Implicit and explicit affect toward food and weight stimuli in anorexia nervosa Victoria L. Spring ⁎, Cynthia M. Bulik The University of North Carolina at Chapel Hill, UNC Center for Excellence for Eating Disorders, Neurosciences Hospital, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599, United States abstract article info Article history: Received 23 April 2013 Received in revised form 24 August 2013 Accepted 16 October 2013 Available online 24 October 2013 Keywords: Anorexia nervosa Implicit affect Eating disorders Thin ideal Recovery Fat phobia We know strikingly little about the core affective processes that drive the development and maintenance of, and recovery from anorexia nervosa (AN). To partially address this knowledge gap, we measured implicit and explicit affect toward pleasant, neutral, unpleasant, food-relevant, and weight-relevant images in three groups: in patients with acute AN, individuals recovered from AN, and healthy controls with no history of AN. Compared with the other two groups, acutely ill AN participants displayed significantly greater implicit positive affect toward pleasant images and significantly greater implicit negative affect toward unpleasant, high-calorie food, and overweight body type images. Recovered participants did not differ significantly from controls on any implic- it affect measure. Explicit affective patterns were similar to implicit, but explicit measures yielded much smaller effect sizes and failed to detect certain group differences. Overall, negative implicit affect toward high-calorie foods and overweight body types may represent core affective processes that are operative during acute AN. © 2013 Elsevier Ltd. All rights reserved. 1. Introduction Affective processes such as fear of fat and drive for thinness are mo- tivating features of anorexia nervosa (AN) (Habermas, 1996; Steinglass, Eisen, Attia, Mayer, & Walsh, 2007), and are typically measured via ex- plicit self-report which is vulnerable to biases such as lack of insight, mo- tivation to conceal, and adherence to social norms (Konstantakopoulos, Tchanturia, Surguladze, & David, 2011; Nisbett & Wilson, 1977). Implicit measures that avoid these complications (Gawronski & Bodenhausen, 2006) reveal a bias against overweight- and toward underweight-related stimuli in AN patients; however, most studies yield only small to moderate effect sizes, fail to provide information about underlying affective processes, and rely on reaction time (Cserjesi et al., 2010; Woud, Anschutz, Van Strien, & Becker, 2011), which may be compromised by executive functioning deficits in AN (Green, Ellimon, Wakeling, & Rogers, 1996; Zakzanis, Campbell, & Polsinelli, 2010). The Affect Misattribution Procedure (AMP; Payne, Cheng, Govorun, & Stewart, 2005), a computer-based measure of implicit affect, is reliable (Cronbach's alphas .8–.9), powerful (Cohen's d N 1.0), and specific to affective valence (Payne et al., 2005). The AMP indexes automatic affec- tive reactions (i.e., implicit affect) to stimuli that are minimally impacted by explicit self-report processes (c.f. Gawronski & Bodenhausen, 2006). Social pressure and motivation to conceal do not affect performance (Payne, Govorun, & Arbuckle, 2008). We used AMP to examine affective processes in AN toward emotionally-valenced and AN-specific stimuli. We hypothesized that AN patients would display significantly more negative responses to overweight and high-calorie stimuli, and significantly more positive responses to underweight and low-calorie stimuli. 2. Material and methods 2.1. Participants Fifty-two females ages 18 to 44 (M = 21.4, Median = 19, SD = 5.79) participated. Nine had current DSM-IV AN; 14 were recovered from AN (i.e., healthy BMI for at least one year and not meeting diagnostic criteria for AN) recruited from university listservs; and 29 were healthy controls with no history of eating disorders, recruited from Introductory Psychology courses. 84.6% of participants were white. This study was approved by the Behavioral Institutional Review Board at UNC Chapel Hill; written informed consent was obtained; and recovered patients were reimbursed $10. 2.2. Measures 2.2.1. Assessments The Structured Clinical Interview for DSM IV—Research Edition (SCID-I/P) Module H (First, Spitzer, Gibbon, & Williams, 2002) and the Eating Disorders Examination Questionnaire (Lang, Bradley, & Eating Behaviors 15 (2014) 91–94 ⁎ Corresponding author at: Department of Psychology, 218 Spence Laboratories of Psychology, University of Iowa, Iowa City, IA 52242, United States. Tel.: +1 919 943 8895. E-mail addresses: victoria-spring@uiowa.edu (V.L. Spring), cynthia_bulik@med.unc.edu (C.M. Bulik). 1471-0153/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.eatbeh.2013.10.017 Contents lists available at ScienceDirect Eating Behaviors