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This study investigates excessive avoidance behaviors in patients with a diagnosis of Anorexia Nervosa (AN) compared to a healthy control group. The study further examines the role of reward (relief) as a putative factor in maintaining excessive avoidance behaviors in AN.
Anorexia Nervosa (AN) is a life-threatening mental disease with a disappointing treatment outcome. Fear of weight gain and diet restrictions are considered the core symptoms of AN. Although from a diagnostic perspective AN is conceptualized as an eating-related disorder connected to an extremely low Body Mass Index (BMI) and body image distortion, AN might represent a specific phenotype of anxiety disorders characterized by tenacious avoidance behaviors, especially the restrictive subtype. To date, avoidance in AN is often investigated as a general personality trait (e.g. harm avoidance) but poorly examined in its behavioral form (which is life-threatening, such as food-avoidance). Hence, the investigators will perform a systematic investigation of excessive avoidance behaviors within a laboratory setting. Within a learning perspective, the investigators will investigate excessive avoidance in a group of 30 AN patients and 30 healthy volunteers. To achieve this, a well-validated avoidance paradigm will be used. Most critically, the investigators will examine whether patients with a diagnosis of anorexia nervosa show persistent avoidance behaviors compared to a control group. Additionally, the investigators will examine if, in the anorexia group, higher subjective relief to successful omissions of negative events during avoidance learning predicts persistent (excessive) avoidance behaviors after fear extinction.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Healthy controls | The healthy control group will perform a well-validated avoidance (behavioral) task and will fill in some questionnaires about eating behaviors, emotions, and feelings. |
| |
| Anorexia Nervosa patients | As the healthy controls, the participants of the anorexia nervosa group will perform the same behavioral task and will fill in the same questionnaires |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Behavioral avoidance task | Behavioral | Behavioral task able to measure avoidance actions, US-expectancy, and reward-related indexes in different learning times |
|
| Measure | Description | Time Frame |
|---|---|---|
| Button clicks during a red cue will be recorded as a measure of avoidance (binary response) | To investigate whether, compared to healthy controls, individuals with a diagnosis of anorexia nervosa show excessive avoidance behaviors (frequent clicking to prevent the aversive stimulus). Repeated measure ANOVA (analysis of variance) will be employed to evaluate differences between groups. If data will violate the assumption of normality, mixed or generalize methods will be used. | through study completion, an average of 1 year |
| Relief pleasantness ratings (Visual Analog Scale, from neutral [0] to very pleasant [100]) | To investigate whether, compared to healthy controls, individuals with a diagnosis of anorexia nervosa show higher relief pleasantness during the omission of the aversive stimuli. The investigators will also test if such responses predict a return in avoidance behaviors (button click) after fear has been extinguished. Repeated measure ANOVA (analysis of variance) and multiple linear regressions will be employed to evaluate differences between groups. If data will violate the assumption of normality mixed or generalize methods will be used. | through study completion, an average of 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| US-Expectancy ratings (Likert scale from 0:no picture to 10:certainly a picture) | To investigate whether, compared to healthy controls, individuals with a diagnosis of anorexia nervosa show higher US-expectancies during both avoidance learning and fear extinction learning. Repeated measure ANOVA (analysis of variance) will be employed to evaluate differences between groups. If data will violate the assumption of normality mixed or generalize methods will be used. |
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Inclusion Criteria:
Exclusion Criteria:
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The anorexia patients are recruited from a primary care clinic. Healthy controls are recruited from the general population
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Laurence Claes, Prof. Dr. | Contact | +32 16 32 61 33 | laurence.claes@kuleuven.be | |
| Bram Vervliet, Prof. Dr. | Contact | bram.vervliet@kuleuven.be |
| Name | Affiliation | Role |
|---|---|---|
| Laurence Claes, Prof. Dr. | KU Leuven | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Psychiatry | UZ Leuven campus Gasthuisberg | Recruiting | Leuven | 3000 | Belgium |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15569892 | Background | Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004 Dec;161(12):2215-21. doi: 10.1176/appi.ajp.161.12.2215. | |
| 10713801 | Background | Godart NT, Flament MF, Lecrubier Y, Jeammet P. Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance. Eur Psychiatry. 2000 Feb;15(1):38-45. doi: 10.1016/s0924-9338(00)00212-1. |
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| ID | Term |
|---|---|
| D001068 | Feeding and Eating Disorders |
| D001008 | Anxiety Disorders |
| D000856 | Anorexia Nervosa |
| ID | Term |
|---|---|
| D012817 | Signs and Symptoms, Digestive |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001523 | Mental Disorders |
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| through study completion, an average of 1 year |
| Eating Disorders Inventory [EDI] | Higher scores at the EDI, and especially to the drive for thinness subscale, correlate with higher avoidance actions. | through study completion, an average of 1 year |
| Distress Tolerance Scale [DTS] | Lower scores at the DTS correlate with higher relief and higher avoidance actions | through study completion, an average of 1 year |
| University of KU Leuven, Faculteit Psychologie en Pedagogische Wetenschappen | Recruiting | Leuven | 3000 | Belgium |
|
| 23201859 | Background | Koskina A, Campbell IC, Schmidt U. Exposure therapy in eating disorders revisited. Neurosci Biobehav Rev. 2013 Feb;37(2):193-208. doi: 10.1016/j.neubiorev.2012.11.010. Epub 2012 Nov 29. |
| 27463780 | Background | Murray SB, Loeb KL, Le Grange D. Dissecting the Core Fear in Anorexia Nervosa: Can We Optimize Treatment Mechanisms? JAMA Psychiatry. 2016 Sep 1;73(9):891-2. doi: 10.1001/jamapsychiatry.2016.1623. No abstract available. |
| 30392878 | Background | Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA. Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev. 2018 Dec;95:383-395. doi: 10.1016/j.neubiorev.2018.10.013. Epub 2018 Oct 28. |
| 25481622 | Background | Wierenga CE, Bischoff-Grethe A, Melrose AJ, Irvine Z, Torres L, Bailer UF, Simmons A, Fudge JL, McClure SM, Ely A, Kaye WH. Hunger does not motivate reward in women remitted from anorexia nervosa. Biol Psychiatry. 2015 Apr 1;77(7):642-52. doi: 10.1016/j.biopsych.2014.09.024. Epub 2014 Oct 22. |
| 25151600 | Background | Park RJ, Godier LR, Cowdrey FA. Hungry for reward: How can neuroscience inform the development of treatment for Anorexia Nervosa? Behav Res Ther. 2014 Nov;62:47-59. doi: 10.1016/j.brat.2014.07.007. Epub 2014 Jul 26. |