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Unhelpful Thinking Styles In Eating Disorder Recovery

Written by Emily Green


The connection between nutrition and psychology is complex and shows up in the relationship we have with food and eating. Food is so often used as a tool to celebrate, show we care for others or in managing uncomfortable emotions. Our relationship with food manifests in our behaviours but also goes right down to the way we think about food, eating and our bodies. It has even been suggested that thinking styles could be more useful in predicting eating disorders than the content of the thoughts (1).


First described by psychiatrist Beck in 1963, unhelpful thinking styles or ‘cognitive distortions’ refer to the ways our brain follows negative habits in the way we think (2). Drawing on concepts from cognitive behavioural therapy (CBT), a type of psychological therapy which focuses on changing thoughts and related behaviours, this article will look at how certain ways of thinking can help or hinder eating disorder recovery.


In eating disorders, unhelpful thought patterns can be exacerbated by insufficient food intake. This is most famously demonstrated in the Minnesota Starvation Experiment (3). In this study, men were subjected to semi-starvation conditions and their physical and psychological state was observed to understand the best treatment approach for malnourishment following World War II. This state of malnutrition is now better known as Starvation Syndrome.


Several treatment options for eating disorders exist depending on the individual and their condition. One of these is a type of CBT specific to the treatment of eating disorders. Enhanced cognitive behavioural therapy or CBT-E is a “transdiagnostic” treatment meaning it can be used for many eating disorder diagnoses and will be highly tailored to the individual (4). It focuses on challenging unhelpful thinking styles to support behaviour change.


Let’s look at the unhelpful thinking styles we see commonly come across:


Black and white thinking

This is also referred to as dichotomous thinking or an ‘all or nothing’ mindset. Black and white thinking is expressed as thinking only in the extremes of the spectrum. Good or bad. Healthy or toxic. Right or wrong. This leaves no room for the endless shades of grey in between. Black and white thinking has been identified as a factor which can maintain eating disorders (5) and can show up as rigid food rules or an increased risk of binge eating.


Example:

I didn’t exercise today, I’m a complete failure.


Reframe:

I’m allowed to listen to my body and take a rest from exercising. It does not say anything negative about me as a person.


'Shoulds' and 'Musts'

The weight of shoulds and musts puts unnecessary pressure on ourselves. This way of thinking often encourages unrealistic expectations and high standards for oneself. High standards are much more difficult to achieve and any perceived ‘failures’ may cause feelings of guilt or shame. Ultimately, this can perpetuate perfectionism which is also a maintaining factor for eating disorders (5).


Example:

I should be better at eating healthy.


Reframe:

I understand healthy eating is a journey and finding balance will take time. I am trying my best.


Compare and Despair

The comparison trap. When we upwardly compare we tend to only see the positive aspects of others and by comparison feel inferior about ourselves (6). This style of thinking can perpetuate negative emotions and may commonly occur on image-based social media. Check out our thoughts on the impact social media has on self esteem and body image here.


Example:

That person is doing better at eating disorder recovery than me.


Reframe:

Everyone is unique in their recovery journey and I am going at my pace. I only see a snapshot of their life on social media, not the whole picture, so it would be unhelpful to make a judgement.


Emotional Reasoning

Thoughts are not facts. Just because you feel a certain way about something, doesn’t mean it is true. For example, feeling anxious or scared of trying a new food doesn’t mean that food is scary. It helps to practice noticing, labelling and thanking your thoughts instead of letting them lead you.


We have little control over which thoughts pop into our head but we can practice just observing and letting them go to develop a happier relationship with food.


Example:

I feel guilty about eating pizza so pizza must be bad


Reframe:

I notice I am feeling food guilt, it’s okay to feel like this but I won't let it define me. All foods have a place in a balanced diet so I will give myself permission to enjoy pizza.


Jumping to conclusions

When we make snap judgements and assumptions about ourselves, others or foods without considering the evidence we can quickly spiral into a negative headspace (6). Alternatively, we can make snap positive judgments about food or people depending on what context we see them in. For example, if we see our favourite influencer's 'What I Eat In A Day' video, we may jump to the conclusion that those foods are responsible for their socially desirable physique. When in fact these videos are not a helpful or healthy comparator.


Example:

If I give myself unconditional permission to eat I will never stop eating ice cream.


Reframe:

It's impossible to know if that will happen, but allowing myself to enjoy all food and eat enough each day will help me trust my body’s hunger and fullness cues.


Labelling

Applying labels to foods based on your emotions, opinions or bad ‘advice’ is so unhelpful. This puts foods into little boxes and can mean we avoid or restrict certain foods or food groups. Labelling commonly shows up in the food rules which perpetuate eating disorder behaviours.


Example:

Sugar is toxic

Gluten is bad

Salads are clean.


Reframe:

Sugar is sugar. Gluten is gluten. Salads are salads. The labels I impose on foods does not change anything about them, only my perceptions.


Challenging negative thought patterns and breaking free from food rules can seem overwhelming at first. If you would like help on your journey to recovery and food freedom, contact the TC Nutrition clinic for specialist support from one of our dedicated eating disorder dietitians.


Emily Green

TCN Intern


Emily is studying MSc Clinical Nutrition, after having graduated from a degree in Nutrition & Psychology from Newcastle University. She has an interest in supporting people to overcome disordered eating, find food freedom and keep a healthy mind. You can find Emily on Instagram @nutritionupontyne and on her blog nutritionupontyne.co.uk

 

REFERENCES:

[1] Nikčević, A., Marino, C., Caselli, G. and Spada, M., 2017. The importance of thinking styles in predicting binge eating. Eating Behaviors, [online] 26, pp.40-44. Available at: <https://www.sciencedirect.com/science/article/pii/S1471015316302987?via%3Dihub> [Accessed 5 June 2022].

[2] Beck, A., 1963. Thinking and Depression. Archives of General Psychiatry, 9(4), p.324.

[3] Keys, A., Brozek, J., Henshel, A., Mickelson, O., & Taylor, H.L. 1950. The biology of human starvation, (Vols. 1–2). University of Minnesota Press. Minneapolis, MN

DNS, 2022. A Description of CBT-E - CBT-E. [online] CBT-E. Available at: <https://www.cbte.co/what-is-cbte/a-description-of-cbt-e/> [Accessed 13 June 2022].

[4] Fairburn, C., Cooper, Z. and Shafran, R., 2003. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, [online] 41(5), pp.509-528. Available at: <https://www.sciencedirect.com/science/article/pii/S0005796702000888> [Accessed 21 June 2022].

[5] Wang, J., Wang, H., Gaskin, J. and Hawk, S., 2017. The Mediating Roles of Upward Social Comparison and Self-esteem and the Moderating Role of Social Comparison Orientation in the Association between Social Networking Site Usage and Subjective Well-Being. Frontiers in Psychology, [online] 8. Available at: <