The DOI matches its Crossref record; 8 of the 8 references it cites were found in a registry or an index.
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…
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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
Citations
Cites
Spitzer, R. L. (1999) · JAMA · doi:10.1001/jama.282.18.1737 · Cited by 9,802
Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00088-8 · Cited by 3,374
New insights into symptoms and neurocircuit function of anorexia nervosa
Kaye, W. H., Fudge, J. L., & Paulus, M. (2009) · Nature Reviews Neuroscience · doi:10.1038/nrn2682 · Cited by 843
Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study
Zipfel, S., Löwe, B., Reas, D. L., Deter, H.-C., & Herzog, W. (2000) · The Lancet · doi:10.1016/s0140-6736(99)05363-5 · Cited by 524
Self-citationMogg, K., Bradley, B. P., Field, M., & De Houwer, J. (2003) · Addiction · doi:10.1046/j.1360-0443.2003.00392.x · Cited by 455
Eye movement assessment of selective attentional capture by emotional pictures.
Nummenmaa, L., Hyönä, J., & Calvo, M. G. (2006) · Emotion · doi:10.1037/1528-3542.6.2.257 · Cited by 454
Browning, M., Holmes, E. A., & Harmer, C. J. (2010) · Cognitive, Affective, & Behavioral Neuroscience · doi:10.3758/cabn.10.1.8 · Cited by 247
Spider fearful individuals attend to threat, then quickly avoid it: Evidence from eye movements.
Rinck, M., & Becker, E. S. (2006) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.115.2.231 · Cited by 231
Flagged first, then by citations
Research works printed but not linked: 31
- Vitousek, 1990, The investigation of schematic content and processing in eating disorders, Cognit Ther Res, 14, 191, 10.1007/BF01176209 · DOI
- Giel, 2010, Processing of pictorial food stimuli in patients with eating disorders—a systematic review, Int J Eat Disord
- Nikendei, 2008, Anorexia nervosa: Selective processing of food-related word and pictorial stimuli in recognition and free recall tests, Int J Eat Disord, 41, 439, 10.1002/eat.20518 · DOI
- Shafran, 2007, Attentional bias in eating disorders, Int J Eat Disord, 40, 369, 10.1002/eat.20375 · DOI
- Shafran, 2008, Effect of psychological treatment on attentional bias in eating disorder, Int J Eat Disord, 41, 348, 10.1002/eat.20500 · DOI
- Stormark, 2004, Selective processing of linguistic and pictorial food stimuli in females with anorexia and bulimia nervosa, Eat Behav, 5, 27, 10.1016/j.eatbeh.2003.07.002 · DOI
- Friederich, 2006, Differential motivational responses to food and pleasurable cues in anorexia and bulimia nervosa: A startle reflex paradigm, Psychol Med, 36, 1327, 10.1017/S0033291706008129 · DOI
- Soussignan, 2010, Subliminal fear priming potentiates negative facial reactions to food pictures in women with anorexia nervosa, Psychol Med, 40, 503, 10.1017/S0033291709990377 · DOI
- Cisler, 2010, Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review, Clin Psychol Rev, 30, 203, 10.1016/j.cpr.2009.11.003 · DOI · Paper page
- Berridge, 2009, “Liking” and “wanting” food rewards: Brain substrates and roles in eating disorders, Physiol Behav, 97, 537, 10.1016/j.physbeh.2009.02.044 · DOI · Paper page
- Bar-Haim, 2007, Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study, Psychol Bull, 133, 1, 10.1037/0033-2909.133.1.1 · DOI · Paper page
- Castellanos, 2009, Obese adults have visual attention bias for food cue images: Evidence for altered reward system function, Int J Obes (Lond), 33, 1063, 10.1038/ijo.2009.138 · DOI · Paper page
- Knudsen, 2007, Fundamental components of attention, Annu Rev Neurosci, 30, 57, 10.1146/annurev.neuro.30.051606.094256 · DOI
- Henderson, 2003, Human gaze control during real-world scene perception, Trends Cogn Sci, 7, 498, 10.1016/j.tics.2003.09.006 · DOI
- Gamble, 2009, The time-course of attentional bias in anxious children and adolescents, J Anxiety Disord, 23, 841, 10.1016/j.janxdis.2009.04.001 · DOI
