On bells, saliva, and abdominal pain or discomfort: Early aversive visceral conditioning and vulnerability for anorexia nervosa
Open accessAbstract
Gastrointestinal (GI) symptoms are common in anorexia nervosa (AN), can predate illness onset, complicate renourishment, and persist after recovery. We explore how, through processes of aversive visceral conditioning, early GI pain and discomfort may increase vulnerability to AN in some individuals. Processes include enhanced preoccupation with the gut resulting from aversive visceral memories and disruptions in the typical acquisition of self‐attunement when children learn to map and interpret interoceptive sensations and develop adaptive actions. We question whether a fear of weight gain, in some cases, may be an epiphenomenon of the recapitulation of actual or perceived GI symptoms that is especially relevant during puberty, especially in girls. This conceptualization has immediate clinical implications and offers ideas for future research. We propose that GI discomfort associated with renourishment may reignite prior aversive visceral experiences. We encourage development of a formulation that organizes the individual's current experience of the body with respect to these prior aversive experiences. Our conceptualization underscores the importance of assessment of GI experiences in individuals with AN; the examination of dietary strategies that minimize GI symptoms and enhance renourishment efficacy; and strategies that attempt to alter this aversive visceral conditioning by mapping sensations to meanings and adaptive actions.
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The physical subdomain of anxiety sensitivity may be particularly salient for eating disorders, because early learning experiences with gastrointestinal distress and pain may create vigilance to gastrointestinal sensations and increase risk for developing an eating disorder.
“The physical subdomain of AS may be particularly salient for EDs, as early learning experiences with gastrointestinal distress and pain may create vigilance to gastrointestinal sensations, increasing risk for developing an ED (Zucker & Bulik, 2020).”
From Early reduction in anxiety sensitivity predicts greater reduction in disordered eating and trait anxiety during treatment for bulimia nervosa. (2024) · cites this paper as Zucker & Bulik, 2020
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Experimental — accuracy not yet measuredThe findings align with anxiety-based models of eating disorders that emphasize the role of fear and avoidance learning.
“Our findings align with anxiety-based models of EDs emphasizing the role of fear and avoidance learning in EDs (Christian & Levinson, 2022; Zucker & Bulik, 2020).”
From Early reduction in anxiety sensitivity predicts greater reduction in disordered eating and trait anxiety during treatment for bulimia nervosa. (2024) · cites this paper as Zucker & Bulik, 2020
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- Authors
- Zucker, N. L., & Bulik, C. M.
- Affiliations
- Duke University (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Zucker, Nancy L.
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2020-03-06
- Volume
- 53
- Issue
- 4
- Pages
- 508-512
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC8344083
- OpenAlex
- W3009375036
- Cited by
- 48
- References
- 36
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 10 · 2023: 5 · 2022: 9 · 2021: 12
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institute of Mental Health (R21MH115397, R33‐MH‐097959)
- Swedish Research Council (538‐2013‐8864)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- anorexia nervosa, gastrointestinal symptoms, abdominal pain, interoception, fear of weight gain, puberty, girls, nutritional strategies
- MeSH terms
- Adolescent, Anorexia Nervosa, Child, Female, Humans, Male, Saliva, Abdominal Pain
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