One of the more recognized features of eating disorders and body dysmorphia is the individual’s inability to view themselves accurately. For instance, someone with anorexia may perceive their body to be much heavier or wider than it actually is, and an individual with body dysmorphia may feel convinced that their face looks deformed or asymmetrical, whereas any reasonable person will have no idea what they are talking about. With these mental health disorders, many cognitive distortions – or biased ways of thinking about oneself – can be present. They may extend beyond how one perceives their physical appearance to how one views their personality, accomplishments, relationships, or other facets of their life.
An important part of recovering from eating or body dysmorphic disorders is to identify, understand, and challenge these cognitive distortions. Individuals struggling with eating disorders or body dysmorphia may feel so stuck or trapped in their own reality that it may seem impossible to have different thoughts, feelings, or experiences about themselves. Thus, identifying distortions may be challenging at first for someone who is so convinced that their thoughts are facts. Fortunately, psychologists have identified various types of distortions and how to manage them.
Below I provide the categories of some cognitive distortions with examples. You may read some of the examples and wonder, “What do these have to do with an eating disorder?” This is a valid question, because some of the examples have to do with relationships, academics, or other characteristics. I provide these examples to show that someone with an eating disorder or body dysmorphia may have a tendency to utilize such distortions throughout their life, and not solely with regards to their body or appearance. Moreover, some distortions that may seem unrelated can actually underlie some of the eating disorder or body dysmorphia thoughts, feelings, and behaviors. In summary, addressing any cognitive distortions that an individual experiences can be helpful to their eating disorder or body dysmorphia recovery.
Here are the categories and examples of cognitive distortions. Keep in mind that many of these categories overlap and each example could demonstrate more than one type.
Overgeneralization: You make overarching conclusions from one single experience.
Example: “I purged after one month of abstinence from this behavior. I will never be behavior-free again.”
All or Nothing (or Black and White) Thinking: You view yourself, your actions, and your experiences in extremes and opposites – bad or good, right or wrong, perfection or failure, etc.
Example: “If I don’t lose __ pounds soon, then I am a failure.”
Jumping To Conclusions: You immediately make negative assumptions without any supporting evidence. This includes mindreading, an act of assuming that someone is feeling or thinking something negative about you; or fortunetelling, presuming that something will not go your way.
Mindreading example: “My friend looks upset, so she must be frustrated with me.”
Fortunetelling example: “I’m certain that I’m going to binge the second I get home.”
Magnification/Catastrophizing or Minimization: You blow negative experiences, thoughts, or feelings out of proportion (magnification), or make those that are positive appear insignificant (minimization).
Magnification example: “Since I’ve gained one pound, not a single one of my clothes is going to fit me.”
Minimization example: “My teacher told me that I’m a great student, but she probably said that because she feels sorry for me.”
Mental Filter/Discounting the Positives: You focus on the negative detail(s) of an experience while rejecting or denying any positive details.
Example: “I graduated from college today but it didn’t matter because I felt fat the whole time.”
Emotional Reasoning: You make assumptions that your feelings are facts.
Example: “I feel that I am letting down all of my family members, so I must be.”
“Shoulding” On Yourself: You have an idea of what you should and shouldn’t be doing, and you feel distressed or guilty if you don’t act accordingly. You may also have similar ideas for others, and feel disappointment, anger, or resentment if they don’t live up to these expectations.
Example: “I should be married by the time I’m 25 years old; otherwise, I’m a loser.”
How to Challenge
Cognitive behavioral therapy, or CBT, has shown to be effective in the treatment of eating disorders, body dysmorphia, and other mental health disorders. One integral part of CBT is to identify these cognitive distortions and challenge them. I’ll use the following example from above to demonstrate this: “I’m certain that I’m going to binge the second I get home.”
- Identify the distortion – If you are having this thought and find it distressing, first, recognize which type of distortion it is. In this case, it’s mind reading.
- Look for evidence – Seek out evidence that supports or discounts your thought.
Evidence that supports:
“I have binged many times when I have been home.”
“I have food at home that I tend to eat during a binge.”
Evidence that discounts:
“I have not binged many times when I have been at home.”
“There have been many times where I was sure I would binge but didn’t.”
“I cannot predict the future.”
“I have the power to do something else instead of binge.”
- Evaluate the evidence – Look at the evidence that supports versus discounts your distortion, and see if either group outweighs the other. Now, this part may appear different for each person, and that’s okay. The point is to leave room to challenge the distortion even in the smallest way. For this example, in reality, there is a chance that you might binge when you get home, and you want to acknowledge that. However, there is also a chance that you might not.
- Create an alternative thought – The next step would be to come up with an alternate, more realistic (i.e. less distorted) thought to replace your original distorted one:
“There is a chance I might binge when I get home, but I can use my skills as best as I can to avoid this.”
Whether or not you struggle with body dysmorphia or eating disorders, chances are you experience cognitive distortions. Next time you do, try to challenge them using the steps above and evaluate how you feel after.
Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual therapy and facilitates Virtual Body Image Groups for adults and adolescents with eating disorders, body dissatisfaction, and comorbid disorders. If you are experiencing body image distress or any other psychological turmoil related to a chronic illness, contact Bahar for a counseling appointment.