This brings us to the explanation of body checking. We have already outlined the most important characteristics of this behavior in the introduction, but will make three further assumptions, all of which we regard as fairly minimal.

The first assumption that we will make is that body checking behavior typically evolves from being intentional and purposeful, to becoming habitual and compulsive. It is widely agreed that body checking is often habitual and compulsive (e.g., Breithaupt et al. 2014), so adding that it evolves to acquire these characteristics from an intentional and purposeful phase is really just to assume that it follows the most common pattern of how such behaviors are formed. Habitual behavior is usually understood as behavior that has shifted from requiring focus and energy to being automatic, and thus requiring little or no attention (Smith and Graybiel 2016). We assume that the same is the case for habitual body checking.

The second assumption that we will make is that body checking in the intentional and purposeful phase should be understood as a form of genuine inquiry, i.e., as an attempt to settle a factual question by gathering information or evidence. For individuals with AN, the burning question is whether or not they are overweight, so in this intentional phase, body checking should be understood as attempts to settle this question. Below, we discuss whether this claim might be rejected, but we assume it for now. This also means that an explanation of how body checking becomes habitual must account for how individuals with AN are motivated to engage in inquiry about their weight long enough and frequently enough to result in a habit. As we shall see, such an explanation can involve several elements, including the identification of a plausible reward to reinforce the behavior, and an explanation for why the inquiry never gets settled.

The third assumption that we will make is not specifically about body checking as inquiry, but about inquiry as such. We adopt Friedman’s influential idea, that genuine inquiry into a question implies being in a state of suspended judgment with respect to its answer (Friedman 2017, 2019). This is because to be inquiring into whether p, one must hold a question-directed or interrogative attitude as to whether p, or, more generally, the question one wishes to settle. Interrogative attitudes include, e.g., wondering and being curious, so one cannot be said to be genuinely inquiring into whether p, unless one is, for example, wondering or curious as to whether p is true. And according to Friedman, holding an interrogative attitude with respect to a question implies suspending judgment on its answer. For example, one cannot wonder whether p, if one already believes that p is true. So, to be genuinely inquiring whether p is true, one must necessarily be suspending judgment as to whether p. Accordingly, an explanation of inquiring body checking must include an explanation of how subjects are kept in a state of suspended judgment, despite the repeated checking.Footnote 9

3.1 Body Checking and the False Belief Model

With these assumptions in place, we can turn to consider what explains inquiring body checking behavior in AN patients. Consider first how the FBM would explain it. An immediate stumbling block for this model is that, by virtue of ascribing a false belief in being overweight to AN patients, the model cannot at the same time comprehend AN patients as being in a state of suspended judgment as to whether they are overweight. Given the above assumption about suspension of judgment as a necessary condition for inquiry, the FBM is barred from understanding AN patients as genuinely inquiring into their weight.

Let us consider a couple of possible responses to this problem on behalf of the FBM. One response might be to claim that during the genuinely inquiring phase of the development of body checking behavior, AN patients do not yet believe that they are overweight, but rather suspend judgment about this. It is only through the biased and motivated process of inquiry that they acquire the false belief, at which point the body checking ceases to be genuine inquiry. Body checking plays a part in this process of biased inquiry, for example by focusing on certain body parts, looking at oneself from angles that make one appear overweight, and by comparing oneself to others with thinner bodies. This is in line with the suggestion mentioned in the introduction, that body checking aims at promoting or maintaining false beliefs about shape and weight. On this line of thought, the false belief, painful as it is, is deliberately pursued by AN patients as an instrument for motivating dietary restraint, and thus furthering the ultimate desire of being thin (Fairburn 2008).

This response, however, raises several questions. First, it inherits a general issue with the FBM, of accounting for how false beliefs about weight are formed and maintained despite the strong evidence of their falsity that AN patients are continually exposed to. Gadsby (2020) recognizes this difficulty and attempts to resolve it by appealing to two factors: abnormal body experiences and the abovementioned desire-driven bias. However, as argued by Varga and Steglich-Petersen (2023), it remains unclear how the instrumental interest in a false belief for motivating dietary restraint could outweigh the significant emotional distress that AN patients, given their fear of being fat, will associate with such a belief. It thus remains unclear why AN patients should be motivated to bias their inquiry in favor of believing that they are overweight, rather than in favor of disbelieving it. Second, and because of this, the response also fails to locate a plausible reward to reinforce the repeated checking behavior, which in turn would make it mysterious how the behavior can become habitual.

