Relative Contributions of Gastrointestinal-Specific Hypervigilance and Anxiety in Explaining Eating Disorder Symptoms

Gastrointestinal (GI) disturbances and eating disorder symptoms commonly co-occur. Hypervigilance and anxiety about GI symptoms may motivate eating disorder behaviors to manage and/or avoid GI symptoms. We hypothesized that GI-specific anxiety would be more strongly associated with dietary restriction and purging than GI-specific hypervigilance. Further, we hypothesized that distinguishing between GI-specific anxiety and hypervigilance would have incremental validity over using an existing measure of GI-anxiety and related constructs initially developed for patients with irritable bowel syndrome, the Visceral Sensitivity Index.

Three hundred and eighty-two undergraduate students with elevated eating pathology (83.5% female, 87.4% White) completed questionnaires assessing GI-specific hypervigilance and anxiety, the Visceral Sensitivity Index, and eating disorder symptoms. Participants were recruited with elevated shape/weight-oriented eating pathology (N = 309) and elevated avoidant/restrictive food intake disorder-related eating pathology (N = 73). Analyses were pre-registered.

Regarding dietary restriction, the relative weight of GI-specific anxiety did not differ from that of GI-specific hypervigilance. Further, neither variable provided incremental validity over the Visceral Sensitivity Index in understanding restriction. Regarding purging, GI-specific anxiety was not more strongly associated with purging than GI-specific hypervigilance. However, GI-specific anxiety, but not GI-specific hypervigilance, demonstrated incremental validity over the Visceral Sensitivity Index in explaining purging.

Distinguishing between GI-specific hypervigilance and anxiety adds incremental validity in understanding purging but not restriction. Future research should examine whether addressing anxious cognitions about GI symptoms improves purging outcomes.