Selective Processing of Eating-, Shape-, and Weight-Related Words in Persons With Bulimia Nervosa Myra J. Cooper Oxford University Department of Psychiatry Warneford Hospital Pavlos Anastasiades Oxford University Department of Psychiatry Warneford Hospital Christopher G. Fairburn Oxford University Department of Psychiatry Warneford Hospital ABSTRACT The Stroop color-naming task was used to investigate selective information processing in people with bulimia nervosa. Three cards were used: a target card consisting of words related to eating, weight, and shape; a control word card; and the standard conflicting-color card. Thirty-six patients with bulimia nervosa were compared with a group of age-matched female controls. It was found that the amount of disruption caused to color naming by the target card was significantly greater in the bulimia nervosa group than in the female control group, whereas that caused by the color card was similar in the two groups. The Stroop color-naming task may be a useful objective measure of one aspect of the cognitive disturbance of patients with bulimia nervosa. Myra J. Cooper is supported by a Studentship from the Medical Research Council. Christopher G. Fairburn holds a Wellcome Trust Senior Lectureship. This research was supported in part by a grant from the Wellcome Trust. This work was completed while Christopher G. Fairburn was a Fellow at the Center for Advanced Study in the Behavioral Sciences at Stanford. Support for this Fellowship was provided both by the Foundation Fund for Research in Psychiatry and by the MacArthur Foundation. We wish to thank Paul Salkovskis for his helpful comments on a draft of this manuscript. Correspondence may be addressed to Christopher G. Fairburn, University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom, OX3 7JX. Received: October 11, 1990 Revised: July 5, 1991 Accepted: July 9, 1991 Clinical observations suggest that patients with eating disorders are unusually preoccupied with thoughts about eating, weight, and shape, and it has been suggested that distorted attitudes toward eating, weight, and shape play an important role in maintaining these disorders ( Fairburn, Cooper, & Cooper, 1986 ). However, despite these observations and the recent interest in cognitive-behavioral treatments for eating disorders ( Fairburn, 1985 ; Garner & Bemis, 1985 ), there have been surprisingly few studies of the cognitive disturbance of these patients. Researchers have used brief objective measures, developed by experimental psychologists, to provide valuable information about the cognitive disturbance present in certain clinical populations. One such measure is the Stroop color-naming task ( Stroop, 1935 ), in which interference with color naming Journal of Abnormal Psychology © 1992 by the American Psychological Association May 1992 Vol. 101, No. 2, 352-355 For personal use only--not for distribution. Page 1 of 611/6/2000http://spider.apa.org/ftdocs/abn/1992/may/abn1012352.htmlappears to occur whenever cognitive representations of the words to be color named are activated ( Mathews & MacLeod, 1985 ). Because thoughts and distorted attitudes toward eating, weight, and shape appear to be important in eating disorders, it might be expected that these patients would show interference in color naming when asked to color name words related to these topics. Three studies have used this paradigm to study patients with eating disorders ( Ben-Tovim, Walker, Fok, & Yap, 1989 ; Channon, Hemsley, & de Silva, 1988 ; Fairburn, Cooper, Cooper, Anastasiades, & McKenna, 1991 ). The first two studies failed to address all three key areas of eating, weight, and shape, looking only at food and body size in the Channon et al. (1988) study and food and body shape in the Ben-Tovim et al. (1989) study. Moreover, the latter study is difficult to interpret because of the method used to analyze the data. We found that patients with bulimia nervosa were slower than female control subjects to color name words related to eating, weight, and shape ( Fairburn et al., 1991 ). This finding suggests that selective processing of eating-, weight-, and shape-related words may be restricted to people with an eating disorder of clinical severity. However, this finding needs to be replicated with improved methodology because, as in the study by Channon et al. (1988) , the cards used for the color naming tasks were presented in the same fixed order with the target card being color named last. This design was chosen so that any practice effect ran counter to the hypothesized interference effect. However, it is also possible that a fatigue effect operated and that this effect rather than selective processing, accounted for the patients' relative difficulty in color naming the target card. To eliminate this explanation, it is necessary to counterbalance the order in which the cards are presented. The aim of the present study, therefore, was to see if we could replicate the main finding of our preliminary report–that patients selectively process information related to eating, weight, and shape–but this time using a counterbalanced design. To achieve this aim, patients with bulimia nervosa were compared with a group of age-matched female control subjects. Method Subjects Patients with bulimia nervosa. These subjects were 36 female patients who fulfilled the proposed DSM—III—R in Development diagnostic criteria for bulimia nervosa ( American Psychiatric Association, 1985 ). The operational definition used has been described in full elsewhere ( Fairburn, 1987 ). All subjects had been referred by local general practitioners and psychiatrists for the treatment of bulimia nervosa. Female control subjects. These subjects were 18 young women recruited by placing advertisements asking for female volunteers to take part in a study investigating thoughts about eating, weight, and shape. No reference was made to eating disorders. Those women with the features of bulimia nervosa or anorexia nervosa were excluded by interview as were those with a history of these disorders. Information was collected on age, weight, and height. Each subject completed the Eating Attitudes Test (EAT; Garner & Garfinkel, 1979 ) and the Beck Depression Inverntory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961 ). Materials The Stroop color-naming cards. Three cards were constructed, as described in our previous paper ( Fairburn et al., 1991 ). Each
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