- Kellough, 2008, Time course of selective attention in clinically depressed young adults: An eye tracking study, Behav Res Ther, 46, 1238, 10.1016/j.brat.2008.07.004 · DOI · Paper page
- Dalton, 2007, Gaze-fixation, brain activation, and amygdala volume in unaffected siblings of individuals with autism, Biol Psychiatry, 61, 512, 10.1016/j.biopsych.2006.05.019 · DOI
- Calvo, 2007, Emotional and neutral scenes in competition: Orienting, efficiency, and identification, Q J Exp Psychol (Colchester), 60, 1585, 10.1080/17470210701515868 · DOI
- Uher, 2006, Cerebral processing of food-related stimuli: Effects of fasting and gender, Behav Brain Res, 169, 111, 10.1016/j.bbr.2005.12.008 · DOI · Paper page
- Hepworth, 2010, Negative mood increases selective attention to food cues and subjective appetite, Appetite, 54, 134, 10.1016/j.appet.2009.09.019 · DOI
- Killgore, 2003, Cortical and limbic activation during viewing of high-versus low-calorie foods, Neuroimage, 19, 1381, 10.1016/S1053-8119(03)00191-5 · DOI
- Killgore, 2007, Positive affect modulates activity in the visual cortex to images of high calorie foods, Int J Neurosci, 117, 643, 10.1080/00207450600773848 · DOI
- Reilly, 2008, Pharmacological treatment effects on eye movement control, Brain Cogn, 68, 415, 10.1016/j.bandc.2008.08.026 · DOI · Paper page
- Fichter, 2001, The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): Reliability and validity, Eur Psychiatry, 16, 38, 10.1016/S0924-9338(00)00534-4 · DOI
- Just, 1980, A theory of reading: From eye fixation to comprehension, Psychol Rev, 87, 329, 10.1037/0033-295X.87.4.329 · DOI
- Kemps, 2009, Attentional bias for craving-related (chocolate) food cues, Exp Clin Psychopharmacol, 17, 425, 10.1037/a0017796 · DOI
- Santel, 2006, Hunger and satiety in anorexia nervosa: fMRI during cognitive processing of food pictures, Brain Res, 1114, 138, 10.1016/j.brainres.2006.07.045 · DOI
- Uher, 2003, Recovery and chronicity in anorexia nervosa: Brain activity associated with differential outcomes, Biol Psychiatry, 54, 934, 10.1016/S0006-3223(03)00172-0 · DOI
- Porubská, 2006, Subjective feeling of appetite modulates brain activity: An fMRI study, Neuroimage, 32, 1273, 10.1016/j.neuroimage.2006.04.216 · DOI
- Kaye, 2008, Neurobiology of anorexia and bulimia nervosa, Physiol Behav, 94, 121, 10.1016/j.physbeh.2007.11.037 · DOI · Paper page
- Keating, 2010, Theoretical perspective on anorexia nervosa: The conflict of reward, Neurosci Biobehav Rev, 34, 73, 10.1016/j.neubiorev.2009.07.004 · DOI
Cited by
Sorted by citations
Items 101–142 of 142
Xie, P., Sang, H., Huang, C., & Zhou, A. (2023) · Scientific Reports · doi:10.1038/s41598-023-43455-6 · Cited by 8
Multiple Composite Scenarios: A Game-Based Methodology for the Prevention of Mental Disorders
Lepe-Salazar, F., & Salgado-Torres, S. (2022) · Entertainment Computing · doi:10.1016/j.entcom.2022.100519 · Cited by 11
Eyes on the body: Assessing attentional bias toward body-related stimuli in Anorexia Nervosa
Meregalli, V., Giovannini, S., Trevisan, A., Romanelli, M., Uğur, S., Tenconi, E., Meneguzzo, P., Cardi, V., & Collantoni, E. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.01.043 · Cited by 6
Meregalli, V., Ambrosini, E., Tenconi, E., Schroeder, P. A., Cardi, V., Veronese, A., Meneguzzo, P., Favaro, A., & Collantoni, E. (2023) · Appetite · doi:10.1016/j.appet.2023.106639 · Cited by 6
Estimation of meal portions in bulimia nervosa compared to anorexia nervosa and healthy controls
Pasi, P., Piccolo, M., Kaufmann, L.-K., Martin-Soelch, C., Müller-Pfeiffer, C., & Milos, G. (2022) · Eating and Weight Disorders · doi:10.1007/s40519-022-01410-w · Cited by 6
“The overestimation of food portion sizes in BN seems to reflect one aspect of the general cognitive distortions typically seen also in AN [27, 28], where perception is not only disturbed in relation to interoceptive awereness [29, 30], but also in relation to non-bodily external objects such as food portion size.”
