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Attentional Processing of Food Pictures in Individuals with Anorexia Nervosa—An Eye-Tracking Study
Abstract
Background Etiologic models of anorexia nervosa (AN) suggest that cognitive factors play a crucial role in the disorder's psychopathology. Attentional aspects of food processing in AN remain largely unknown. Both an early attentional bias (vigilance) and inattentiveness (avoidance) to food pictures have been reported in patients with eating disorders. The study's aim was to examine the vigilance-avoidance hypothesis concerning food information processing by unraveling the time course of attention deployment in individuals with AN. Methods We used eye-tracking to examine continuous attention deployment in 19 individuals with AN during free visual exploration of food pictures versus nonfood pictures compared with 18 fasted and 20 nonfasted healthy control subjects. Results Compared with healthy control subjects, AN patients allocated overall less attention to food pictures but showed no early attentional bias toward food pictures. Attentional engagement for food pictures was most pronounced in fasted healthy control subjects. The extent of attention deployment in AN patients was associated with indicators of the disorder's severity. Conclusions Gaze data suggest that individuals with AN show no early vigilance but later avoidance when confronted with food information. This suggests that initially, AN patients perceive incentive salience from food information because they process food pictures in the same way healthy control subjects do. The time course of attention deployment s…
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“Consistent with this finding, other studies have found that AN patients exhibit approach toward, as well as avoidance of, food stimuli (Giel et al., 2011; Murray & Strigo, 2018).”
From Advancing the treatment of anxiety disorders in transition‐age youth: a review of the therapeutic effects of unconscious exposure. (2025) · cites this paper as Giel et al., 2011
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Innovative Techniques for Evaluating Behavioral Nutrition Interventions
Scherr, R. E., Laugero, K. D., Graham, D. J., Cunningham, B. T., Jahns, L., Lora, K. R., Reicks, M. M., & Mobley, A. R. (2017) · Advances in Nutrition · doi:10.3945/an.116.013862 · Cited by 32
“Individuals with eating disorders show attentional avoidance of food information that increases with disorder severity (92).”
BackgroundA Putative Association of COMT Val(108/158)Met with Impulsivity in Binge Eating Disorder
Leehr, E. J., Schag, K., Brückmann, C., Plewnia, C., Zipfel, S., Nieratschker, V., & Giel, K. E. (2015) · European Eating Disorders Review · doi:10.1002/erv.2421 · Cited by 31
Self-citationLiterary reading and eating disorders: survey evidence of therapeutic help and harm
Troscianko, E. T. (2018) · Journal of Eating Disorders · doi:10.1186/s40337-018-0191-5 · Cited by 28
“At one end, as noted, sufferers may over-attribute significance to specific (often inappropriately externalised or objectified) body- and food-related stimuli [42, 43], and at the other, they may have avoidant attitudes towards the embodied experience of hunger that are predictive of clinical outcomes [44].”
Backgroundde Vries, R., de Vet, E., de Graaf, K. C., & Boesveldt, S. (2020) · Appetite · doi:10.1016/j.appet.2020.104718 · Cited by 31
“5 kg/m2 and obese>30 kg/m2) weight classes (Castellanos et al., 2009; Giel et al., 2011).”
Different attention bias patterns in anorexia nervosa restricting and binge/purge types
Mann, T. G., Hamdan, S., Bar‐Haim, Y., Lazarov, A., Enoch‐Levy, A., Dubnov‐Raz, G., Treasure, J. L., & Stein, D. J. (2018) · European Eating Disorders Review · doi:10.1002/erv.2593 · Cited by 25
Garcia‐Burgos, D., Lao, J., Munsch, S., & Caldara, R. (2017) · Food Research International · doi:10.1016/j.foodres.2017.04.011 · Cited by 26
Heightened attentional capture by visual food stimuli in anorexia nervosa.
Neimeijer, R. A. M., Roefs, A., & de Jong, P. J. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000275 · Cited by 28
“In line with this, previous research using a free viewing task involving food stimuli found evidence for attentional avoidance of food in AN patients (Giel et al., 2011).”
