Perspective taking processes across anorexia nervosa subtypes: considering egocentric and altercentric bias

While research has identified difficulties in perspective taking (PT) among patients with anorexia nervosa, it is unclear how these difficulties may vary across anorexia subtypes. This study assessed PT in individuals with restrictive (AN-R) and binge/purge (AN-B/P) subtypes of anorexia nervosa using the Level-2 Visual Perspective-Taking task, which isolates the PT processes of self-other distinction, self-other priority, altercentric bias, and egocentric bias. A sample of 172 women (88 healthy controls, 56 AN-R, 28 AN-B/P) completed this task, revealing subtype-specific PT biases. Patients with AN-R exhibited a stronger altercentric bias, as reflected in longer response times, suggesting that their own perspective may be involuntarily influenced by the perspectives of others, even when those perspectives are irrelevant. This effect on response time rather than accuracy may indicates that participants actively perceive perspective conflicts and expend additional cognitive effort to process them. In contrast, patients with AN-B/P displayed a greater egocentric bias, as evidenced by their accuracy rates. This suggests a more dominant self-perspective and reduced processing of others' viewpoints, suggesting that perspective conflict is overlooked rather than explicitly processed. These preliminary findings highlight subtype-specific PT biases in patients with AN during visual PT and advocate for further replication.