(PS14-10) The Association Between Internalized Weight Bias and Illness Severity in Adolescent Anorexia Nervosa and Atypical Anorexia Nervosa

Abstract Text: Whereas internalized weight bias (IWB) is associated with disordered eating in people across the weight spectrum, IWB in adolescents with anorexia nervosa (AN) and atypical AN is unclear.  This study examined relationships between IWB and weight-related experiences, mental health characteristics, and premorbid weight status in 179 adolescents (M age = 15.6 years, SD =1.5) with AN (n=81, 45.2%) and atypical AN (n=98, 54.8%). Participants completed the Weight Bias Internalization Scale (WBIS), the Eating Disorders Examination Questionnaire (EDEQ), the Clinical Impairment Assessment Questionnaire (CIA), and the Reynolds Child Anxiety and Depression Scale (RCADS) at treatment outset.  
No significant differences in IWB were found for diagnosis or premorbid weight status. Regression models indicated that participants higher WBIS scores reported greater exposure to weight victimization (b = 0.03, p = .03, 95% CI [.004, .052]), maternal dieting (b = -0.34, p = .01, 95% CI [.60, .08]), sibling dieting (b = 0.40, p = .01, 95% CI [.08, .71]), and maternal weight comments (b= 0.46, p = .04, 95% CI [.03, .89]).  In turn, greater IWB was associated with eating disorder severity (b = 0.78, p < .001, 95% CI [.64, .92], clinical impairment (b = 6.42, p < .001, 95% CI [5.41, 7.43]), depression (b = 7.87, p < .001, 95% CI [6.13, 9.60]), and anxiety (b = 8.35, p < .001, 95% CI [6.39, 10.32]).  Findings suggest that IWB is an important consideration in the assessment and treatment of adolescent AN and atypical AN, independent of a patient’s premorbid and presenting weight status. Whereas front-line interventions for AN do not address IWB, this may be an important treatment consideration.