242 Eating Disorders
was at high school she was “on everything; thyroid pills, diet pills, laxatives.”
Mazel developed an obsession with diuretics which could determine whether
she gained or lost up to 10 pounds in one day. She then discovered that
eating only fruit could have a very similar effect, which forms the core of
her diet. She advised, “Buy enough...five pounds of grapes on a grape day
is not excessive,” and boasted that “I can peel and eat a mango while driv-
ing a standard shift car wearing a white dress.” However, these episodes of
starvation existed purely to compensate for the inevitable binges: “I still
eat a triple order of potato pancakes without choking, an entire roast beef
without blinking an eye, a whole, extra rich cheese cake without a single
gasp...so can you.” Therefore, a diet aimed to cause weight loss was designed
as a fruit diet punctuated by episodes of bingeing: “If you have loose bowel
movements, hooray! Keep in mind that pounds leave your body in two ways
- bowel movements and urination. The more time you spend on the
toilet the better.” As Wooley and Wooley (1982) stated, “The Beverly Hills
diet marks the first time an eating disorder – anorexia nervosa – has been
marketed as a cure for obesity.” Further they said, “That training in anorexic
psychopathology is selling so well holds a message...the figures mean that
women are so afraid of fat they are no longer willing to wait for a safe, sci-
entific method of weight control...the prevailing belief is that nothing is
worse than being fat; that no price is too high for thinness, including health.”
In summary, cognitive behavioral approaches have been used to explain
both anorexia and bulimia. At their most basic they emphasize how the core
behaviors of these eating disorders are established through the processes
of positive and negative reinforcement. The more complex models include
descriptions of antecedents, and some explicitly describe the individual’s
cognitive state.
Problems with a cognitive behavioral model
Cognitive behavioral models describe both cognitive and reinforcement
factors as being important, and have face validity. There is also some empir-
ical evidence to support aspects of faulty thinking and the effectiveness of
treatment based on these models (e.g., Fairburn, 1981; and see chapter 11).
There are several problems with a cognitive behavioral approach to eating
disorders:
- The behavioral models cannot explain how the eating disorder is caused,
only how it is maintained. - These models only describe cognitions implicitly.