Contemporary study (anorexia option): Reichel et al. (2014)

Aims and sample

Aim: to investigate emotional processing of extremely emaciated body pictures in adolescents and young adults with and without anorexia, using physiological measures of appetitive (positive) and aversive (negative) reactions.

Sample: 72 females aged 14 to 21: 36 with anorexia (ICD-10 diagnosis, mean illness duration 1.3 years) and 36 controls matched for age and education. Excluded: hearing or visual impairment, neurological disease, or medication affecting the startle reflex. Written consent from participants, plus guardians for minors.

Procedure

• Stimuli: From about 8,000 images on pro-anorexia websites, a smaller set was pre-selected and rated in a pilot by 100 healthy volunteers. The final set had 52 pictures: 12 unpleasant, 12 neutral, 12 pleasant and 16 emaciated body pictures (faces not shown).
• Participants sat 1.5 m from a screen; two sets of 26 pictures (counterbalanced) with a 15-minute break. Each picture was shown for 12 seconds.
• A startle noise (50 ms, 95 dB white noise through headphones) was played during three-quarters of the pictures (and some blank screens), so it was unpredictable.
• Measures: startle reflex (EMG of the eye-blink muscle, orbicularis oculi), skin conductance, heart rate, self-report ratings (SAM) and the EDI-2 questionnaire.

Logic: the startle blink is smaller when viewing something pleasant (appetitive) and larger for something unpleasant (aversive).

Results, conclusions and evaluation

• Controls: startle was larger for body pictures than for neutral or pleasant ones: an aversive reaction.
• Anorexia group: startle was smaller for body pictures than for neutral and unpleasant ones: an appetitive reaction.
• Both groups rated the body pictures more negatively than neutral pictures on self-report, and skin conductance (arousal) was higher for body pictures in both groups.

Conclusions: emaciated bodies may be automatically appealing to people with anorexia, even though they say otherwise; fear of weight gain is not a full explanation, and therapy might address the rewards of starvation.

Evaluation

• Objective physiological measures that are hard to fake, contrasting with self-report.
• Controlled lab procedure (standardised timing, counterbalancing): reliable but low ecological validity.
• Small sample, reduced further by technical exclusions; females only.
• Ethics: showing pro-anorexia images to patients risks harm.
• Stimuli rated by healthy volunteers, not patients.

Worked example

Why did Reichel et al. use the startle reflex rather than only asking participants how they felt?

1. Self-report is open to social desirability: patients may say emaciated pictures are unpleasant because that is the expected answer, or may not be aware of their automatic reactions.
2. The startle blink is involuntary and is reduced when a picture is pleasant.
3. This revealed that patients' automatic reaction was appetitive, even though their ratings were negative.

Answer: An involuntary physiological measure revealed reactions that self-report hid.

Check yourself

1. How many females took part in Reichel et al. (2014)?
   Show answer

   72 participants. 36 with anorexia + 36 controls = 72.

2. Of the 52 pictures, 16 were body pictures. What percentage is that? Give your answer to 1 decimal place.
   Show answer

   30.8 %. 16 / 52 x 100 = 30.8%.

3. In the startle paradigm, a smaller startle blink while viewing a picture suggests
   • an aversive (negative) reaction
   • the participant was asleep
   • the noise was too quiet
   • an appetitive (positive) reaction
   Show answer

   an appetitive (positive) reaction. Pleasant states inhibit the startle reflex.

4. How did participants with anorexia react to emaciated body pictures?
   • Smaller startle than to neutral and unpleasant pictures
   • Larger startle than to unpleasant pictures
   • No startle at all
   • They refused to look
   Show answer

   Smaller startle than to neutral and unpleasant pictures. A reduced startle is an appetitive pattern.

5. What did self-report ratings show?
   • Only patients rated them as pleasant
   • Only controls rated them as pleasant
   • Patients and controls alike rated the body pictures as unpleasant
   • No ratings were taken
   Show answer

   Patients and controls alike rated the body pictures as unpleasant. Ratings conflicted with the physiological data in the patient group.

6. Explain one strength of using physiological measures in Reichel et al. (2014).
   Show answer

   The startle reflex is involuntary, so it is an objective measure that participants cannot easily fake, avoiding social desirability bias in self-report.. Involuntary measures avoid self-report bias.

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Sources

• Pearson Edexcel International Advanced Subsidiary/Advanced Level in Psychology specification (issue January 2026)
• Pearson IAL Psychology component guide: WPS04 (Issue 2, November 2024)
• Pearson IAL Psychology summary of studies: WPS04

Last updated 8 November 2026. Spotted a mistake? Tell us.