of patients with early onset anorexia nervosa. Arch Dis Child 63:5–9. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Strober M (2004) Pathologic fear conditioning and anorexia nervosa: on the search for novel paradigms. Int J Eat Disord 35:504–508. CrossRefPubMedGoogle Scholar
  30. 30.
    Fichter M, Quadflieg N, Hedlund S (2006) Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord 39:87–100. CrossRefPubMedGoogle Scholar
  31. 31.
    Fairburn C, Cooper P, Cooper M, McKenna F, Anastasiades P (1991) Selective information processing in bulimia nervosa. Int J Eat Disord 10:415–422.<415::AID-EAT2260100406>3.0.CO;2-R CrossRefGoogle Scholar
  32. 32.
    Green M, Wakeling A, Elliman N, Rogers P (1998) Impaired colour-naming of clinically salient words as a measure of recovery in anorexia nervosa. Behav Cogn Psychother 26:53–62. CrossRefGoogle Scholar
  33. 33.
    Friedman K et al (2016) A narrative review of outcome studies for residential and partial hospital-based treatment of eating disorders. Eur Eat Disord Rev 24:263–276. CrossRefPubMedGoogle Scholar
  34. 34.
    Mathews A, MacLeod C (2005) Cognitive vulnerability to emotional disorders. Annu Rev Clin Psychol 1:167–195. CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of Missouri-Kansas CityKansas CityUSA
  2. 2.Department of PsychologyJohn Carroll UniversityUniversity HeightsUSA

Personalised recommendations