From Bad to Worse: Safety Behaviors Exacerbate Eating Disorder Fears

Abstract

When evaluating ambiguous situations, humans sometimes use their behavior as a source of information (behavior-as-information effect) and interpret safety behaviors as evidence for danger. Accordingly, we hypothesized that eating disorder safety behaviors (restrictive eating, body checking, etc.) might aggravate fear and anxiety in individuals with an eating disorder. The present study tested to what extent eating disorder safety behaviors increase threat perception in individuals with and without an eating disorder. For this, 108 individuals with a self-reported eating disorder diagnosis and 82 healthy controls rated the dangerousness of several short situations. The situations systematically varied in the presence of eating disorder safety behaviors and danger information. As expected, all participants perceived situations in which the protagonist executed an eating disorder safety behavior as more threatening than situations without a safety behavior. This 'behavior-as-information' effect was equally strong in individuals with and without an eating disorder. Additionally, safety behaviors strengthened threat perception more in safe situations than in dangerous situations. To conclude, the presence of eating disorder safety behavior can increase threat perception regardless of whether individuals have an eating disorder or not. This makes eating disorder safety behaviors a potential risk factor for the development and maintenance of eating disorder fears.

Keywords: anorexia nervosa; behavior as information; bulimia nervosa; eating disorder; fear of weight gain; safety behaviors; vignette study.

Figure 1

Decision tree for the exclusion of participants from the analysis. Note. HC = healthy control; ED = individuals with an eating disorder; AN = anorexia nervosa; BN = bulimia nervosa.

Figure 2

Mean threat ratings across the different variations of the situations for individuals with an eating disorder (ED) and healthy controls (HCs). Note. SB = safety behavior; blue solid line: eating disorder group and dangerous situation; blue dashed line: eating disorder group and safe situation; red solid line: healthy controls and dangerous situation; red dashed line: healthy controls and safe situation.