ResultO'Hara, C., Keyes, A., Renwick, B., Giel, K. E., Campbell, I. C., & Schmidt, U. H. (2016) · PLoS ONE · doi:10.1371/journal.pone.0165104 · Cited by 27
Self-citationCeleghin, A., Palermo, S., Giampaolo, R., Fini, G. D., Gandino, G., & Civilotti, C. (2023) · Brain Sciences · doi:10.3390/brainsci13030465 · Cited by 29
Sharpe, E. E., Wallis, D. J., & Ridout, N. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.04.065 · Cited by 21
“Nevertheless, it is comparable with sample sizes reported in three eye-tracking studies involving participants with clinical (Giel et al., 2011) and non-clinical disordered eating (Gao et al., 2011; Hewig et al., 2008).”
InfluentialPlacebo Effects on Visual Food Cue Reactivity: An Eye-Tracking Investigation
Potthoff, J., Jurinec, N., & Schienle, A. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00525 · Cited by 21
“Similar free-exploration instructions have been used before to study attentional biases in visual food cue perception (27, 28).”
MethodAltered orienting of attention in anorexia nervosa
Dalmaso, M., Castelli, L., Franchetti, L., Carli, L., Todisco, P., Palomba, D., & Galfano, G. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.06.044 · Cited by 30
“…social stimuli specifically related to AN, such as food or bodies, revealing the presence of an attentional bias towards these stimuli, at least under some circumstances (e.g., Brooks et al., 2011; Giel et al., 2011; Urgesi et al., 2012; Aspen et al., 2013; Urgesi et al., 2013; Kim et al., 2014).”
Fletcher-Watson, S., & Hampton, S. (2018) · Scientific Reports · doi:10.1038/s41598-018-32444-9 · Cited by 20
Horne, D., Palermo, R., Neumann, M. F., Housley, R., & Bell, J. (2019) · Appetite · doi:10.1016/j.appet.2019.04.017 · Cited by 19
Giel, K. E., Rieber, N., Enck, P., Friederich, H., Meile, T., Zipfel, S., & Teufel, M. (2013) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2013.09.012 · Cited by 20
“According to previous eye-tracking studies [5,20], 4 different gaze data measures were used: (1) the orientation of the initial fixation (percentage of trials on which the initial fixation is directed on the respective AOI after the trial’s onset), (2) the latency of the initial fixation (time elapsed after trial onse…”
BackgroundMethodSelf-citationReward sensitivity predicts ice cream-related attentional bias assessed by inattentional blindness
Li, X., Tao, Q., Fang, Y., Chen, C., Hao, Y., Qi, J., Li, Y., Zhang, W., Wang, Y., & Zhang, X. (2015) · Appetite · doi:10.1016/j.appet.2015.02.010 · Cited by 17
Antisaccadic Training to Improve Impulsivity in Binge Eating Disorder
Giel, K. E., Schag, K., Plewnia, C., & Zipfel, S. (2013) · European Eating Disorders Review · doi:10.1002/erv.2245 · Cited by 17
“While we have used an established paradigm predominantly assessing reward sensitivity (Castellanos et al., 2009; Giel et al., 2011a), we newly developed an adapted version of the antisaccade task to investigate food-related impulsivity (Figure 1b).”
BackgroundMethodSelf-citationProcessing of Emotional Faces in Patients with Chronic Pain Disorder: An Eye-Tracking Study
Giel, K. E., Paganini, S., Schank, I., Enck, P., Zipfel, S., & Junne, F. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00063 · Cited by 17
Self-citationBehrens, S. C., Streuber, S., Keizer, A., & Giel, K. E. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1011620 · Cited by 20
“Eye-tracking, which was traditionally bound to experimental setups requiring head fixation (12), can be used to enable gaze recording in relatively natural settings (13, 14) and hands-free navigation in setups that need the user to keep still (15).”
BackgroundSelf-citationMurray, S. B., & Strigo, I. A. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22883 · Cited by 14
“For instance, some studies of those with AN have found reduced psychophysiological reactivity to palatable food images (Soussignan, Jiang, Rigaud, Royet, & Schaal, 2010), and lesser attentional allocation to food cues (Giel et al., 2011).”
