Perhaps There is More Driving Anorexia Than Weight

The fear of weight gain (or fatphobia, FP) has long been considered one of the central characteristics of anorexia nervosa (AN). However, recent research challenges this traditionally accepted idea, indicating there may be more driving anorexia than weight.

Anorexia Nervosa and Fear of Weight Gain

Eating disorder specialists and medical professionals have traditionally believed the underlying reason driving AN behaviors (e.g., food restriction, over-exercise, and purging) is the fear of weight gain. In fact, in the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), fear of weight gain is outlined as one of the fundamental criteria used to diagnose AN [1]. Consequently, one of the main priorities of traditional anorexia treatment is addressing and reducing the fear of weight gain [2].

However, recent research suggests not all individuals with AN are driven by fatphobia or the fear of weight gain [3]. For example, according to one study, approximately 20 percent of people with AN do not report a fear of weight gain [4]. Furthermore, the 5th and most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) no longer includes fatphobia as an essential criterion for AN diagnosis [5].

Is There More Driving Anorexia Than Fear of Weight Gain?

Though recent findings seem to challenge the notion that fear of weight gain is a universally central feature of AN, research on the subject is still relatively limited. In fact, the majority of studies on fear of weight gain among AN patients have relied on self-report surveys, meaning answers may be biased, misleading, or false [6]. In order to better understand the role fatphobia and fear of weight gain plays in AN, a group of researchers recently conducted a study using the Implicit Association Test (IAT) on AN patients in Germany [7].

The goal of the study was to uncover why some individuals with AN deny experiencing fear of weight gain by determining if a) fear of weight gain does not exist in these people, b) if they simply cannot consciously perceive their fear of weight gain, or c) if they deny their fear of weight gain [8]. As the researchers attest, uncovering the role fatphobia and fear of weight gain plays in anorexia may help guide AN diagnoses and improve future treatment outcomes.

Measuring Fear of Weight Gain Among AN Patients

Unlike the majority of studies on this subject, the researchers did not rely on explicit, self-report questionnaires, which may be susceptible to false or misleading answers. Instead, they used the Implicit Association Test (IAT), which simply asks participants to categorize items on a screen.

The speed at which participants categorized each item was then analyzed to determine their implicit drive for thinness. Though drive for thinness is not identical to fear of weight gain or fatphobia, prior research shows that it is an effective way to uncover implicit fatphobia among AN patients [9].

Interestingly, the results revealed that individuals with anorexia nervosa consistently exhibit a greater implicit drive for thinness than healthy control subjects [10]. The results also indicated that an implicit drive for thinness is directly associated with ED symptomatology, suggesting fear of weight gain is, in fact, one of the key characteristics of AN. However, the results did show varying degrees of implicit drive for thinness, with a higher drive for thinness directly associated with more pronounced ED psychopathology.

Conclusions

Though explicit studies (i.e., tests that ask participants to self-report their fear of weight gain and utilize yes-no questions) often suggest individuals with AN do not always experience a fear of weight gain, the IAT indicates AN patients consistently experience an implicit drive for thinness (and subsequently, a fear of weight gain).

This finding indicates the importance of using implicit tests to measure fatphobia instead of relying on explicit, self-report questionnaires. By utilizing implicit measures to screen for fatphobia, researchers and practitioners may more accurately determine AN patients’ fear of weight gain and use this information to guide diagnoses and inform more effective therapeutic approaches.

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References:

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington DC: American Psychiatric Association; 1994.
[2] Borgers, T., Krüger, N., Vocks, S. et al. Overcoming limitations of self-report: an assessment of fear of weight gain in anorexia nervosa and healthy controls using implicit association tests. J Eat Disord 9, 26 (2021). https://doi.org/10.1186/s40337-021-00379-8
[3] ibid.
[4] ibid.
[5] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Association; 2013. https://doi.org/10.1176/appi.books.9780890425596.
[6] Borgers, T., Krüger, N., Vocks, S. et al. Overcoming limitations of self-report: an assessment of fear of weight gain in anorexia nervosa and healthy controls using implicit association tests. J Eat Disord 9, 26 (2021). https://doi.org/10.1186/s40337-021-00379-8
[7] ibid.
[8] ibid.
[9] ibid.
[10] ibid.

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About the Author:

Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.

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We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published April 20, 2021, on EatingDisorderHope.com
Reviewed & Approved on April 20, 2021, by Jacquelyn Ekern MS, LPC