Diagnostic, clinical, and personality correlates of food anxiety during a food exposure in patients diagnosed with an eating disorder

  • Cheri A. LevinsonEmail author
  • Margarita Sala
  • Stuart Murray
  • Jackie Ma
  • Thomas L. Rodebaugh
  • Eric J. Lenze
Original Article
Part of the following topical collections:
  1. Personality and Eating and Weight disorders



Eating disorders are characterized by high levels of anxiety, especially while eating. However, little is known about anxiety experienced during meals and specifically what other variables may impact such anxiety.


We sought to further quantify and understand the relationship between food anxiety, eating disorders, and related correlates (e.g., comorbid diagnoses, personality).


In the current study [N = 42 participants diagnosed with an eating disorder (n = 36 participants with anorexia nervosa)], we quantified anxiety before, during, and after a meal using data from a food exposure session in a partial hospital eating disorder center. We examined diagnostic, personality, and clinical factors as correlates of food anxiety.


Participants were more likely to experience higher food anxiety if they had a current diagnosis of major depression, obsessive–compulsive disorder, or post-traumatic stress disorder (PTSD). Concern over mistakes was the strongest and most consistent correlate of food anxiety regardless of time during the meal that anxiety was assessed. Other significant correlates were fear of positive evaluation, social appearance anxiety, BMI, and trust.


These findings show how diagnoses, perfectionism (concern over mistakes), and other correlates relate to anxiety during meals. Food exposure interventions may benefit from personalizations that address these factors.

Level of evidence

IV Evidence from a randomized control trial, but from the first session before effects of the design would be present.


Fear of food Exposure therapy Anorexia nervosa Social appearance anxiety Perfectionism 



This research was supported by NIMH F31-MH096433 to Cheri A. Levinson. The funding source had no role in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The Washington University IRB approved all procedures in this study and all the procedures performed in the current study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendment.

Informed consent

Informed consent was obtained for experimentation with human subjects.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Psychological and Brain SciencesUniversity of LouisvilleLouisvilleUSA
  2. 2.Department of PsychologySouthern Methodist UniversityDallasUSA
  3. 3.Department of PsychiatryUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Department of Psychological and Brain SciencesWashington UniversitySt. LouisUSA
  5. 5.Department of PsychiatryWashington UniversitySt. LouisUSA

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