Psychological Explanations for Anorexia Nervosa: Cognitive Theory (AQA A Level Psychology): Revision Note

The role of cognitive distortions

• Cognitive theory sees the core psychopathology of AN as cognitive distortions about body shape and weight, the most significant of these being a disturbed perception of the person's own 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

The role of irrational beliefs

• 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 believes 'if I'm not thin, I'm fat' or 'if I don't control my weight, I'm worthless', with no middle ground

  • catastrophising – the individual puts the worst possible interpretation on a minor event, e.g., 'I ate half a biscuit today, I've got no willpower at all'

  • magical thinking – the individual believes that if they could just reach their (usually totally unreasonable) target weight, then they would be happy and popular

• A key irrational belief in AN is perfectionism, the view that the individual has to meet the most demanding standards at all times, and that failure to do so is judged severely

  • Hewitt et al. (2003) claim that perfectionism is not satisfied when goals are achieved — instead the individual raises their standards still higher, trapped in a cycle of pursuing an unrealistic goal they can never attain

Research which investigates cognitive theory as an explanation for AN

• Halmi et al. (2012) studied 728 women over the age of 16, all diagnosed with AN, using the EATATE Lifetime Diagnostic Interview to measure AN symptoms and indicators of perfectionism in childhood, and found that childhood perfectionism was a significant predictor of the later development of AN

  • This suggests that perfectionism precedes the onset of AN, making it a potential risk factor for developing the disorder

• Sachdev et al. (2008) used fMRI and found that when participants viewed images of other people's bodies, the same brain areas were activated in people with AN and controls, but when shown images of themselves, those with AN showed very little activation in areas thought to be involved in attention

  • This suggests that cognitive distortions do exist in AN, but that they are specific to the individual's own body image and do not extend to bodies in general

Evaluation of cognitive theory as an explanation for AN 

Strengths

• Cognitive explanations have practical applications through CBT, which attempts to change distorted cognitions and irrational beliefs about food, eating, weight loss and body shape

  • E.g. Dalle Grave et al. (2014) studied 26 women hospitalised with AN and found a significant increase in weight and decrease in concerns about body shape, maintained at one-year follow-up

• 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

Limitations

• It is not clear that cognitive distortions cause AN rather than resulting from it, e.g., Shott et al. (2012) found that younger participants with AN were no worse at set-shifting than non-AN controls, whereas older participants were

  • This suggests cognitive inflexibility does not make an individual vulnerable to developing AN, but is instead a consequence of the disorder

• Cornelissen et al. (2013) compared women with and without AN on a morphing task, adjusting a computerised image of themselves until it matched their estimated body size, and found no significant differences between the groups in accuracy of their estimates

  • As it is not possible to distinguish between the body size estimates of women with and without AN, this suggests that over-estimation is not pathological, challenging the central role of body image distortion in cognitive theories of AN

Issues & Debates

• The cognitive theory is deterministic, suggesting that irrational and distorted thought patterns (e.g., perfectionism, body dissatisfaction) inevitably lead to anorexia nervosa, which may underplay the role of free will in resisting or recovering from these thoughts

  • This is problematic as it ignores the many individuals who share these cognitions but do not develop AN

• The cognitive approach emphasises nurture, as maladaptive thought patterns are shaped by life experience and social pressures

  • However, it may neglect biological influences, such as genetics or neurotransmitters, offering only a partial explanation of the disorder