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We explore how, through processes of aversive visceral conditioning, early GI pain and discomfort may increase vulnerability to AN in some individuals. Processes include enhanced preoccupation with the gut resulting from aversive visceral memories and disruptions in the typical acquisition of self\u2010attunement when children learn to map and interpret interoceptive sensations and develop adaptive actions. We question whether a fear of weight gain, in some cases, may be an epiphenomenon of the recapitulation of actual or perceived GI symptoms that is especially relevant during puberty, especially in girls. This conceptualization has immediate clinical implications and offers ideas for future research. We propose that GI discomfort associated with renourishment may reignite prior aversive visceral experiences. We encourage development of a formulation that organizes the individual's current experience of the body with respect to these prior aversive experiences. Our conceptualization underscores the importance of assessment of GI experiences in individuals with AN; the examination of dietary strategies that minimize GI symptoms and enhance renourishment efficacy; and strategies that attempt to alter this aversive visceral conditioning by mapping sensations to meanings and adaptive actions.<\/jats:p>","DOI":"10.1002\/eat.23255","type":"journal-article","created":{"date-parts":[[2020,3,6]],"date-time":"2020-03-06T10:04:01Z","timestamp":1583489041000},"page":"508-512","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["On bells, saliva, and abdominal pain or discomfort: Early aversive visceral conditioning and vulnerability for anorexia nervosa"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2278-5008","authenticated-orcid":false,"given":"Nancy L.","family":"Zucker","sequence":"first","affiliation":[{"name":"Department of Psychology and Neuroscience Duke University  Durham North Carolina USA"},{"name":"Department of Psychiatry and Behavioral Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7772-3264","authenticated-orcid":false,"given":"Cynthia M.","family":"Bulik","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Nutrition University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,6]]},"reference":[{"issue":"8","key":"e_1_2_7_2_1","first-page":"3727","article-title":"Enteric methane emissions from low\u2010 and high\u2010residual feed intake beef heifers measured using GreenFeed and respiration chamber techniques","volume":"95","author":"Alemu A. 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