A review of attention biases in women with eating disorders

Abstract

There is robust evidence that women with eating disorders (EDs) display an attention bias (AB) for disorder-salient stimuli. Emerging data suggest that the presence of these biases may be due, in part, to neurological deficits, such as poor set shifting and weak central coherence. While some have argued that these biases function to predispose and/or act to maintain disordered eating behaviours, evidence supporting this view has rarely been examined. This report summarises and integrates the existing literature on AB in EDs and other related psychiatric disorders to better understand its potential role in the development and maintenance of an ED. The domains reviewed include experimental data using the dot-probe and modified Stroop task and neurobiological findings on AB in women with EDs as well as the role of AB in current theoretical models. We conclude by proposing an integrated model on the role of AB in EDs and discuss treatment approaches aimed at modifying these biases.

Figure 1

A limbic-medial prefrontal circuit view of emotional processing of threat-based stimuli. Relevant structures are separated into three functional groups (core limbic, evaluation and regulation). Threat based material is processed by the limbic system which includes the amygdala and insula. More extensive evaluation of the stimuli occur in the prefrontal cortex, specifically the dorsomedial PFC (dmPFC) and the dorsal anterior cingulate (dACC). Regulation of emotion and core limbic processing occurs through the ventromedial PFC (vmPFC) and the rostral and subgenual anterior cingulate (sgACC, rACC). Finally, the lateral PFC including the ventrolateral PFC (vlPFC) is involved in explicit behavior (e.g., attention/avoidance) and thought to modulate limbic activity.

Figure 2

Meta-analysis and forest plot for positive shape stimuli

Figure 3

Meta-analysis summary statistics and forest plot for negative shape stimuli.

Figure 4

Meta-analysis summary statistics and forest plot for positive eating stimuli

Figure 5

Meta-analysis summary statistics and forest plot for negative eating stimuli.

Figure 6

Proposed Model on the Role of AB in EDs.