13.3.4 Psychological Explanations for Anorexia Nervosa: Cognitive Theory

• Cognitive theory sees AN as the product of maladaptive thought processes, such as an individual wishing to attain an unattainable level of perfection (in this case unrealistic thinness) in order to be an acceptable person
• These dysfunctional thought processes produce cognitive distortions, which are errors in thinking that negatively affect an individual’s body image
• Cognitive distortions may result in someone imposing very strict rules on themselves about eating, with rule-breaking leading to a sense of self-disgust and further lowering self-esteem
• This negative spiral of cognitive distortions may in turn lead to even more severe AN 
• The most common cognitive distortions for an individual with AN are:
  • Connecting self-worth to physical appearance only
  • Perceiving the body as overweight when it is underweight
  • Having faulty beliefs about eating and dieting

Cognitive distortions lead to strict rules on eating

• Irrational beliefs are unrealistic ideas that lead to the development and maintenance of AN
• Some examples of irrational beliefs are:
  • All or nothing thinking - the individual has eaten one chip or one piece of chocolate and this immediately leads them to believe that they will put on lots of weight 
  • Magnification and minimisation - the individual believes that they are a complete failure if they cannot restrict their eating - but they also believe their weight loss is minimal and is not harmful
  • Magical thinking - the individual believes that if they could just reach their (usually totally unreasonable) target weight then they would be happy and popular
• Apart from being unrealistic, the two common characteristics of cognitive distortions and  irrational beliefs are catastrophising and perfectionism

Catastrophising is common in  those with AN.

Research which investigates cognitive theory as an explanation for AN

• Halmi et al. (2000) measured the need for perfectionism in individuals with AN on the Multi-Dimensional Perfectionism Scale, and found that there was a positive correlation between the need for perfectionism and AN, with AN sufferers scoring much higher on a need to be perfect than a control group, supporting the cognitive explanation that those with AN have high levels of perfectionism across behaviours
• Sachdev et al. (2008) used fMRI brain scans and found that when participants were shown images of themselves, those with AN showed little activation in parts of the brain thought to be involved in attention, while there was no difference between the AN sufferers and a control group when shown images of others, suggesting that cognitive distortions do exist in individuals with AN but they are limited to the individual’s own body image

Evaluation of cognitive theory as an explanation for AN 

Strengths

• Cognitive explanations for anorexia have practical applications as they have led to the development of successful cognitive treatments for AN, especially cognitive behavioural therapy (Dalle Grave et al, 2014)
• The multiple characteristics of AN contain two key elements: low self-esteem and a high need for perfectionism, both of which can be explained by cognitive theory

Weaknesses

• Cognitive theory, and associated research cannot identify whether maladaptive thought processes are a cause of AN or a result of having AN, as all that can be shown is a correlation
• Many females and males are unhappy with their bodies and have been or are on diets, but only a few develop AN, which cognitive theory cannot explain

Link to Issues & Debates: 

While the explanations given by the cognitive theory may seem at first to be nomothetic and applicable to all individuals with AN, there is some variation in the particular cognitive distortions and irrational beliefs that each individual with AN experiences. These variations will be dependent upon the person’s experience and therefore have an element of individuality. Thus cognitive explanations are more idiographic than biological explanations. This is demonstrated also in the fact that individual cognitive-behavioural therapy is used successfully to treat AN.