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Psychological explanations for anorexia and bulimia

Weight-related schemata Social factors translate into behaviour through cognitive processes. Despite the many differences in presenting problems, Fairburn’s cognitive model proposed a similar cognitive disturbance in both anorexia and bulimia: a set of distorted beliefs and attitudes towards body shape and weight. Thinness and weight loss are prioritized, perhaps because of the high status given to looking thin and attractive, and the individual works to avoid weight gain and becoming fat.

The underlying schemata involve judging one’s self-worth on the basis of achieving a low body weight and being thin – so-called weight-related self-schemata. Once weight-related schemata are established, they distort the way the individual perceives and interprets their experiences. Other people are evaluated not on the basis of personal qualities, but in terms of being thinner or fatter than the individual. All activities are assessed in terms of weight control, and any situation that leads to self-evaluation also results in an intensif i ed focus on weight and shape. Any weight fl uctuation has a profound effect on thoughts and feelings. For some people, their concerns and prioritizing control over their weight refl ect a wider lack of self-esteem, a vulnerability to cultural messages about body weight, and the desire to gain control over one aspect of their life. They hope to feel better about themselves if they are thinner – a process that leads them to be perpetually dissatisfi ed with their appearance and to be continually working to lose weight.

Depression that may result from anorexic behaviour may intensify feelings of low self-esteem and increase dependence on controlling weight as a means of maintaining self-worth.

Both anorexia and bulimia may reflect different ways of coping with the same underlying cognitions. According to Fairburn, people with anorexia are more able to sustain longterm control over their eating than those with bulimia, who are more chaotic and less consistent. He suggested that because of their restrictive dietary habits, individuals with both bulimia and anorexia are under signifi cant psychological and physiological pressure to binge eat. To cope with these demands, both groups set a series of rules to govern their eating: when they should eat, what they can and cannot eat, and so on. These rules are typically perfectionist and diffi cult to achieve. Despite this, people with anorexia have suffi cient self-control to be able to follow the rules they have set. By contrast, individuals with bulimia may on occasion fail to do so. This type of analysis is supported by personality studies that have found both anorexia and bulimia to be consistently characterized by perfectionism, obsessive-compulsiveness, neuroticism, negative emotionality, and harm avoidance. However, anorexia is typically associated with traits of high constraint and persistence, while people with bulimia are more impulsive and sensation-seeking.

Distorted body image A second cognitive model, involving a distorted body image, applies only to people with anorexia. This suggests that such people feel ‘fat’ even when their weight is actually clinically subnormal. Summarizing a plethora of research studies, Gupta and Johnson  suggested that many people with anorexia considerably overestimate their body proportions, have a low opinion of their body shape, and consider themselves to be unattractive. By contrast, Slade and Brodie suggested that many of these reports represent an emotional reaction to their body shape rather than a perceptual experience. They suggested that those who experience an eating disorder are uncertain about their body size and shape, and only when they are compelled to make a judgement about these issues do they err on the side of reporting an overestimated body size. Skrzypek et al. reached a similar conclusion, concluding from their summary of the relevant research that body image disturbance is not due to any perceptual deficit, but is based on ‘cognitive-evaluative dissatisfaction’.

The restricted food intake achieved by people with anorexia may have biological effects unrelated to body size or shape that serves to perpetuate any cognitive distortions. Starvation affects a number of cognitive processes, resulting in poor concentration, concrete thinking, rigidity, withdrawal, obsessive-compulsive behaviour and depression. As a result, starvation may lead to a positive feedback loop in which people with anorexia become increasingly rigid in their beliefs and are unable to consider other ways of looking at their problem.

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