Cognitive Theory in Anorexia Nervosa and Bulimia Nervosa: A Review

Abstract

This paper reviews cognitive theories of eating disorders as they are usually applied in treatment. More recent theoretical contributions and theory that is not widely applied are also reviewed. A set of hypotheses is derived from these theories and evidence for the validity of each hypothesis is discussed: this includes evidence from treatment studies, questionnaire studies and from experimental psychology. Following review of existing evidence, the paper summarizes the current status of cognitive theory in eating disorders. It then considers ways in which theory and research could be developed in order to improve and extend our understanding of cognitive content and processes in eating disorders. Limitations of existing models are highlighted and gaps in our knowledge, including knowledge of variables that typically have a central role in cognitive theory, are identified. Further strategies to test the validity of hypotheses derived from cognitive theory are suggested, together with strategies that might extend existing theory. It is concluded that much further research is needed, both to test the validity of existing theoretical contributions and to extend theory so that it will be more useful in clinical practice.

Modeling individual differences in perceptual and attentional processes related to bulimic symptoms.

“…According to Cooper (1997), most clinical theories of the role of cognition in bulimia can be traced to Garner and Bemis's (1982) cognitive-behavioral model of anorexia, which was based, in turn, on Beck's (Beck, Rush, Shaw, & Emery, 1979) cognitive theory of depression. Garner and Bemis's model asserted that anorexia is maintained by distorted automatic thoughts, core beliefs, and underlying assumptions about weight, shape, food, and eating.…”

“…Support for the role of beliefs, assumptions, and automatic thoughts in maintaining bulimic behaviors has come from experimental evidence that women with eating disorders are more likely than control participants to report distorted and negative beliefs, automatic thoughts, self-statements, and assumptions about shape, food, weight, eating, and themselves (e.g., Cooper, 1997;Cooper & Hunt, 1998;Mizes & Christiano, 1995;Williamson et al, 1999;Zotter & Crowther, 1991). Experimental manipulations designed to elicit negative weight-and body-related emotions also have yielded support for the hypothesized pattern of self-reported thoughts.…”

“…Research on bulimia, influenced by the "cognitive revolution" in clinical psychology, increasingly has focused on (a) the role of cognitive factors in the development and maintenance of bulimic symptoms and (b) the development of effective cognitive-behavioral treatments for these symptoms (e.g., Cooper, 1997;Mizes & Christiano, 1995;Williamson, Muller, Reas, & Thaw, 1999). Treatment research, however, has tended to overrun the foundational knowledge coming from the basic etiological research.…”

Emotional eating and eating psychopathology in nonclinical groups: A cross-cultural comparison of women in Japan and the United Kingdom

“…Finally, there is considerable interest in the Japanese literature in the issue of treatment (Kikuchi, 1996;Naruo, Homan, Soejima, Nozoe, & Tanaka, 1996;Taguchi, Kawakami, & Yamauchi, 1996). However, models of the eating disorders that are in common use in Japan reflect Western models that stress the centrality of food-, shape-, and weight-related cognitions (Cooper, 1997;Fairburn & Cooper, 1989). Therefore, it is not clear how the link between emotional eating and bulimic psychopathology varies across cultures.…”

Cognitive therapy versus dietary counselling in the outpatient treatment of anorexia nervosa: effects of the treatment phase

“…A core feature of the psychopathology of eating disorders is the associated dysfunctional beliefs (Bruch, 1973). Cognitive treatment, which emphasizes the importance of modifying thoughts and beliefs, has now been shown to be effective in a wide range of psychiatric disorders (Enright, 1997) and four cognitive-behavioural models have been applied to eating disorders (Garner and Bemis, 1982;Fairburn et al, 1986;Vitousek and Hollon, 1990;Guidano and Liotti, 1983; reviewed by Cooper, 1997).…”