Another possible response on behalf of the FBM to the problem described above, would be to comprehend AN patients as alternating between suspended judgment and belief. On the face of it, this would make the FBM compatible with an interpretation of body checking as genuine inquiry. Incidentally, this is also how Friedman understands (non-pathological) repeated checking, namely, as a process of asking a question and settling on an answer by forming a belief, only to reopen the inquiry again soon after by once again suspending judgment on the relevant question, inquiring again, and so on.Footnote 10 This, in turn, leads to her diagnosis of what is epistemically irrational about repeated checking. According to Friedman, repeated checking is epistemically irrational when and to the extent that it involves moving from belief to suspended judgment between the acts of checking, without this move being based on good epistemic reason.

Although we don’t want to deny that repeated checking may sometimes be a matter of moving back and forth between belief and suspended judgment, as suggested by Friedman, we doubt that this could be the general picture. Belief is generally considered to require a degree of stability and resilience in the face of doubt, so it would require some special explanation to make sense of how the repeated cycles of belief and suspension described by Friedman are even possible (Leitgeb 2014; Steglich-Petersen 2019). It is also questionable that subjects would be able to maintain the ability to form beliefs in response to checking, if they have experienced repeatedly losing this belief soon after without reason. At the very least, we should expect that the subject’s ability to conclude the inquiry by forming a belief degrades over time, eventually resulting in being unable to acquire the relevant belief. But in that case, it becomes hard to see how this process of alternating between suspension and belief could be part of the FBM, which, after all, depends on subjects being able to believe falsely that they are overweight. In summary, given the three initial assumptions, it seems fair to conclude that the FBM has severe difficulties accounting for key characteristics of body checking.

3.2 Body Checking and the Recalcitrant Fear Model

We now move on to consider the explanatory resources of the RFM in relation to the inquiry stage of body checking. Two immediate advantages of the RFM over the FBM are worth noting right away. First, since the RFM reserves ascription of false beliefs about weight to severe cases of AN without insight, it is not prevented from understanding the majority of AN patients, and certainly those at the inquiry stage of body checking, as suspending judgment and thus inquiring about their weight.

The second advantage is somewhat more subtle. A critical issue for the FBM was to account for how body checking could serve to promote a false belief that one is overweight. This proved challenging in part because AN patients typically have ample evidence from other sources that they are not overweight. But it is also challenging because the evidence obtained from the body checking itself can be assumed to objectively support the belief that they are not overweight—in fact, to outside observers, it is often enigmatic how AN patients can avoid concluding the obvious, namely that they are dangerously thin. The FBM therefore needs to ascribe a very considerable bias in the body checking to account for the false belief.

The RFM, on the other hand, does not need to explain how body checking could result in a false belief. Instead, the RFM faces only the considerably easier task of explaining why the repeated checker tends not to form the true belief that they are not overweight, but rather remains in a state of suspended judgment. To be sure, this is not without difficulty. In particular, since the checking can be assumed to often result in relatively strong evidence that the checker is not overweight, something must be said to account for how it is possible for checkers not to form this belief. However, as we will now explain, fear of p being true provides the perfect epistemic pretext for being held in a state of suspended judgment as to whether p, even when the evidence in fact supports that p is false. Accordingly, a fear of being overweight provides the perfect epistemic environment for being held in a state of suspended judgment as to whether one is in fact overweight, even when the evidence supports that one is not overweight. Taking Friedman’s necessary condition for inquiry into account, fear of being overweight thus explains why AN patients can be kept in a state of inquiry into their weight.

Generally speaking, fear of p promotes suspended judgment as to whether p in at least two ways. First, it can cause subjects to selectively attend to evidence supporting p. As mentioned in the previous section, it is widely accepted that emotions encompass various perceptual and physiological changes, such as visceral and cardiovascular alterations, that aid in the activation of motivational and cognitive resources. This includes the fine-tuning of attentional mechanisms, which help filter information and tackle competing environmental stimuli (Oatley and Jenkins 1996). As such, emotions improve stimulus detection and processing and keep attention focused on emotionally valenced stimuli. For instance, fear narrows the scope of attention towards threatening stimuli, makes it challenging to shift focus away from such stimuli, and allocates a lesser priority to the processing of neutral information (Najmi et al. 2012). Applied to AN, when patients fear being overweight, they will attend selectively to evidence supporting that they are overweight, for example, by attending to body parts that appear to them most overweight, or by tending to look at themselves from angles or in positions that make them appear overweight. Even if the evidence does not support that one is overweight, individuals with AN may thus be held in a state of suspended judgment. Note again that even both the RFM and the FBM rely on bias in their respective explanations of body checking, the RFM places a significantly lighter explanatory burden on this bias than the FBM, since the RFM only relies on the bias to explain how subjects are hindered from believing that they aren’t overweight, while the FBM relies on it to explain how subjects come to believe that they are overweight.

