Approach and avoidance motivation in eating disorders Amy Harrison a, ⁎, Janet Treasure a , Luke D. Smillie b a Kings College London, Institute of Psychiatry, Section of Eating Disorders, London, UK b Department of Psychology, Goldsmiths, University of London, UK abstract article info Article history: Received 5 May 2010 Received in revised form 12 April 2011 Accepted 20 April 2011 Keywords: Eating disorders Anorexia nervosa Bulimia nervosa Recovery Reinforcement Sensitivity Theory BIS BAS Reward reactivity It has been proposed that approach and avoidance processes may be critically involved in the development and maintenance of eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN). The Behavioural Inhibition System and Behavioural Activation System Scales (BIS/BAS) and Appetitive Motivation Scale (AMS) questionnaires were administered to 286 participants: 91 healthy controls (HCs), 121 participants with a current ED, either AN (restrictive and binge purge subtypes), or BN and 74 participants recovered from an ED. Individuals with EDs had higher levels of sensitivity to punishment and lower levels of reward reactivity than controls. Individuals in recovery from an ED scored the same as those in the acute group, with the exception of BAS fun seeking, for which they scored significantly higher than those with restricting AN. Discriminant analysis revealed that HCs were maximally separated from those in the acute and recovered ED groups along a dimension reflecting high punishment sensitivity and low reward sensitivity. Classification analysis demonstrated that ED and HC group membership was predicted from reward and punishment sensitivity measures; however recovered participants tended to be misclassified as ED. This study suggests high punishment sensitivity and low reward reactivity/sensitivity might form a personality cluster associated with the risk of developing an ED. © 2011 Published by Elsevier Ireland Ltd. 1. Introduction Processes concerning approach and avoidance motivation are a prominent feature in the landscape of personality and psychopathology research, and it has been suggested that two brain-behaviour systems regulate approach of appetitive stimuli and avoidance of aversive stimuli (e.g. Cloninger, 1987; Gray, 1991; Fowles, 1993; Zuckerman, 2005; Depue, 2006; Elliot, 2008; Carver et al., 2009; Smillie et al., 2010). The approach system, the Behavioural Activation System (BAS), is theorised to underlie personality dispositions reflecting reward-sensitivity, includ- ing Extraversion or Impulsivity (see Pickering and Smillie, 2008). The avoidance system, the Behavioural Inhibition System (BIS), is thought to relate to personality dispositions reflecting punishment-sensitivity, including anxiety and Neuroticism (see Corr et al., 1997). In this article, we refer to punishment sensitivity more broadly, as the theoretical predictions and psychometric measures employed do not distinguish between these processes (fear/anxiety). In recent years, it has been proposed (Loxton and Dawe, 2001; Dawe and Loxton, 2004; Loxton and Dawe, 2006, 2007) that approach and avoidance processes may be critically involved in the development and maintenance of eating disorders (EDs). There are a range of reasons why individuals may engage in disordered eating behaviours such as bingeing and purging. For example, using confirmatory factor analysis, Wedig and Nock (2010) recently reported that people binge and purge to regulate their emotional state, specifically to decrease negative emotions and increase positive emotions, or for social reasons, namely to communicate needs to others, or to escape social interaction. Claes et al. (2010), using discriminant analysis found that individual differences in BIS motivation and top-down control independently predicted bingeing/purging behav- iours. However, the proposed relationship between reinforcement sensitivity theory and EDs has been necessarily speculative (Dawe and Loxton, 2004, p. 7). Nevertheless, it has been suggested that the elevated anxiety frequently found in ED populations (e.g., Vitousek and Manke, 1994; Grau and Ortet, 1999) might have a basis in dispositional punishment sensitivity. For example, Ampollini et al. (1999) report that high levels of harm avoidance (a BIS-related construct) are associated with anxiety and depression, which are core features of EDs (Godart et al., 2003; Blinder et al., 2006; Pallister and Waller, 2008). Several authors have confirmed associations between punishment sensitivity and disordered eating (Loxton and Dawe, 2001; Kane et al., 2004; Nederkoorn et al., 2004; Claes et al., 2006). In a recent systematic review, Harrison et al. (2010) found that people with an ED had elevated scores on trait measures of punishment sensitivity (anxiety and harm avoidance measured using the Tridimensional Personality Questionnaire (TPQ) (Cloninger, 1987) and the Temperament and Character Inventory (TCI) (Cloninger, 1993) relative to healthy controls. Genetic data support the notion that such relationships reflect dispositional tendencies rather than transient states or symptoms. For instance, Wilksch and Wade Psychiatry Research 188 (2011) 396–401 ⁎ Corresponding author at: Kings College London, Institute of Psychiatry, Department of Psychological Medicine and Psychiatry, Eating Disorders Research Unit, 5th Floor, Bermondsey Wing, Guy's Hospital. St Thomas Street, London, SE1 9RT, UK. Tel.: + 44 207 188 0190; fax: +44 207 188 0167. E-mail address: amy.harrison@kcl.ac.uk (A. Harrison). 0165-1781/$ – see front matter © 2011 Published by Elsevier Ireland Ltd. doi:10.1016/j.psychres.2011.04.022 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres