Treatment for eating disorders usually prioritizes weight restoration, resumption of regular eating patterns, and other behavioral changes. Later on, treatment also commonly addresses problematic thinking patterns.
Different Kinds of Cognitive Distortions
Different patterns of problematic thoughts are commonly experienced by people with eating disorders. Recognizing, challenging, and changing negative thought patterns is one of the main components of cognitive behavioral therapy (CBT). Learning the patterns of cognitive distortions through CBT or another type of therapy can help you learn to recognize them. Here are a few of the most common cognitive distortions experienced by people with eating disorders.
“Shoulds”
“Shoulds” are demands that you place on yourself such as thinking “I should have done better.” or “I must be perfect.” Regarding eating disorders, “shoulds” might include thoughts about needing to exercise, what foods should/shouldn’t be eaten, or what you should weigh.
All or Nothing Thinking
This type of thinking is sometimes known as black and white thinking. It contributes to perfectionistic tendencies because it causes you to believe that something is either completely okay/right or completely wrong. When you have an eating disorder, this can crop up when you have a plan to adhere to a specific dietary rule—you may feel as if the day is completely ruined when you eat something ‘wrong’ or the scale reads something other than what you’d like to see.
Overgeneralizing
Overgeneralizing is like or nothing thinking. It occurs when you believe that a negative experience or situation describes your life completely. An example might be believing that a relapse means that you will never recover fully, rather than seeing it as a temporary setback.
Catastrophizing
Any time you believe that a situation is so bad that you simply cannot survive it, you may be catastrophizing about the situation or its outcome. For example, you might believe that if you weighed a certain amount, no one would like you or your self-worth would plummet. You might also believe that your weight will rise based on what you have eaten at one meal or snack.
Labeling
Labeling is a distortion that attempts to place people and things in specific categories. Examples of this might be “I’m such a loser," “I have no self-control," or “These foods will make me gain weight.” Typically, these labels are overly simplistic and are unable to describe all of the complexities humans possess.
Rejecting the Positive
Many cognitive distortions focus only on the negative aspects of something and reject anything positive. For someone with an eating disorder, this type of distortion may focus only on criticizing mistakes or focus only on the caloric content of food instead of on the nutrition and energy in the food.
Unfavorable Comparisons
Many people with eating disorders compare the way they look, what they weigh, and how much they eat to the people around them. These comparisons tend to always be negative. For instance, if you think someone weighs less than you do, the eating disorder thoughts may focus on how you ‘should’ also weigh less. However, if you believe that you weigh less, the eating disorder thoughts focus on keeping you at the lower weight.
Blaming and Personalizing
Blaming and personalizing are two sides of the same issue. When someone personalizes, they believe that everything is their fault, whereas when someone blames others, they believe that everything is someone else’s fault. The truth likely lies somewhere in the middle—and sometimes it is no one’s fault that something has happened.
How to Track and Change Your Cognitive Distortions
Keep a record of thoughts that occur before food restrictions, binges, purges and/or times you feel upset. See if they follow any of the patterns described above. Typically people with anorexia skip meals or restrict calories based on these cognitive distortions, which is most likely the trigger for that behavior. Such distortions can also trigger binging or purging behaviors. Once you are aware of your cognitive distortions you can learn some strategies for managing and modifying cognitive distortions. A cognitive-behavioral therapist can also help you to run experiments to test the validity of these thoughts.
