The perception of food size and food shape in anorexia nervosa

Visual perception of food size and shape in anorexia nervosa (AN) is an understudied topic, notwithstanding its relevance in approaching food, key-element in weight restoration. In addition, it is unclear how visual perception in AN is related to the age and the duration of illness. Here, we compared patients with AN to healthy controls (HCs) on their spatial resolution, biases in perceived food size, and holistic processing of food shape. A total of 122 participants were enrolled: 48 adolescents (27 AN and 21 HCs) and 74 adults (33 AN and 41 HCs). Participants at two academic sites (Israel and Italy) completed measures of psychopathology and experiments measuring visual resolution (Just Noticeable Difference), biases in food-size perception (Points of Subjective Equality), and holistic processing of food shape (indicated by the height-width illusion). Adolescents and adults with AN differed in the duration of illness and body mass index but showed comparable eating psychopathology and body measures. Patients with AN showed preserved visual resolution but distorted perception of food size, perceiving food as bigger than non-food objects, in both age groups. Patients with AN, both adolescents and adults, also processed food stimuli in a more analytic fashion, and were immune to the height-width illusion. The preserved perception of non-food stimuli in AN coupled with biases in food-size perception and in analytic processing of food shape highlight patients' real-world difficulties in approaching food. Future treatments on AN may consider taking these differences into account.