Eating Disorders 239and extinction. They then add the components central to cognitive theory
such as beliefs, images, ideas, and attitudes. Models of anorexia and bulimia
will be considered separately.
Anorexia nervosa
At their most basic, models of anorexia regard it as a behavior which has
been learned and is maintained through a process of reinforcement. It is
argued the individual reduces their food intake as a means to lose weight
due to the social pressure to be thin. This behavior is then promoted by a
wide variety of negative reinforcers. For example, being overweight or
simply not being thin results in disapproval from others and a sense of
unattractiveness, and food avoidance reduces the anxiety associated with
eating and any accompanying weight gain. Aspects of food restriction have
also been described as bringing positive consequences. For example, food
avoidance produces attention, particularly from mothers (Ayllon, Haughton,
and Osmond, 1964); having an empty stomach may be a pleasurable expe-
rience (Gilbert, 1986); starvation may result in the production of pleasur-
able brain chemicals (Szmukler and Tantam, 1984); and not eating may
generate the positive state of feeling in control (Wyrwicka, 1984).
These essentially behaviorist models have been criticized for their focus
on maintaining factors rather than causal factors and for the absence of
antecedents (de Silva, 1995). Slade (1982) addressed the issue of antecedents
and suggested a role for two important processes. The first involves a con-
dition of dissatisfaction which derives from both interpersonal problems
and conflicts within the family such as difficulties in establishing independence
and autonomy, interpersonal anxiety, and the internal attribution of failure.
According to Slade, this dissatisfaction then combines with a perfectionistic
tendency which reflects a desire for total control and total success. This is
supported by research indicating a high level of self-orientated perfectionism
in those with an eating disorder (Castro-Fornieles et al., 2007b; Wade et al.,
2008) and evidence that the link between perfectionism and eating-disordered
behaviors may be stronger in women than in men (Forbush et al., 2007).
The two factors of dissatisfaction and perfectionism then trigger dieting
behavior which is reinforced by praise and avoidance of eating-related
anxiety as described above. This model addresses some of the problems with
the behaviorist approaches. However, although cognitions are implicit
within such models in the form of beliefs about weight and beliefs about
the family, they have been criticized for omitting an explicit cognitive dimen-
sion (de Silva, 1995).