Exploring the relationship between proactive inhibition and restrictive eating behaviours in severe and enduring anorexia nervosa (SE-AN)

Savani Bartholdy; Bethan Dalton; Samantha J. Rennalls; Maria Kekic; Jessica McClelland; Iain C. Campbell; Owen G. O’Daly; Ulrike Schmidt

doi:10.1186/s40337-024-01165-y

Exploring the relationship between proactive inhibition and restrictive eating behaviours in severe and enduring anorexia nervosa (SE-AN)

Savani Bartholdy, Bethan Dalton, Samantha J. Rennalls, Maria Kekic, Jessica McClelland, Iain C. Campbell, Owen G. O’Daly, Ulrike Schmidt^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: There is a need for improved understanding of why 20–30% of individuals with anorexia nervosa (AN) develop a severe and enduring form of illness (SE-AN). Previously, we reported differences in proactive inhibition (a pre-emptive slowing of responses) in individuals with AN compared to healthy controls (after controlling for intolerance of uncertainty). The present study is a preliminary exploration of proactive inhibition in which we compared women with SE-AN with healthy comparison (HC) women and explored its association with restrictive/avoidant eating behaviours. Methods: Thirty-four women with SE-AN (defined by >3 years of illness and a previous unsuccessful course of eating disorder treatment) and 30 HCs completed (a) a cued reaction time task, to assess proactive inhibition, and (b) questionnaires assessing restrictive/avoidant eating behaviours and intolerance of uncertainty. Results: Both SE-AN and HC participants showed slower reaction times under conditions of uncertainty, indicating proactive inhibition in both groups. There was a main effect of group, with SE-AN participants showing significantly slower reaction times compared to HC. There was no interaction between group and condition, suggesting that individuals with SE-AN did not differ in proactive inhibition compared to HCs. However, post-hoc analysis between-group tests for each trial type revealed that group differences were only present under conditions of uncertainty. Proactive inhibition was not significantly associated with self-reported restrictive/avoidant eating behaviours, including when taking intolerance of uncertainty into consideration. Conclusions: It is unlikely that proactive inhibition contributes to avoidant and restrictive eating behaviours seen in SE-AN. Our findings suggest that the SE-AN group are relatively more cautious when responding under conditions of uncertainty. Longitudinal studies and between-group comparisons of individuals across different stages of illness will be required to elucidate the way in which proactive inhibition is specifically implicated in SE-AN, rather than in AN more generally.

Original language	English
Article number	1
Journal	Journal of Eating Disorders
Volume	13
Issue number	1
DOIs	https://doi.org/10.1186/s40337-024-01165-y
Publication status	Published - 3 Jan 2025

Keywords

Anorexia nervosa
Inhibitory control
Intolerance of uncertainty
Proactive inhibition
Restrictive eating

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10.1186/s40337-024-01165-y

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title = "Exploring the relationship between proactive inhibition and restrictive eating behaviours in severe and enduring anorexia nervosa (SE-AN)",

abstract = "Background: There is a need for improved understanding of why 20–30% of individuals with anorexia nervosa (AN) develop a severe and enduring form of illness (SE-AN). Previously, we reported differences in proactive inhibition (a pre-emptive slowing of responses) in individuals with AN compared to healthy controls (after controlling for intolerance of uncertainty). The present study is a preliminary exploration of proactive inhibition in which we compared women with SE-AN with healthy comparison (HC) women and explored its association with restrictive/avoidant eating behaviours. Methods: Thirty-four women with SE-AN (defined by >3 years of illness and a previous unsuccessful course of eating disorder treatment) and 30 HCs completed (a) a cued reaction time task, to assess proactive inhibition, and (b) questionnaires assessing restrictive/avoidant eating behaviours and intolerance of uncertainty. Results: Both SE-AN and HC participants showed slower reaction times under conditions of uncertainty, indicating proactive inhibition in both groups. There was a main effect of group, with SE-AN participants showing significantly slower reaction times compared to HC. There was no interaction between group and condition, suggesting that individuals with SE-AN did not differ in proactive inhibition compared to HCs. However, post-hoc analysis between-group tests for each trial type revealed that group differences were only present under conditions of uncertainty. Proactive inhibition was not significantly associated with self-reported restrictive/avoidant eating behaviours, including when taking intolerance of uncertainty into consideration. Conclusions: It is unlikely that proactive inhibition contributes to avoidant and restrictive eating behaviours seen in SE-AN. Our findings suggest that the SE-AN group are relatively more cautious when responding under conditions of uncertainty. Longitudinal studies and between-group comparisons of individuals across different stages of illness will be required to elucidate the way in which proactive inhibition is specifically implicated in SE-AN, rather than in AN more generally.",

keywords = "Anorexia nervosa, Inhibitory control, Intolerance of uncertainty, Proactive inhibition, Restrictive eating",

author = "Savani Bartholdy and Bethan Dalton and Rennalls, {Samantha J.} and Maria Kekic and Jessica McClelland and Campbell, {Iain C.} and O{\textquoteright}Daly, {Owen G.} and Ulrike Schmidt",