BackgroundGiel, K. E., Conzelmann, A., Renner, T. J., Richter, T., Benito, S. M., Zipfel, S., & Schag, K. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23209 · Cited by 11
Self-citationEichin, K., Georgii, C., Schnepper, R., Voderholzer, U., & Blechert, J. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.24028 · Cited by 6
“In behavioral tasks, they show neither an attentional bias (looking at foods longer than at objects; Giel et al., 2011) nor an approach bias to foods (Paslakis et al., 2016).”
BackgroundLeehr, E. J., Schag, K., Vogel, J., Dresler, T., Zipfel, S., Fallgatter, A. J., Hautzinger, M., Dannlowski, U., Ehlis, A., & Giel, K. E. (2022) · Appetite · doi:10.1016/j.appet.2022.106386 · Cited by 8
Self-citationHeath, D. S., Jhinjar, N., & Hayward, D. A. (2021) · Scientific Reports · doi:10.1038/s41598-021-94117-4 · Cited by 6
“54 favouring the alternative), while the DE and ED groups did not (DE: t(17) = 1.”
BackgroundMethodVisual attention to food cues and the course of anorexia nervosa.
Jonker, N., Glashouwer, K. A., Ostafin, B., & de Jong, P. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103649 · Cited by 5
Eye tracking as an objective measure of hyperphagia in children with Prader‐Willi syndrome
Key, A. P. F., Zengin‐Bolatkale, H., Dimitropoulos, A., & Doernberg, E. A. (2020) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.61606 · Cited by 7
Carroll, G., Cohen, L. R., McParland, A., Jack, S., & Montrose, V. T. (2020) · Animals · doi:10.3390/ani10040721 · Cited by 5
“Participants were instructed to view 30 pairs of images as if they were watching television, and to focus on the fixation point between image presentations [66].”
BackgroundFantozzi, P., Billeci, L., Muratori, P., Maestro, S., Muratori, F., Chakrabarti, B., & Calderoni, S. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01075-z · Cited by 6
Surber, C., Hoepfel, D., Günther, V., Kersting, A., Rufer, M., Suslow, T., & Bodenschatz, C. M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1338194 · Cited by 5
Neuropsychological Aspects of Eating Disorders
Zucker, N. L., Moskvich, A., & Soo, A. (2011) · Psychiatric Annals · doi:10.3928/00485713-20111017-07 · Cited by 4
Xie, P., Sang, H., Wang, X., & Huang, C. (2025) · Appetite · doi:10.1016/j.appet.2025.107913 · Cited by 2
Financial scarcity and financial avoidance: an eye-tracking and behavioral experiment
Hilbert, L. P., Noordewier, M., Seck, L., & van Dijk, W. V. (2024) · Psychological Research · doi:10.1007/s00426-024-02019-7 · Cited by 3
“For example, research shows that people with anorexia nervosa avoid looking at pictures of food (Giel et al., 2011 ), people with arachnophobia avoid looking at pictures of spiders (Rinck & Becker, 2006 ), and people with social anxiety disorder are less likely to look others in the eye (Chen &…”
Loizou, P., Παναγιώτου, Γ., Zanos, P., & Paraskevopoulos, E. (2024) · PLoS ONE · doi:10.1371/journal.pone.0299529 · Cited by 3
Processing of food stimuli in anorexia nervosa: An ERP-study comparing adolescents and adults.
Stonawski, V., Mai-Lippold, S., Graap, H., Moll, G. H., Kratz, O., Doren, J. V., & Horndasch, S. (2023) · European eating disorders review · doi:10.1002/erv.3040 · Cited by 3
Kuester, A., Schumacher, S., Niemeyer, H., Engel, S., Spies, J., Weiß, D., Muschalla, B., Burchert, S., Tamm, S., Weidmann, A., et al. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101726 · Cited by 4
Kuester, A., Niemeyer, H., Schumacher, S., Engel, S., Spies, J., Weiß, D., Muschalla, B., Burchert, S., Tamm, S., Weidmann, A., et al. (2020) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2020.03.003 · Cited by 3
Attentional Processing Biases in Young People With Binging and Purging Behavior
Freccero, A., Burmester, V., Rodrigues, R., Gallucci, A., Nicholls, D., & Simplicio, M. C. D. (2025) · Brain and Behavior · doi:10.1002/brb3.70322 · Cited by 2
Potthoff, J., & Schienle, A. (2024) · Appetite · doi:10.1016/j.appet.2024.107820 · Cited by 3
Koning, E., Chaves, C., Kirkpatrick, R. H., & Brietzke, E. M. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01185-8 · Cited by 2
Rodriguez, B., Pantano, L., Nef, T., Müri, R. M., & Z'Graggen, W. J. (2024) · European Journal of Neurology · doi:10.1111/ene.16507 · Cited by 2
Do we know our visual preferences?