The second way in which fear of p can work to retain subjects in suspended judgment as to whether p is by causing subjects to raise the evidential threshold for believing that p is false. One way of motivating this claim is via the theory of “pragmatic encroachment” on rational belief. It is widely regarded as plausible that an individual's practical circumstances can influence whether someone is in a position to know or rationally believe a proposition. To motivate this idea, consider the following set of cases from Schroeder (2012, 266–267), adapted from Stanley (2005) and DeRose (1992):

Low Stakes: Hannah and her wife Sarah are driving home on a Friday afternoon. They plan to stop at the bank on the way home to deposit their paychecks. It is not important that they do so, as they have no impending bills. But as they drive past the bank, they notice that the lines inside are very long, as they often are on Friday afternoons. Hannah remembers the bank being open on Saturday morning a few weeks ago, so she says, ‘Fortunately, it will be open tomorrow, so we can just come back.’ In fact, Hannah is right—the bank will be open on Saturday.

A common intuition held by many is that Hannah’s belief that the bank will be open could be considered epistemically rational. Her recollection of seeing the bank open a few weeks earlier, when combined with pertinent background knowledge, appears to provide adequate epistemic justification for her belief that the bank will be open. However, contrast this Low Stakes scenario with the following High Stakes situation:

High Stakes: Hannah and her wife Sarah are driving home on a Friday afternoon. They plan to stop at the bank on the way home to deposit their paychecks. Since their mortgage payment is due on Sunday, they have very little in their account, and they are on the brink of foreclosure, it is very important that they deposit their paychecks by Saturday. But as they drive past the bank, they notice that the lines inside are very long, as they often are on Friday afternoons. Hannah remembers the bank being open on Saturday morning a few weeks ago, so she says, ‘Fortunately, it will be open tomorrow, so we can just come back.’ In fact, Hannah is right—the bank will be open on Saturday.

Contrary to the Low Stakes scenario, it is a widely held intuition that Hannah's belief is not epistemically rational in the High Stakes situation. Since the two situations are identical in epistemic aspects—Hannah forms her belief in both scenarios based on her recollection of the bank being open—and only diverge in the practical matter of the urgency for the couple to deposit their paychecks by Saturday, it can be concluded that this practical element is the determining factor in whether Hannah’s belief is epistemically rational..

On the standard understanding, the significance of depositing the checks in the two cases makes an epistemic difference, as it alters the potential severity of the consequences if Hannah incorrectly believes that the bank will be open. In the terminology favored within this debate, it impacts the 'stakes' associated with holding the belief that the bank will be open. In the Low Stakes scenario, if Hannah falsely believes the bank will be open and delays depositing her checks until Saturday based on this belief, the result is inconvenient but not catastrophic—she will simply have made an unsuccessful trip to the bank. In the High Stakes scenario, however, acting on such a false belief could lead to severe consequences. Thus, the ramifications of holding, and acting upon, a false belief that the bank will be open are markedly greater in High Stakes compared to Low Stakes.

Although these cases are standardly taken to illustrate a normative epistemic effect on rational belief, it is highly plausible that they also indicate a descriptive psychological effect, namely that we, as a matter of fact, tend to raise our evidential threshold for belief when we perceive the stakes to be high. This may simply consist in a judgment to the effect that acting on a particular false belief would carry adverse consequences, but it seems that affective states, and in particular emotions, will often be what underlies such a perception of high stakes. For example, if I fear spiders, I will tend to regard it as much worse to believe falsely that there are no spiders in my bed, than if I don’t have a fear of spiders. Consequently, we would expect someone who fears spiders to operate with a higher evidential threshold for believing that no spiders are present.Footnote 11

