It’s easy to get caught up in the behaviors of eating disorders. We can obsess over a child’s eating patterns, exercise, and body weight. But the real thing we need to be looking at is their thought patterns because their thoughts underlie the behaviors.
People who have eating disorders often exhibit 10 common cognitive (thinking) distortions that are well known in psychology. In fact, many cognitive therapists begin with an assessment of these 10 cognitive distortions. These distortions are a hallmark of anxiety, depression, eating disorders, and many other mental disorders. The good news is that cognitive therapy is very effective in helping people overcome these distortions and gradually learn to replace distorted thinking with healthy, adaptive thinking.
These distorted thinking patterns must be addressed during eating disorder treatment, and they may linger after the eating disorder behaviors have receded. It is a good idea to be aware of these cognitive distortions and continue your child’s therapy as long as these distortions are present.
1. All-or-nothing Thinking
Someone who has an eating disorder often has what is commonly called “black-or-white” thinking. Nothing in nature is only one way or another. We all exist in the gray areas in between. When we have an eating disorder, we apply this thinking to our selves and, by extension, our bodies, weight, and food. For example, we think “I’m fat” if we have even an ounce of fat on our bodies, despite the fact that we must have some fat in order to be alive. We think “I ate too much” if we have stomach feedback, even though feelings of fullness and satiety are perfectly natural biological feedback. We think “sugar is bad” even though sugar is just a food and is part of a normal diet.
Someone who has an eating disorder tends to take note of negative experiences and conclude that if they happen once, they will happen over and over again. For example, we think “I always overeat, and that’s why I’m fat” even if we barely eat anything most of the time and then, to compensate, occasionally binge eat. If we fail to meet an arbitrary weight goal, we think “I’m never going to lose weight and will be lonely and miserable my whole life.” This overgeneralization feels like the absolute truth, despite the fact that many people may tell us in specific terms that we are incorrect.
3. Mental Filter
When we have an eating disorder, we tend to create an inaccurate mental filter of how we appear and who we are. We see ourselves as if through a distorted fun-house mirror. This is easily seen in body dysmorphia, in which we literally see our bodies in a way that they do not exist. We may see bulges and bumps that are not there to any but our own eyes. Over time, we find it almost impossible to view ourselves in any other way, even when others objectively and authoritatively tell us that we are incorrect.
4. Disqualifying the positive
People who have an eating disorder have an amazing ability to take neutral or positive feedback and turn it into something that reflects negatively upon ourselves. For example, if someone tells us we look nice, we may say we gained weight. If someone tells us we’ve lost weight, we may say that it’s not enough – we still have more to go. If someone tells us we are a healthy eater, we tell them we are far from perfect and need to be better. This becomes compulsive and we are unable to accept a neutral or positive comment without washing it away with something self-deprecating. The belief behind the disqualification is typically some “fatal flaw” or belief of being “less than.”
5. Jumping to conclusions
Many of us who have eating disorders believe we can read other people’s minds, especially when it comes to negative feelings towards us. We may “know” that someone thinks we’re fat and ugly, stupid and lazy, or any other negative belief. Our mind-reading efforts are almost limitless – we will read the minds of people who are actually not even aware of our presence, and obsess about what a man who passed us in a hallway was thinking about us even when he actually had no thoughts about us at all! Sometimes we take our mind-reading to epic proportions and confront people about their supposed thoughts with no evidence. This can have disastrous effects and result in a self-fulfilling prophecy in which we begin to shape the way people see us by telling them what we think they are thinking about us.
6. Magnification and Minimization
This is a habit in which a person who has an eating disorder magnifies their perceived flaws while simultaneously minimizing the idea that there is a problem with how they perceive themselves. For example, we may think “I’m so disgusting, nobody will ever love me, and I’m going to be sad and alone forever.” If we actually say this out loud, a loved one may (understandably) become concerned and urge us to seek treatment. At that point, we will switch to minimizing the problem. We may say “everyone feels like this, I’m nothing special. Life is just hard.” Minimization is partly how we deny the severity of an eating disorder with the full belief that we are not sick enough to warrant treatment.
7. Emotional reasoning
When we have an eating disorder, we take our emotions and emotional thoughts as evidence of the “truth.” This means that if we think we are fat, we must be fat. If we think we eat too much, we must eat too much. This can also be seen in binge eating mentality, which can begin with “I’ve already broken the rules, I may as well keep eating.” Emotional reasoning is dangerous because our thoughts and beliefs are not usually facts. In fact, usually the first, easiest thought we have about ourselves is a societally-driven, conditioned thought. This is classically experienced as “I feel fat.” In our society, “fat” is a euphemism for any number of emotions, including depressed, lonely, sad, angry, scared, etc. When we get stuck in emotional reasoning, we forget to look deeper at our thoughts and take them at face value rather than utilizing them as signals pointing us towards what is really bothering us.
8. Should statements
Maintaining an eating disorder is often based on “shoulds.” Our most common shoulds are “I should lose weight,” and “I should eat healthy/exercise more.” These shoulds come directly from our society and are reinforced in almost every aspect of life unless they become so pronounced that people notice them as the problematic beliefs they are. The trouble with should statements is the shame that accompanies them. Because we inevitably break our shoulds, and our behavior will inevitably fall short of our expectations when we are should-ing all over ourselves. When we succeed in meeting our shoulds, we may feel a temporary sense of self-righteousness, but this is always followed by the terrible fall into bitterness and shame when we inevitably fail something else.
9. Labeling and mislabeling
The deeper we get into our eating disorders, the more we feel we need to label ourselves, and ultimately it comes down to whether we are “good” or “bad.” Rather than saying “I ate a big meal at lunch today,” we will say “I always eat too much.” Rather than saying “I carry my body weight in my hips,” we will say “I’m a fat cow.” These big labels help us feel we have some measure of control over our bodies. This is a false belief because except in very extreme cases our bodies will find a way to achieve the genetic blueprint that largely determines our weight and shape. The biggest mistake we make when we have an eating disorder is equating our self with our bodies. A self is not a body – it is infinitely more flexible, adaptable, and interesting. When we define ourselves based on our bodies, we suffer tremendously and deny the world of a bright mind and unique self.
Many of us who have eating disorders take things very personally – that is, we believe that we are personally responsible for other people’s feelings and actions. This means we are carrying a heavy emotional load that does not help anybody. Personalization is a terrible situation in which we get stuck pointing our fingers at ourselves, no matter what happens. If we don’t lose weight because our body’s metabolism slowed down, it’s our fault. We also believe that the size of our bodies is responsible for how other people feel. So if we maintain a “reasonable” weight, our parents will feel like they have succeeded, our doctors will be happier, and the whole world will be better. Of course, this is not true. If people have any feelings about the weight of our bodies, that is because they have internalized weight stigma. It has nothing to do with us, and everything to do with them. Other people are completely responsible for their own choices, beliefs, and behaviors. While we have influence over other people, we are never responsible for another person’s feelings.
The inspiration for this article came from the book Feeling Good: The New Mood Therapy, by David D. Burns, M.D. We recommend this book as an excellent guide to better understand and address mental disorders including depression, anxiety, and eating disorders.