Guy, N., Kardosh, R., Sklar, A. Y., Lancry-Dayan, O. C., & Pertzov, Y. (2023) · Journal of Vision · doi:10.1167/jov.23.2.9 · Cited by 3
No effect of very brief exposure to masked food pictures on fear of food in anorexia nervosa
Palmer, S., Gronemann, J., Mattler, U., Febry, H., Wünsch‐Leiteritz, W., Leiteritz, A., & Brockmeyer, T. (2021) · European Eating Disorders Review · doi:10.1002/erv.2835 · Cited by 2
“In patients with AN, food avoidance tendencies seem to conflict with approach tendencies (Giel et al., 2011; Murray & Strigo, 2018), given that food stimuli are considered a primary reward (Skinner, 1953).”
BackgroundBiopsychiatric Theories of Eating Disorders
Madden, S. (2015) · doi:10.1002/9781118574089.ch17 · Cited by 2
Siegel, P., & Peterson, B. S. (2025) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.14037 · Cited by 2
Reshaping restriction: virtual embodiment modulates eating biases in anorexia nervosa
Dimakopoulou, M., Ciorli, T., Pyasik, M. M., Col, M. D., Boggio, F., Andriulli, C., Bevione, F., Romanisio, M., Martini, M., Guerraz, M., et al. (2026) · npj Mental Health Research · doi:10.1038/s44184-026-00221-6 · Cited by 1
“Given that such distorted behaviors present signi fi cant challenges to effective treatment 8,9 , approaches targeting earlier stages of visual and behavioral processing are of considerable clinical relevance.”
Food perception in Orthorexia nervosa: Craving or avoidance?
Aiello, M., Umiltà, M. A., Ottoboni, G., & Tessari, A. (2026) · Eating and Weight Disorders · doi:10.1007/s40519-026-01826-8 · Cited by 1
“Interestingly, the attentional pattern that we observed aligns with observations in patients with anorexia nervosa [43–45] and corresponds well with the vigilance-avoidance model, according to which threatening stimuli automatically capture attention at the initial stage but, in later stages, they…”
Pelzer, M., Brockmeyer, T., Tuschen‐Caffier, B., & Werthmann, J. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01459-9 · Cited by 1
“More recent studies, using more refined measures which can distinguish between different attention mechanisms, reveal a less coherent picture (see e.g [49–51]).”
Ralph‐Nearman, C., Hooper, M. A., & Filik, R. (2021) · Cognition & Emotion · doi:10.1080/02699931.2021.1987862 · Cited by 1
“That is, higher or lower BMI in individuals with an eating disorder or in the general population has been shown to be related to attending toward or avoiding different types of foods (e.g., Calitri et al., 2012; Giel et al., 2011; Nummenmaa et al., 2011), and body images (e.”
BackgroundOcular Manifestations of Psychiatric Diseases
Elder, J. E., & Court, A. (2017) · Springer eBooks · doi:10.1007/978-3-319-18389-3_17 · Cited by 1
Temporal attentional bias to food stimuli in adolescent anorexia nervosa – an ERP study
Nannt, J., Wolz, I., Vagedes, J., & Svaldi, J. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01800-w
“Indeed, patients with AN evaluate high-calorie food more negatively and reported anxiety and disgust in response to such stimuli [14, 77, 86–88].”
Szepesi, C. I., Rekenyi, V., Horváth, N., Nagy, R. L., Soós, M., Szemán-Nagy, A., Kondé, Z., Kurucz, G., Xiaonuo, L., & Kolozsvári, L. R. (2026) · Nutrients · doi:10.3390/nu18172899
“Individuals with AN often exhibit initial vigilance followed by rapid avoidance of high-calorie food cues—a strategy hypothesized to regulate food-related anxiety [24–26].”
Zemmahi, A. G., Debatisse, J., Germain, N., David, J., Roullot, M., Météreau, E., Carrier, L., Massoubre, C., Galusca, B., & Tremblay, L. (2026) · International Journal of Eating Disorders · doi:10.1002/eat.70155
Faster Grasping of High-Calorie Food Objects in Virtual RealityPreprint
Schroeder, P. A., Collantoni, E., Lohmann, J., Butz, M. V., & Plewnia, C. (2021) · Research Square · doi:10.21203/rs.3.rs-524244/v1 · Cited by 2
Neurosurgery for Obsessive-Compulsive Disorder: Indications and Procedures
Lopes, A. C. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108164313.022
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