#foodie: Implications of interacting with social media for memory
Zimmerman, J., & Brown-Schmidt, S. (2020) · Cognitive Research · doi:10.1186/s41235-020-00216-7 · Cited by 14
Baldofski, S., Lüthold, P., Sperling, I., & Hilbert, A. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.07.005 · Cited by 13
Homeostatic modulation on unconscious hedonic responses to food
Sato, W., Sawada, R., Kubota, Y., Toichi, M., & Fushiki, T. (2017) · BMC Research Notes · doi:10.1186/s13104-017-2835-y · Cited by 13
How do patients with eating disorders perceive and evaluate food portion sizes? A systematic review
Dörsam, A. F., Mack, I., Kögel, L., Zipfel, S., & Giel, K. E. (2020) · European Eating Disorders Review · doi:10.1002/erv.2743 · Cited by 16
Self-citationThe origins of disordered eating and childhood food neophobia
Maratos, F. A., & Sharpe, E. E. (2018) · Elsevier eBooks · doi:10.1016/b978-0-08-101931-3.00015-x · Cited by 14
Bahadori, A. R., Javadnia, P., Bordbar, S., Zafari, R., Taherkhani, T., Davari, A., Tafakhori, A., Shafiee, S., & Ranji, S. (2025) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-025-01716-5 · Cited by 12
Soleymani, A., Mazidi, M., Neimeijer, R. A. M., & de Jong, P. J. (2022) · Appetite · doi:10.1016/j.appet.2022.105934 · Cited by 14
“the free-viewing paradigm for measuring AB towards various food-related stimuli (Baldofski, Lüthold, Sperling, & Hilbert, 2018; Giel et al., 2011; Graham, Hoover, Ceballos, & Komogortsev, 2011; Horndasch et al., 2020; Hummel, Ehret, Zerweck, Winter, & StroebeleBenschop, 2018; Nijs, Muris, Euser, & Franken, 2010; Potth…”
BackgroundInfluentialBroadley, M. M., Bishop, T., White, M. J., & Andrew, B. (2019) · Appetite · doi:10.1016/j.appet.2019.05.025 · Cited by 10
Lee, I., Preissl, H. T., Giel, K. E., Schag, K., & Enck, P. (2018) · Scientific Reports · doi:10.1038/s41598-017-19112-0 · Cited by 12
Self-citationHow fat will it make me? Estimation of weight gain in anorexia nervosa.
Milos, G., Baur, V., Schumacher, S., Kuenzli, C., Schnyder, U., Mueller-Pfeiffer, C., & Martin-Soelch, C. (2017) · Appetite · doi:10.1016/j.appet.2017.04.002 · Cited by 12
Surgical Treatments for Anorexia Nervosa
Sun, B., Li, D., Liu, W., Zhan, S., Pan, Y., & Zhang, X. (2014) · Springer eBooks · doi:10.1007/978-94-017-9576-0_15 · Cited by 9
Schag, K., Rauch-Schmidt, M., Wernz, F. D., Zipfel, S., Batra, A., & Giel, K. E. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00724 · Cited by 13
“Experimental Paradigms and Stimulus Material Eye tracking with similar paradigms has been used in addiction (30, 31) and eating disorder research (32, 33) before.”
MethodSelf-citationSmartEye: An Accurate Infrared Eye Tracking System for Smartphones
Brousseau, B., Rose, J., & Eizenman, M. (2018) · Ubiquitous Computing, Electronics & Mobile Communication Conference · doi:10.1109/uemcon.2018.8796799 · Cited by 11
“that it has great potential as a medical instrument, having been used in the assessment of mood, attention, perception and learning disorders, the detection of Alzheimer’s [7], autism [8], depression [9], schizophrenia [10], [11], dyslexia [12], and anorexia [13], [14].”
