What Cognitive Distortions Are Common in Eating Disorders?

In the field of eating disorders, a series of cognitive distortions occur that must be taken into account for intervention. Learn more.

Written and verified by el psicólogo Gorka Jiménez Pajares.

Last update: 13 March, 2023

Eating disorders are extraordinarily complex. Two elements come together in these individuals: Emaciated weight and strong resistance to treatment. In fact, quite frequently, these patients are unaware that they’re suffering from a complex health problem because, among other factors, they experience a multitude of cognitive distortions.

Consequently, for the professionals who are caring for them, the concern is paramount. And that’s why interventions focused on restructuring and modifying the distortions that these people present are being investigated with great intensity. These distortions impact patients in an intense way, influencing the way they think and how they experience emotions.

What are cognitive distortions?

If professionals are able to find out the prototypical and core cognitive distortions of each patient, they’ll be able to intervene in a more focused and precise way (Losada, 2020). In this regard, cognitive distortions are “maladaptive ways of looking at and internalizing the reality that surrounds people”.

In general terms, these errors allude to the distorted perception of self, the experiences that they live in the present, and what the future holds. For these patients, these three factors have a generally negative character. In fact, there are many cognitive errors, for example (Carrobles, 2014):

• Inferring conclusions irrationally, without having real and evident data to support the conclusions they reach. For example “I’m a very bad person because I thought about wanting to eat a hamburger.”
• Tending to “make a mountain out of a molehill.” Being catastrophic implies that when we evaluate something, we see it as much direr than it really is. For example, “It’s better not to eat anything at all, because if I end up eating a bar of chocolate, I’m sure I’ll put on 10 pounds.”
• Comparisons are often hateful. Especially if, as a result of them, we feel “less valid” than others. For example, “I’m trying my best to be as thin as that actress, but I can’t do it. I have to lose more weight.”
• Conclusions that swing between extremes are also cognitive distortions. For example “Either I’m capable of going without food for an entire day, or I’m a loser.”
• Personalization. This cognitive distortion involves merging situations with the way others react, which causes great discomfort. For example “Andrés looked at me when he saw that cake. I’m sure he thinks I’m obese.“
• Self referencing. This implies reaching conclusions that gravitate around one’s self. The self-centeredness of these conclusions can be seen in thoughts like “I’m deeply ashamed that my co-workers can see me eating something.”
• Superstitious thought. This implies believing that, in the face of a certain event, a very negative consequence will follow. However, this cause-effect relationship is far from realistic. For example, “I think it’s better that you try not to enjoy the moment because, without a doubt, it’ll end quickly.”

These cognitive distortions are ways in which our minds try to slow us down, sabotage us, and prevent us from finding kinder ways of interpreting everyday life.

Those that we’ve reviewed also characterize healthy subjects to a greater or lesser extent. However, in the context of eating disorders, in addition to these, other more specific and pernicious ones occur. These are known as cognitive disorders around food.

What are cognitive distortions around food?

The way in which people with these clinical disorders process information is different. In fact, they tend to talk about themselves in terms of the condition they have. For example “I’m Anton and I’m anorexic” instead of “I’m Anton and I suffer from anorexia”.

As a result of this fusion, different cognitive distortions emerge that clinicians and psychotherapists must take into account when dealing with cases and intervening effectively. Therefore, the following cognitive distortions around food have been identified (Losada, 2020).

Thought-Action Fusion (FPA)

“If I think about eating, I’m going to gain weight” or “If I imagine myself bingeing, I’ll end up throwing up.” These two sentences are good examples of this food-related cognitive distortion. Specifically, the subjects believe that “it is as bad to think about it as to carry it out.”

In other words, FPA alludes to the fact that the person believes that their thoughts will amplify and enhance the probability that the consequence they fear will occur. And, in addition to this, they believe that harboring such thoughts in their mind is equal to or more pernicious than committing them.

This distortion also occurs in patients with obsessive-compulsive disorder, which reinforces the hypothesis that eating disorders are likely to share a substrate with this entity. Consequently, people with eating disorders feel extraordinary guilt and try to neutralize it through behaviors that prevent them from gaining weight.

Thought-shape fusion

A patient undergoing treatment, when taking a hypercaloric shake with the aim of gaining weight, may think “right now I’m much fatter”. This is a typical thought of people with eating disorders. For researchers, it’s a different form of food-related cognitive distortion from the previous one. It’s further subdivided into three factors (Losada, 2020):

• Probability thought-shape fusion. For these people, having thoughts in a loop (ruminations) about the act of eating caloric foods causes them to perceive themselves as “fatter” or to underestimate their size.
• Moral shape-though fusion. Ruminating about eating caloric foods is just as bad as actually eating them.
• Emotional thought-emotional form. Merely thinking about eating foods that are high in calories detracts from the person.

These forms of fusion exponentially increase the suffering these people go through. Especially because culture tends to gravitate around food and socializing, situations that frequently occur in restaurants and establishments where food is consumed on a regular basis.

Beliefs that gravitate around “I should be”

“I’m as big as a cow”, “I look like a walrus, no one is going to like me”, “Unless I lose 20 pounds, I’m not going to go outside”, “I’m not going to wear that dress to see how it looks on me because I won’t fit in it.”

These “should be” phrases are the core of cognitive distortions around food. They’re characterized by reaching a series of conclusions even in the absence of logical support or even when there’s evidence to the contrary.

For example, a patient may say “I had a binge-eating episode yesterday”, to which the therapist may ask, “What did you eat?” And the patient answers, “two olives.” Given this, the patient may go on to say “I need to learn to control my appetite.”

This cognitive distortion occurs with intensity in the case of anorexia. In this regard, patients may overestimate or expand their perception of the amount of food they eat and, consequently, overestimate the number of calories they eat, as well as their weight.

In this way, they describe themselves in absolute terms “I should be thinner” or “I should exercise strict control over my hunger.”

Polarized thoughts

A clear example can be found in a typical functioning pattern in people with eating disorders. When they binge on food (for example, in the case of bulimia nervosa), they tend to compensate by means of an extraordinarily restrictive dietary pattern.

At the same time, they may also think that, “either I’ll get thin, and therefore achieve happiness and success” or the person will be tremendously unhappy, feel like a failure, and, consequently, other people will despise them.

Why is it so important to identify cognitive eating distortions in eating disorders?

Because doing so allows us to address the thoughts and beliefs of patients in a multidisciplinary way. Therefore, psychologists, doctors, and nutritionists can intervene in a more precise and focused way in the idiosyncratic thoughts and emotions of patients.

In this regard, the idea is that, after restructuring, symptomatological improvement will lead to a firm and positive transformation in the lives of these people. In this regard, the identification of food-related cognitive distortions is essential when applying cognitive-behavioral therapy because it’s what has the greatest scientific support in the treatment of these disorders (Fonseca, 2021).