The detection of psychiatric illness by questionnaire

Research testing the predictions of cognitive-behavioral theory related to the psychopathology of eating disorders has lagged behind treatment outcome research. Central to cognitive theories of eating disorders is the hypothesis that beliefs and expectancies pertaining to body size and to eating are biased in favor of selectively processing information related to fatness/thinness, dieting, and control of food intake or body weight. In recent years, controlled investigations of the predictions of cognitive theories of eating disorders have yielded empirical support for these theories. This paper reviews research which has tested the predictions of cognitive-behavioral theory and discusses the implications of these findings for the treatment of eating disorders. Understanding of information processing biases may assist the clinician in understanding a range of psychopathological features of anorexia and bulimia nervosa, including denial, resistance to treatment, and misinterpretation of therapeutic interventions.

Cognitive bias in eating disorders: implications for theory and treatment.

A systematic review and meta-analysis of cognitive bias to food stimuli in people with disordered eating behaviour.

Body image has been a useful construct for understanding eating disorders. In that capacity, body image has been defined in many ways: One concept of body image is as an internalized view of one's appearance that drives behavior and influences information processing. This cognitive schema definition of body image was tested in a series of studies. Other recent studies have investigated cognitive processes with body image information, but they have focused on weight-related body image. A combination of Higgins' self-discrepancy theory and Markus' self-schema theory were used to describe a modern interpretation of body image as an internalized self-representation. Both of these theories predict specific information processing consequences of an organized cognitive representation. In turn, these consequences confirm the existence of that representation. Several studies were conducted to test a specific schema-like view of body image. In Study 1 body image schema variables were correlated with traditional measures of body image. In Study 2 subjects exposed to schema relevant contents showed information processing consequences consistent with self-representation theory. Finally, in Study 3 instructional set was shown to modify the schema activation effect. These effects give evidence of body image schema and yield limited information about the nature of that representation.

Body image: A cognitive self-schema construct?

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.

Cognitive Theory in Anorexia Nervosa and Bulimia Nervosa: A Review

The specificity of the retardation effect on the Stroop Naming task with eating disorder clients was examined by comparing anorexic patients and normal weight controls with obese restrained eaters. Although the expected differences between normal weight controls and anorexics were found for color naming of food and body size words, obese restrained eaters were not differentiated from the clinical sample. It is suggested, therefore, that the Stroop phenomena do not have a precise relationship to the extent of psychopathology and that factors such as the ability to “fake” the test and poor concentration leading to general slowing, may explain the results. © 1994 by John Wiley & Sons, Inc.

Celia Hinton

Papers

Selective processing of food and body size words: Application of the stroop test with obese restrained eaters, anorexics, and normals