It is worth mentioning that this conclusion about the psychological effect of fear-driven stake-perception on the evidential threshold that subjects require for belief may be reachable without relying on normative epistemic claims about pragmatic encroachment on epistemic rationality.Footnote 12 Nagel (2008, 2010) argues that we naturally expect different epistemic behavior from subjects who perceive stakes to be high, e.g., by collecting more evidence than low-stakes subjects before settling on a belief, but not because of any change in normative epistemic standards. Instead, subjects in the different conditions engage in adaptive thinking, weighing the anticipated costs of gathering more evidence against the prospective value of increased accuracy. This leads to the adjustment of cognitive effort in reaction to the perceived stakes or, as Nagel puts it, their level of “epistemic anxiety. And the subject’s stake-perception is clearly influenced by fear in the way sketched above.

We can now apply these observations to understand body checking in AN. Just like fear of spiders will lead subjects to operate with a higher evidential threshold for believing that no spiders are present, so will fear of being overweight lead individuals with AN to operate with a higher evidential threshold for believing that they are not overweight. This will have the effect that individuals with AN will be disposed to remain in a state of suspended judgment in evidential circumstances that would normally lead non-patients to believe that they are not overweight. Because of this, individuals with AN will continue to inquire into their body weight and shape by engaging in repeated checking. Add to this the fear-driven bias, which leads AN patients to focus on evidence that indicates the feared possibility of being overweight. This, too, will lead AN patients to remain in a state of suspended judgment in circumstances that would normally lead others to reject that they are overweight.

Having described these two ways in which fear of being overweight can cause AN patients to be held in a state of suspended judgment and continued inquiry, we can return briefly to the question of irrationality, which was the main focus of the epistemological literature on repeated checking. In both cases, the culprit of the irrationality is the intense fear and preoccupation with being overweight. It is this state that drives the attention bias, causing patients to attend selectively to evidence supporting the feared scenario. And it is this fear that causes patients to attribute a high cost to believing falsely that one is not overweight, and thus raise the evidential threshold for belief. This is in line with the RFM, which locates the irrationality of AN in the emotions.

Even if the irrationality stems from the fear of being overweight, this does not imply that it is not irrational for AN patients to suspend judgment in response to the repeated body checking. But if it is irrational, it is certainly only irrational in a rather qualified sense. Consider the two effects of fear in turn. When fear biases our attention to focus on some stimuli over others, this can be understood in one of two ways. Either the biased attention results in the subject’s evidence being restricted to that stemming from the stimuli focused on, or the biased attention does not affect the available evidence, but makes the subject give more weight to the evidence that she is biased towards. In the first case, although the bias itself can be considered in some sense irrational, the belief resulting from the bias would not necessarily conflict with the subject’s evidence, and hence not be epistemically rational. In the second case, the belief resulting from the bias would conflict with the available evidence, and hence be straightforwardly irrational. Whether to understand attention bias in the first or the second sense is a question beyond the scope of this paper; perhaps, in most cases, the answer is somewhere in the middle, with the bias both restricting the pool of evidence and directing attention to a selected part of the evidence. But either way, the irrationality of suspending judgment that results from the attention bias is not entirely straightforward.

When fear makes subjects increase their evidential threshold for belief, it is even less clear in what sense this results in epistemic irrationality. At least, it is compatible with a very significant degree of epistemic rationality on behalf of the subjects. To see this, note that AN patients may well have a relatively realistic assessment of the degree to which the evidence raises the likelihood of them being overweight. In the paradigmatic cases considered above, pragmatic encroachment does not operate by affecting how likely subjects should deem the target proposition to be in light of the evidence, but rather by affecting the evidential threshold required for belief. This also opens up the possibility that AN patients have an appropriately high credence that they are not overweight, while failing to believe that they are not overweight, although this further possibility requires that credences and categorical beliefs are independent, such that an arbitrarily high credence in a proposition can coexist with the absence of a categorical belief in that same proposition.Footnote 13 Without pursuing these questions here, we think it is safe to conclude that the epistemic irrationality of suspending judgment is at best qualified.

There is a further sense in which it might be irrational for AN patients to continue their inquiry by repeated checking. As they experience over time that their repeated body checking does not result in them settling the question of their weight by forming a belief, they acquire higher-order evidence about their own epistemic dispositions, indicating that they will not be able to settle the inquiry. Such evidence, when strong enough, might in itself make it irrational to continue inquiry.Footnote 14 But again, the irrationality of continued inquiry is certainly not straightforward.