Backgroundde Vries, R., Boesveldt, S., & de Vet, E. (2021) · doi:10.1016/j.foodqual.2021.104338 · Cited by 10
Leslie, M. R., Leppänen, J., Paloyelis, Y., & Treasure, J. L. (2020) · Journal of Neuroendocrinology · doi:10.1111/jne.12843 · Cited by 11
Shankland, R., Favre, P., Corubolo, D., Méary, D., Flaudias, V., & Mermillod, M. (2019) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-019-00687-8 · Cited by 11
“In experimental investigations, the visual processing of food appraisal has become a reference [16, 27, 32, 38].”
BackgroundPuttevils, L., Bruecker, M. D., Allaert, J., Sánchez-López, Á., Schryver, N. D., Vervaet, M., Baeken, C., & Vanderhasselt, M. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.06.039 · Cited by 9
Frausto, H. R., Roesmann, K., Klinkenberg, I. A. G., Rehbein, M. A., Föcker, M., Romer, G., Junghoefer, M., & Wessing, I. (2021) · Psychological Medicine · doi:10.1017/s003329172100088x · Cited by 9
“Finally, when the visual exploration of food stimuli was captured by eye-tracking, both HC and AN patients directed their initial attention towards food stimuli, but in a later time interval, AN patients showed attentional disengagement (Giel et al., 2011).”
BackgroundAttention towards food: Conflicting mechanisms in anorexia nervosa.
Horndasch, S., Oschmann, S., Graap, H., Heinrich, H., Moll, G., & Kratz, O. (2020) · Appetite · doi:10.1016/j.appet.2020.104800 · Cited by 9
Ralph-Nearman, C., & Filik, R. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22961 · Cited by 9
Eye Tracking as a Marker of Hyperphagia in Prader-Willi Syndrome
Key, A. P. F., & Dykens, E. M. (2018) · Developmental Neuropsychology · doi:10.1080/87565641.2017.1367395 · Cited by 11
“For example, Giel et al. (2011) studied the effects of food restriction on visual attention in persons with anorexia nervosa and typical controls.”
BackgroundMeregalli, V., Ambrosini, E., Granziol, U., Zech, H., Daga, G. A., Martini, M., Sala, A., Ceccato, E., Tenconi, E., Cardi, V., et al. (2024) · Appetite · doi:10.1016/j.appet.2024.107697 · Cited by 9
Sierra, I., Senín-Calderón, C., Roncero, M., & Perpiñá, C. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.723732 · Cited by 8
Schroeder, P. A., Collantoni, E., Lohmann, J., Butz, M. V., & Plewnia, C. (2024) · Behavioural Brain Research · doi:10.1016/j.bbr.2024.115096 · Cited by 9
“In behavioural measures, energy-dense food stimuli are considered more attractive than non-food stimuli in clinical and non-clinical populations [15,68].”
Background
Metadata
- Authors
- Giel, K. E., Friederich, H.-C., Teufel, M., Hautzinger, M., Enck, P., & Zipfel, S.
- Affiliations
- Universitätsklinikum Tübingen (DE)
- University Hospital Heidelberg (DE)
- University of Tübingen (DE)
- Corresponding author
- Giel, Katrin E.
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2011-04
- Volume
- 69
- Issue
- 7
- Pages
- 661-667
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2012452018
- Cited by
- 161
- References
- 0
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 12 · 2023: 9 · 2022: 10 · 2021: 12 · 2020: 11 · 2019: 12 · 2018: 18 · 2017: 16 · 2016: 6 · 2015: 15 · 2014: 6 · 2013: 13 · 2012: 4
- FWCI
- 7.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bundesministerium für Bildung und Forschung (01GV0624)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- anorexia nervosa, food images, attentional bias, food avoidance, attentional deployment, eye movements, incentive salience, eating disorders, food processing, disorder severity
- MeSH terms
- Adolescent, Adult, Analysis of Variance, Anorexia Nervosa, Attention Deficit Disorder with Hyperactivity, Female, Fixation, Ocular, Food, Humans, Orientation, Photic Stimulation, Psychophysics, Statistics as Topic, Visual Perception, Young Adult
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