- Self-reported active AN showed highest internalised weight stigma, thin-ideal internalisation and self-objectification; recovered intermediate; controls lowest.
- Using symptom-based recovery, recovered participants matched controls; self-reported recovered but symptomatic resembled active AN.
- Unsupervised clustering found high-bias and low-bias profiles; active AN concentrated in high-bias, recovered split, suggesting biases as aftercare targets.
Int J Eat Disord. 2026 Oct 8. doi: 10.1002/eat.70238. Online ahead of print.
ABSTRACT
OBJECTIVE: Many people relapse following treatment for Anorexia nervosa (AN). Internalization of appearance-related societal biases, including weight stigma, idealization of thinness, and body self-objectification, is related to eating disorder (ED) onset and maintenance, but their association with AN recovery is unclear.
METHOD: We recruited 425 women using Prolific: 136 with self-reported active AN, 143 who self-reported being recovered, and 146 controls with no ED history. They completed online measures of ED symptoms, internalized weight stigma, thin-ideal internalization, and self-objectification. Group differences were examined using two MANCOVAs: one based on self-reported recovery status and one using ED symptom scores instead. We also compared those whose symptom scores did and did not match their self-reported recovery status. Finally, unsupervised machine learning explored whether internalized bias profiles mapped onto recovery status.
RESULTS: Using self-reported status, the active group scored highest on all biases, followed by the recovered group, then controls (ps ≤ 0.002). When symptoms defined recovery, recovered participants no longer differed from controls (ps ≥ 0.92), whereas the active AN group scored higher than the other groups (ps ≤ 0.001). Participants who identified as recovered but scored above the symptom cut-off resembled the active group, whereas those below the cut-off resembled controls. Machine learning identified two severity-based clusters: active AN participants were concentrated in a high-bias cluster, controls in a low-bias cluster, and recovered participants were split across these clusters.
DISCUSSION: Internalized societal biases are strongly associated with AN recovery status, especially when it is defined based on symptom levels rather than self-report. These biases may represent important targets for aftercare interventions.
PMID:42850211 | DOI:10.1002/eat.70238
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