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doi = "10.1186/s40337-024-01165-y",

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AU - Bartholdy, Savani

AU - Dalton, Bethan

AU - Rennalls, Samantha J.

AU - Kekic, Maria

AU - McClelland, Jessica

AU - Campbell, Iain C.

AU - O’Daly, Owen G.

AU - Schmidt, Ulrike

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2025/1/3

Y1 - 2025/1/3

N2 - Background: There is a need for improved understanding of why 20–30% of individuals with anorexia nervosa (AN) develop a severe and enduring form of illness (SE-AN). Previously, we reported differences in proactive inhibition (a pre-emptive slowing of responses) in individuals with AN compared to healthy controls (after controlling for intolerance of uncertainty). The present study is a preliminary exploration of proactive inhibition in which we compared women with SE-AN with healthy comparison (HC) women and explored its association with restrictive/avoidant eating behaviours. Methods: Thirty-four women with SE-AN (defined by >3 years of illness and a previous unsuccessful course of eating disorder treatment) and 30 HCs completed (a) a cued reaction time task, to assess proactive inhibition, and (b) questionnaires assessing restrictive/avoidant eating behaviours and intolerance of uncertainty. Results: Both SE-AN and HC participants showed slower reaction times under conditions of uncertainty, indicating proactive inhibition in both groups. There was a main effect of group, with SE-AN participants showing significantly slower reaction times compared to HC. There was no interaction between group and condition, suggesting that individuals with SE-AN did not differ in proactive inhibition compared to HCs. However, post-hoc analysis between-group tests for each trial type revealed that group differences were only present under conditions of uncertainty. Proactive inhibition was not significantly associated with self-reported restrictive/avoidant eating behaviours, including when taking intolerance of uncertainty into consideration. Conclusions: It is unlikely that proactive inhibition contributes to avoidant and restrictive eating behaviours seen in SE-AN. Our findings suggest that the SE-AN group are relatively more cautious when responding under conditions of uncertainty. Longitudinal studies and between-group comparisons of individuals across different stages of illness will be required to elucidate the way in which proactive inhibition is specifically implicated in SE-AN, rather than in AN more generally.

AB - Background: There is a need for improved understanding of why 20–30% of individuals with anorexia nervosa (AN) develop a severe and enduring form of illness (SE-AN). Previously, we reported differences in proactive inhibition (a pre-emptive slowing of responses) in individuals with AN compared to healthy controls (after controlling for intolerance of uncertainty). The present study is a preliminary exploration of proactive inhibition in which we compared women with SE-AN with healthy comparison (HC) women and explored its association with restrictive/avoidant eating behaviours. Methods: Thirty-four women with SE-AN (defined by >3 years of illness and a previous unsuccessful course of eating disorder treatment) and 30 HCs completed (a) a cued reaction time task, to assess proactive inhibition, and (b) questionnaires assessing restrictive/avoidant eating behaviours and intolerance of uncertainty. Results: Both SE-AN and HC participants showed slower reaction times under conditions of uncertainty, indicating proactive inhibition in both groups. There was a main effect of group, with SE-AN participants showing significantly slower reaction times compared to HC. There was no interaction between group and condition, suggesting that individuals with SE-AN did not differ in proactive inhibition compared to HCs. However, post-hoc analysis between-group tests for each trial type revealed that group differences were only present under conditions of uncertainty. Proactive inhibition was not significantly associated with self-reported restrictive/avoidant eating behaviours, including when taking intolerance of uncertainty into consideration. Conclusions: It is unlikely that proactive inhibition contributes to avoidant and restrictive eating behaviours seen in SE-AN. Our findings suggest that the SE-AN group are relatively more cautious when responding under conditions of uncertainty. Longitudinal studies and between-group comparisons of individuals across different stages of illness will be required to elucidate the way in which proactive inhibition is specifically implicated in SE-AN, rather than in AN more generally.

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KW - Restrictive eating

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Exploring the relationship between proactive inhibition and restrictive eating behaviours in severe and enduring anorexia nervosa (SE-AN)

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