Cognitive impairment and eating disorders

Cognitive distortions are inaccurate or exaggerated thoughts or thinking patterns. They are sometimes called dysfunctional, negative or automatic thoughts. Cognitive distortions about food, weight, and body image are the core symptoms of anorexia nervosa and bulimia nervosa, and many others have also experienced it. Thoughts, emotions, and behaviors are interrelated, so these automatic thoughts or cognitive distortions can lead to behavioral disorders.

The treatment of eating disorders usually prioritizes restoring weight, restoring normal eating patterns, and other behavioral changes. Later, treatment usually also addresses problematic thinking patterns.

Different kinds of cognitive distortions

People with eating disorders often experience different problem thinking patterns. Identifying, challenging, and changing negative thinking patterns is one of the main components of cognitive behavioral therapy (CBT).

Understanding patterns of cognitive distortion through CBT or other types of therapy can help you learn to recognize them.

Remember, determining the exact type of problem thinking you are experiencing is not a key component-you just want to learn more about them.

The following are some of the most common cognitive distortions in people with eating disorders.


“Should” is what you ask of yourself, such as “I should do better.” Or “I must be perfect.” Regarding eating disorders, “should” might include thoughts about what foods should/should not be eaten, or should be weighed.

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All or nothing thinking

This way of thinking is sometimes called black and white thinking. It leads to perfectionist tendencies because it makes you believe that something is either completely right/correct or completely wrong. When you have an eating disorder, if you have a plan to follow certain dietary rules, this may happen suddenly-when you eat the “wrong” thing or what the scale shows is different from yours, you may feel that this day I want to see it completely ruined.


Overgeneralizing is like thinking or not thinking at all. This happens when you think that a negative experience or situation completely describes your life. An example might be believing that relapse means you will never fully recover, rather than treating it as a temporary setback.


Anytime you think that the situation is so bad that you cannot survive at all, you may feel disastrous about the situation or its consequences. For example, you might think that if your weight reaches a certain amount, no one will like you or your self-worth will decrease. You may also think that your weight will increase based on what you eat in a meal or snack.

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Labeling is a distortion that attempts to put people and things into specific categories. Examples of this might be “I am a real loser”, “I have no self-control” or “These foods will make me fat.” Often, these labels are too simple to describe all the complexities that humans have.

Reject the positive

Many cognitive distortions only focus on the negative aspects of things and reject any positive aspects. For people with eating disorders, this distortion may only focus on criticizing errors or only focusing on the calorie content of the food, rather than the nutrition and energy in the food.

Unfavorable comparison

Many people with eating disorders compare their appearance, weight, and how much they eat with those around them. These comparisons are often negative. For example, if you think someone’s weight is lighter than you, your thoughts about eating disorders may focus on how you “should” lose weight. However, if you think you have lost weight, the point of the idea of ​​eating disorders is to keep you low.

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Blame and personalization

Blame and personalization are two aspects of the same problem. When someone is personalized, they think everything is their own fault, and when someone blames others, they think everything is their fault. The truth may be somewhere in between—sometimes what happens is not anyone’s fault.

How to track and change your cognitive distortion

Record thoughts that occurred before restricting food, overeating, defecate, and/or feeling depressed. See if they follow any of the above patterns. Usually, patients with anorexia will skip meals or limit calorie intake based on these cognitive distortions, which is likely to be the cause of this behavior. This distortion may also trigger binge eating or clearance behavior.

Once you are aware of your cognitive distortions, you can learn some strategies for managing and correcting cognitive distortions. A cognitive behavioral therapist can also help you conduct experiments to test the effectiveness of these ideas.


Cognitive impairment and eating disorders
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