240 Eating Disorders
Researchers and clinicians such as Garner and Bemis (1982), Fairburn,
Cooper, and Cooper (1986), and Bruch (e.g., 1974) include a more explicit
role for cognitions. Central to these cognitive behavioral approaches to
anorexia is their emphasis on the anorexic’s faulty thinking about food,
eating, weight, and shape which parallel Beck’s work on depression (Beck,
1976). De Silva (1995) described the following cognitive dysfunctions as
central to the development of anorexia:
- Selective abstraction, which involves focusing on selected evidence
(e.g., “I am very special if I am thin” or “The only way I can be in control
is through eating”) - Dichotomous reasoning, which involves thinking in terms of extremes
(e.g., “If I am not in complete control, I will lose all control” or “If I put
on one pound, I will become fat”) - Overgeneralization, which involves making conclusions from single
events and then generalizing to all others (e.g., “I failed last night so I
will fail today as well”) - Magnification, which involves exaggeration (e.g., “Gaining 2 pounds will
push me over the brink”) - Superstitious thinking, which involves making connections between
unconnected things (e.g., “If I eat this it will be converted into fat
immediately”) - Personalization, which involves making sense of events in a self-
centered fashion (e.g., “They were laughing, they must be laughing at me”)
From this perspective the anorexic’s food restriction is reinforced through
pressures to be thin and the praise or concern that this brings. The high
value placed on thinness and the fear of becoming fat is established and
perpetuated through the anorexic’s faulty thinking, which gets increasingly
well established and is challenged less and less as the anorexic becomes more
socially isolated. In line with this, Wolf et al. (2007) used a journaling exer-
cise to explore the cognitions of patients with an eating disorder. Eleven
inpatients were asked to write an essay which was then analyzed for the
specific use of words and reported that compared to controls and those who
had recovered from AN, the inpatients used more self-related words, more
negative emotion and fewer positive emotion words, and fewer words
relating to social processes. The authors concluded that this methodology
provided an insight into the cognitive styles of people with an eating dis-
order. Within this analysis, anorexia is seen as a behavior which is learned